Anxiety Screenings Could Become a Normal Part of Your Annual Physical

As part of an effort to address the US mental health crisis, a panel of medical experts has proposed a recommendation that all adults under the age of 65 be screened for anxiety disorders.

The draft recommendations, by the US Preventive Services Task Force, suggest that primary care providers use questionnaires and other tools to help identify early symptoms of anxiety disorders and support patients in obtaining additional mental health care.

“Everyone has anxiety. It’s just part of being a human being.” Dr Sanjay Mathew, medical director of the Anxiety and Depression Association of America, told Verywell. “The fact that it has been recommended for screening may elevate its status, so to speak, to a medical symptom that warrants further exploration.”

Routine screening for anxiety and depression could help doctors spot mental health needs earlier. According to one study, the median length of delay for anxiety treatment in the US is 23 years.

Draft guidance has been in the works since before the COVID-19 pandemic. But more people have reported high levels of anxiety due to stressors in recent years, including fear of illness and loss of loved ones to COVID-19.

In February 2021, 41.5% of adults had recent symptoms of anxiety or depressive disorder, up from 36.4% in August 2020.

The panel made a similar recommendation for anxiety screening for children and adolescents earlier this year. It also updated its 2016 recommendation to screen adults younger than 65 for depression and suicide risk.

The guide has been published in draft form. The task force is accepting public comments through October 17 and will finalize recommendations in the coming weeks.

How can the evaluation of anxiety be

The task force said anxiety disorders are “characterized by excessive and persistent fear and anxiety about everyday events.” These include generalized anxiety disorder, social anxiety disorder, and agoraphobia.

At a primary care visit, providers may ask patients a series of questions to assess whether they may be experiencing symptoms of an anxiety disorder. They may ask questions about the patient’s lifestyle, whether they worry excessively and intensely, and about physical manifestations of anxiety, such as sweating and shakiness.

There is a possibility that the anxiety screening test will give false negative results. Some symptoms that appear to be related to anxiety disorders may be “transient” and go away over time, Mathew said. Also, self-reported information may not be entirely accurate.

“Unlike screening for blood pressure or diabetes issues, etc., it can be much more difficult to get a valid and reliable screening tool,” said Matthew.

Once a patient has received a positive screening result, they are referred to a mental health specialist who can provide diagnosis and treatment for the anxiety disorder.

To be diagnosed with an anxiety disorder, a patient must meet a specific set of criteria as defined in the DSM-5, the standard manual for mental health disorders. The doctor must rule out other factors, such as medical conditions that could mimic psychiatric symptoms and substance use.

Screening for anxiety and depression is not recommended for everyone

The task force said that anxiety assessment is a “B-grade”, meaning it will provide a “moderate net benefit” to patients. While healthcare providers are not required to follow the guidance, the panel’s recommendations greatly influence the standard of care across the country.

In 2016, the task force directed physicians a screen adults, including pregnant or postpartum people, for depression. The panel said that, as a result, the prevalence of depression and symptoms of depression among adults has decreased.

But mental health screenings in a primary care setting may not always be helpful. There was insufficient evidence to conclude that screening for suicide risk would do more good than harm in the general adult population, according to a draft recommendation this year.

The task force did not recommend anxiety screening for adults older than 65 years because evidence of benefits and harms for this age group is limited. The symptoms of anxiety often resemble the symptoms of aging, such as fatigue and widespread pain.

“Certainly this is a more medically complicated population. They may be on multiple medications, with multiple chronic illnesses, many of which are already associated with anxiety,” Mathew said.

Address mental health disparities

Even after receiving a positive screening test for anxiety or depression, some patients can find it difficult to receive a diagnosis and get the mental health care they need.

In some closed health systems, patients may be referred to internal mental health professionals. But most health care settings may not have the resources to provide mental health care to everyone who needs it. In fact, less than “half of people experiencing mental illness will receive mental health care,” the task force said.

Access to care will be particularly important for groups who are more likely to be living with a mental health disorder.

For example, women have nearly twice the risk of depression compared to men, according to the task force. Black patients are less likely to receive treatment for mental health problems than white patients, and black and Hispanic patients are more likely to receive a misdiagnosis.

One study showed that while overall suicide rates among US young adults decreased for the first time between 2018 and 2019, suicide rates increased among black, Asian, and Pacific Islander young adults during this period.

During the pandemic, these needs have been further exacerbated. Adults ages 18 to 44 were less likely to have received mental health treatment in 2019, but that trend is in reverse. In 2021, nearly one in four adults in this age group received treatment.

“There has definitely been an increased demand for mental health services in general,” Mathew said. “Although these recommendations were made before then, they may take on more importance in this era.”