The task force defines anxiety disorders as “characterized by increased duration or intensity of a stress response over everyday events.” Recognized types include generalized anxiety disorder, social anxiety disorder, and agoraphobia. The USPSTF drafts also recommend screening for major depressive disorder in adults, consistent with the 2016 depression screening recommendations.
Pbert, a clinical psychologist and professor at the University of Massachusetts Chan School of Medicine, said an anxiety recommendation was prioritized “because of its importance to public health, especially with the increased focus on mental health in this country that we have had in the past a few years.”
Detection tools now available
The anxiety recommendation would apply to adults age 19 and older who do not have a diagnosed mental health disorder. Depression screening recommendations apply to people over the age of 18 who do not have a diagnosed mental health disorder and do not show recognized signs of depression or suicide risk.
Pbert stressed that people who are already showing signs or symptoms should be evaluated and connected to care.
Brief screening tools for both anxiety and depression have been developed and are available for use in primary care. Most current screening tools include questionnaires and scales.
Any positive screening results should lead to further confirmatory testing, the task force says. It also notes that there is little evidence regarding the optimal time and interval for screening, and more evidence is needed.
USPSTF says that, in the absence of data, a pragmatic approach might include testing all adults who have not been tested before and use clinical judgment when considering other factors, such as underlying health conditions and life events, to make decisions. whether further evaluation is necessary. needed for people who are at high risk.
The recommendations for screening for anxiety and depression are what the USPSTF calls “B” ratings, meaning a doctor must offer the service because there is a “moderate net benefit.”
Also included in the draft recommendations are two “I statements,” which do not have enough evidence to recommend for or against the evaluation, Pbert said. The statements are for anxiety screening in adults over 65 years of age and for suicide risk screening in adults. The task force calls for more research on the two I-statement topics in order to help older Americans, as well as to understand the role of primary care in suicide prevention.
“There are missed opportunities within primary care practice, and that’s why we need research to understand how best we can screen people who don’t have recognized signs or symptoms of suicide risk, that we can identify and connect them. carefully,” he said.
Raise awareness about mental health care
Screening for anxiety disorders is important because of the lifetime prevalence in the US, which according to draft recommendations is 26% for men and 40% for women, Pbert noted.
“This is a very common mental health problem,” he said. “That’s why it’s so important for us to address anxiety disorders and assess them.”
The draft recommendations for screening for anxiety, depression, and suicide risk were brought together because “we really want to help primary care physicians address the urgent need to address mental health in America’s adults,” he said. Pbert. “So we’re really looking at this set of recommendations as an opportunity to be able to provide clinicians working with adult patients with comprehensive guidance in terms of how to approach screening for anxiety, depression and suicide risk.”
Task force members also hope the recommendations will raise awareness of the need for mental health screening and treatment.
“That’s an area where we need a lot of work,” Pbert said. “There are so many gaps in terms of providing mental health care, and our hope is that this set of recommendations will lift it.”
The task force is also very concerned about health equity, Pbert said.
“Our hope is that by raising awareness of these issues and having recommendations for clinicians, we can help all adults in the United States, including those experiencing disparities,” he said.
The public will be able to comment on the draft recommendations until October 17.
“We’d like people to be honest, to provide their input and perspectives,” Pbert said, adding that the task force will read all comments. “It’s really important because it allows us to listen to the public, and the public includes people who are specialists in these areas… We really value the input of other specialists who can give us their perspective and feedback.”