Anxiety disorders often go unrecognized and undetected in primary care: one study cited by the task force found that the median time to start anxiety treatment is staggering. 23 years.
While the initial deliberations of the anxiety screening task force predate the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, a clinical psychologist and professor in the School of Chan Medicine at the University of Massachusetts in Worcester, Massachusetts.
“Covid has taken a tremendous toll on the mental health of Americans,” Pbert said. “This is a prioritized issue because of its importance to public health, but clearly there is an increased focus on mental health in this country in recent years.”
In April, the task force made similar recommendations for starting anxiety screening in children and adolescentsfrom 8 to 18 years old. The proposal announced Tuesday focuses on young and middle-aged adults, including those who are pregnant or postpartum, and cites research showing screening and treatment can improve anxiety symptoms in people younger than 65.
But the guidance surprisingly stops short of recommending anxiety screening for people over 65.
One reason: Many common symptoms of aging, like trouble sleeping, pain, and fatigue, can also be symptoms of anxiety. The task force said there was not enough evidence to determine the accuracy of screening tools in older adults, who may not be sensitive enough to distinguish between symptoms of anxiety and conditions of aging.
The task force advised clinicians to use their judgment when discussing anxiety with older patients. the working group it also reiterated an earlier recommendation that adults of all ages be routinely screened for depression.
The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, wields enormous influence, and while its advice is not mandatory, the panel’s recommendations often change the way healthcare providers doctors practice medicine in the United States.
Some doctors questioned how the recommendations would play out in the real world, where mental health providers they say they can no longer keep up with patient demand, and patients complain of waiting months for an appointment with a therapist.
“Screening is great, but with severe staffing shortages, it’s puzzling unless there are plans to increase funding for doctors,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young and Healthy Minds.
The global prevalence of anxiety and depression increased by 25 percent during the first year of the pandemic, the World Health Organization reported at the beginning of this year. By the end of 2021, the WHO said, “the situation had improved somewhat, but today too many people are still unable to get the care and support they need for pre-existing and newly developed mental health conditions.”
Anxiety, with its telltale terror and harrowing, throbbing, sweaty physical signs, can manifest in a number of different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others.
Together these form the most common mental illnesses in the United States, it affects 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, particularly cognitive behavioral therapy; antidepressant or anti-anxiety medications; as well as various relaxation, mindfulness and desensitization therapies, the doctors said.
The panel also considered the benefits of screening patients for suicide risk, but concluded that Even though suicide is a leading cause of death among adults, “there is not enough evidence on whether screening people without signs or symptoms will ultimately help prevent suicide.”
Still, the panel urged providers to use their own clinical judgment in determining whether individual patients should be screened for suicide risk.
For primary care physicians, who are already in the midst of a “crisis” From exhaustion, the stress of the pandemic, and your own mental health challenges, adding another screening test to a long list of clinical tasks can seem like a burden.
“If primary care providers are asked to assess one more thing, we are going to run out of more resources,” said a nurse practitioner in Northern California, who asked not to be named because she did not have permission from her clinic to speak. . about the topic
Checking off current requirements, such as checking for up-to-date cervical, colon and breast cancer screenings, as well as food insecurity, domestic violence, alcohol and tobacco use, he said everything must be included in a 15-minute appointment, while also treating patients with complex and chronic diseases.
“It just feels bad if people are positive for depression or anxiety, and we don’t have the mental health support to help them,” the practitioner said.
But Mahmooda Qureshi, an internal medicine doctor at Massachusetts General Hospital, said additional support for patients suffering from depression or anxiety will help.
“After 2020, it’s rare that the patient is not anxious,” said Qureshi, who noted that he now routinely asks patients, “How’s your stress?” “We found that when it comes to mental health, if we don’t ask, we often don’t know.”
The task force acknowledged the challenges of providing mental health care to all who need it, adding that less than “half of people who experience mental illness will receive mental health care.”
The panel also cited “racism and structural policies” that disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services compared to other groups, and that misdiagnosis of mental health conditions occurs more frequently in blacks and Hispanics. patients
Pbert said the latest guidance is just one step in addressing the urgent mental health needs of patients. “Our hope is that this set of recommendations can raise awareness of the need to create greater access to mental health care across the country,” he said, as well as highlighting “gaps in the evidence for funders to support.” critically needed research in these areas. .”
The proposed recommendations are open for public comment until October 17, after which the working group will consider them for final approval.
