During 2020, the first year of the Covid19 pandemic, the global prevalence of anxiety and depression shot by as much as 25%. The lockdown had fragmented people’s mental health, a cautionary tale for healthcare providers and governments to monitor mental health issues with vigilance. This is the current context, when a panel of US doctors recently recommended that all adults between the ages of 16 and 65 should be routinely screened for anxiety, even if they don’t show any symptoms. This is one of the first official guidelines recommending preventive screenings for mental illness, marking a change in the way we approach mental health care.
The US Preventive Services Task Force has written a set of mental health screening guidelines that apply to young and middle-aged adults, including pregnant and postpartum people. “When you go to your primary care provider, you get screened for many, many preventative conditions — blood pressure, heart rate, all sorts of things,” said Dr. Lori Pbert, a member of the task force and a professor in the Department of Population and Quantitative Health Sciences at the UMass Chan School of Medicine.
“Mental health conditions are just as important as other physical conditions, and we really need to treat mental health conditions with the same urgency that we treat other conditions.” The idea also blurs the rigid lines of separation between mental and physical health in public health.
Anxiety is common and commonly misunderstood in health discourse. At least one in seven people in India she is believed to be living with anxiety disorders and depression, but the true extent of the burden remains undiagnosed. The prevalence does little to counter misconceptions: the cultural response is to equate it with disdain for routine “stress” and “worry,” as if anxiety were not a diagnosable psychiatric condition. The “invisibility” of mental health conditions like anxiety, and the many ways it presents itself, also reinforces the silence that surrounds it. According to one study, the delay in starting treatment for anxiety, from the time one is referred to a health center until arrival at receiving liaison health facility — is 23 years. But even in their supposed invisibility, anxiety levels have risen dramatically over the course of the pandemic, as adults experience an onslaught of stressors, in the form of job burnout, isolation, loneliness, relationship difficulties and abuse.
These recommendations reiterate that screening tests are useful for those who do not have a diagnosed mental health disorder or do not show recognized signs or symptoms. Recommendations like these are instructive for the broader health care discourse, as seeing mental health care as part of routine visits with primary care physicians may change the way people view anxiety and, better yet, , how is it treated.
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While the task force recommended the use of tools such as questionnaires to survey people about feelings of fear, worry or other disturbing emotions, it has not specified how often the assessment should be done.
The need for a preventive care model around anxiety, rather than a curative one, has been noted over the years. The evidence around screening shows that it has helped with the early identification and treatment of anxiety. It serves to sensitize people, inform them about signs and treatments that are free of cultural bias, and legitimize the experiences of millions of people. Thinking of anxiety screening as something that is routine for a health checkup also puts a dent in the cultural silence around mental health care.
But there are notable risks that experts have pointed out before. Screening test results can be inaccurate, there can be bias and ignorance on the part of health care providers, and follow-up care may not always be effective. “The most important thing to recognize is that a screening test alone is not enough to diagnose anxiety,” Pbert said.
In this case, given the urgency of mental health issues catalyzed by the pandemic, the panel noted that the benefits of screening programs far outweigh the risks. “Anyone showing signs or symptoms of depression, anxiety, or suicide risk should receive care,” said Dr. Pbert. Additionally, screening could help people who are showing symptoms but may not recognize their experiences as signs of an underlying disease. Then, it takes away from people the responsibility to know, identify and name their anxiety in a culture where this is not always possible.
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cultural contexts and access to medical care play an important role in how anxiety disorders develop in different settings. While routine screenings address the stigma and urgency of mental health, they still require a more robust and cushioned infrastructure that most countries do not currently have. Screening requires primary health care providers, but the world is currently facing a shortage of doctors and nurses.
In India, there was a 7% physician shortfall in primary health centers and a 57% physician shortfall in community health centers, according to the Rural Health Statistics 2021. India is also notoriously lacking in accurate data on the practice of health professionals, with some estimates including AYUSH physicians who practice homeopathy. Experts have warned against this inclusion; “Ayush doctors cannot be treated on a par with MBBS doctors in total figure”, one said.
Accessing anxiety screening also presents other logistical challenges, such as mobility, affordability, and geographic access to health care providers. Detection of physical ailments, such as cancers Y tuberculosis, it is still a half won battle. Furthermore, the stigma around mental health and anxiety would also complicate people’s access. This is most true for women and people of marginalized identities, who have limited economic agency and are systematically excluded from health care due to gender roles and caste hierarchies. The mental health burden of anxiety disorders among womenin particular, it is significantly higher than in men.
Arguably, there is a need for early detection because it addresses anxiety with an air of legitimacy, validating people’s experiences and struggles. It is an incomplete but still important framework, and must take into account cultural variations that restrict access to quality health care.
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