US Task Force Recommends Anxiety Screening for all Adults. But why?

Hi, I'm Dr. Courtney! In this article, I provide my bi-weekly research summary on a topic I think may help others in some way. This week I focused on Adult Anxiety and the new USPS Task Force health recommendation. I read the research so you don't have to 😌

US Preventative Services Task Force Recommends Anxiety Screening to all adults 19-64. But why?

What is the US Preventative Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services. The USPSTF's recommendations are used by primary care clinicians to help them decide which preventive services are appropriate for their patients. The recommendations are also used by health insurance companies to determine which preventive services they will cover.

Why are Anxiety Disorders important to address overall?

Anxiety disorders are really common. Some specific types of anxiety disorders include Generalized Anxiety Disorder, Panic Disorder, and Phobias. Many times, anxiety disorders go unrecognized in primary care settings (like when you're visiting your doctor for a check-up or general physical health concern). This causes significant and substantial delays in people getting the proper care and treatment they need for their symptoms. However, full recovery is possible.

Today I'm going to summarize for you the following article: 

Title: Screening for Anxiety Disorders in Adults: US Preventative Services Task Force Recommendation Statement

Author/s:US Preventative Services Task Force

Publication and Year: JAMA, June 20, 2023

DOI:10.1001/jama.2023.9301

This article is for anyone who has an Anxiety Disorder or has experienced anxiety symptoms, or those who care for these individuals in some capacity. If you find this information helpful, please share this article with your community. 

Why Adults Should Be Screened for Anxiety Disorders

Anxiety disorders are characterized by disproportionate and constant fear over everyday events accompanied by behavioral and somatic complaints (eg, restlessness, fatigue, problems concentrating, irritability, or sleep problems). They can be caused by a variety of factors, including genetics, environmental factors, and life experiences. There are a variety of treatments available for anxiety disorders, including psychotherapy, medication, and lifestyle changes, but if we are never getting screened for anxiety disorders, than it's unlikely we're going to get the proper treatment. 

Who Is Most At Risk of an Anxiety Disorder?

Females, Black people, individuals of non-Hispanic ethnicity, and people of low socioeconomic status are at a higher risk of anxiety disorders. And, people with depressive disorders may have overlapping symptoms or diagnoses of anxiety. One study showed that 67% of people with a depressive disorder also had a current anxiety disorder.

Which Anxiety Screening tests should be used?

The most common screening tools for anxiety disorders include the Generalized Anxiety Disorder (GAD) scale, the Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale, the Geriatric Anxiety Scale (GAS), and the Geriatric Anxiety Inventory (GAI).

It is important to note that screening tools alone are not enough to diagnose an anxiety disorder. If you are concerned that you or someone you know may have an anxiety disorder, it is important to see a doctor for a diagnosis and treatment.

How often should we receive an Anxiety Screening?

They don't have too much evidence on the best time to screen or how often to screen. Remember, they've never recommended this before! They are currently recommending completing an Anxiety Screen on any adult aged 19-64 who has never been screened for anxiety in the past and that you should talk to your doctor about risk factors, other conditions you're experiencing, and life events to see if you should be screened sooner and/or more often. They do highly recommend ongoing Anxiety Screenings throughout someone's pregnancy and postpartum.

What are the Potential Benefits and Harms of routine Anxiety Screenings?

The benefits of screening for anxiety disorders include:

• Early identification and treatment of anxiety disorders can help to improve a person's quality of life and reduce the risk of complications.
• Screening can help to reduce the stigma associated with mental health conditions.
• Screening can help to improve access to mental health services.

The potential harms of screening for anxiety disorders include:

• False-positive results can lead to unnecessary anxiety and worry.
• Screening can identify people who do not have an anxiety disorder, which can lead to unnecessary treatment.
• Screening can be time-consuming and may not be feasible in all settings.

Overall, the benefits of screening for anxiety disorders outweigh the potential harms. However, it is important to consider the specific context in which screening is being done and to make sure that there are adequate resources available to support follow-up and treatment.

In addition to the benefits and harms of screening, it is also important to consider the barriers to screening for anxiety disorders. These barriers include:

• Lack of knowledge and comfort level among clinicians with screening.
• Inadequate systems to support screening or to manage positive screening results.
• Impact on care flow, given the time constraints faced by primary care clinicians.
• Stigma issues associated with mental health diagnoses.
• Lack of connection between mental health and primary care.
• Patient hesitation to initiate treatment.
• Non-adherence to medication and therapy.
• Wealth inequities, which can result in barriers to receiving mental health services.
• Misdiagnosis of mental health conditions in Black and Hispanic/Latino patients.

It is important to address these barriers in order to make screening for anxiety disorders more effective.

How To Apply What You Learned

This recommendation highlights the importance of not only understanding the impacts that anxiety can have on our health (both physical and mental), but also how the impact that primary care doctors attending to our anxiety can have on our overall lives. 

So, good news is, doctors and insurance companies should hopefully be on board with screening adults for anxiety in a non-stigmatizing, more compassionate way.

More good news? I created a list of things you can go over with your primary care doctor when it comes to anxiety symptoms you may be experiencing.

Here are some specific questions or statements you can share with your doctor (and that you can expect to hear from your doctor) regarding the desire to obtain an Anxiety Screening during your next medical appointment:

Questions to ask your doctor about Anxiety:

• • What are the symptoms of anxiety?
  • What are the different types of anxiety disorders?
  • What are the causes of anxiety disorders?
  • How is anxiety diagnosed?
  • What are the different treatments for anxiety disorders?
  • What are the risks and benefits of each treatment?
  • What is the best treatment for me?
  • How can I manage my anxiety?
  • What are the resources available to me?

Questions that your doctor may ask you about Anxiety:

• • How long have you been experiencing anxiety symptoms?
  • How often do you experience anxiety symptoms?
  • What are your anxiety symptoms like?
  • What triggers your anxiety symptoms?
  • How do your anxiety symptoms affect your life?
  • Have you tried any treatments for anxiety in the past?
  • What are your goals for treatment?

Here are some additional questions that you may want to ask your doctor: 

• • What are the side effects of the medications that you are considering?
  • How long will I need to take medication? *this is an important one
  • What are the lifestyle changes that I can make to help manage my anxiety?
  • What resources are available to me in my community?
  • Are there any support groups for people with anxiety disorders?

Thanks for reading and see you in a couple of weeks! If you haven't checked out this week's other article titled "Seasonal Depression in the Summer? Top tips to combat it ☀️", check it out to see what your answer should be and why.

Remember: You're a human first, your unconscious is showing, and I'm so glad you exist.

Written by Dr. Courtney Tracy, LCSW, PsyD aka "The Truth Doctor"