Task force urges US physicians to screen asymptomatic adults for anxiety for the first time

By MDLinx staff
Published September 22, 2022

Key Takeaways

  • The US Preventive Service Task Force (USPSTF) is recommending for the first time that US doctors do anxiety screening for all adult patients under age 65, even if they don't have symptoms.

  • The USPSTF report noted that mental health is a top priority as a result of the COVID-19 pandemic, and its research found clear evidence of the benefits of treating anxiety in adults.

  • Once anxiety has been identified in a patient, the USPSTF suggested that physicians do a confirmatory diagnostic assessment and further follow-up. Recommended therapies include psychotherapy, pharmacotherapy, and relaxation and desensitization therapies.

 An influential health group is encouraging US physicians for the first time to routinely screen adult patients under age 65 in primary care settings for anxiety, even if they don't have symptoms.

The US Preventive Services Task Force (USPSTF) announced its recommendation on September 20, 2022.[] The guidance applies to adults, 19 years or older including those pregnant or in postpartumwho do not have a diagnosed mental health disorder or are not showing recognized signs or symptoms of anxiety. The USPSTF did not recommend screening for anxiety in adults aged 65 and older.

The Task Force's review and statement are available for comment until October 17, 2022, at which point the Task Force is expected to affirm this guidance.

The recommendations are timely. A Statista survey published August 31, 2022, found that between April 2020 and August 2022, approximately 32% of females and 25% of males in the US reported symptoms of anxiety disorder during the past 2 weeks.[]

Study supports treatment

The USPSTF report, now available as a 707-page Draft Evidence Review, is based on a review of 20,543 abstracts and 1,176 full-text articles on the benefits and harms of screening and treatment for depression, anxiety, and suicide risk.[] Ultimately, 173 studies covering an estimated 8.5 million individuals were analyzed. Study conclusions supported the benefits of treatment for anxiety.

“While evidence is insufficient to draw conclusions about the benefits or harms of anxiety screening interventions, there is clear evidence that treatment for anxiety is beneficial,” the report authors wrote.

This research began before the onset of the COVID-19 pandemic, although the report indicated it impacted the study over time.

"Given our current time in history, in the midst of a pandemic and with increasing numbers of serious natural disasters affecting the US, attention to mental health may be more important than ever."

O’Connor, et al, USPSTF Draft Evidence Review

Benefits outweigh risks

The USPSTF Draft Recommendation Statement cited potential risks to screening for anxiety such as inaccurate results leading to unnecessary follow-up care, but ultimately found that the study results supported a “moderate net benefit” of screening adults.[]

The statement, however, found that the evidence wasn’t sufficient to support screening for anxiety in adults 65 and older, stating that “the balance of benefits and harms cannot be determined.”

MDLinx Medical Advisory Board member Amanda Zeglis, DO, of Premier Psychiatry LLC, supported the USPSTF position on anxiety screening, saying “The earlier the better when it comes to identifying underlying or overt mental health concerns. As a result, screening is the first step.”

"Screening for symptoms of anxiety, even with brief questionnaires, can be effective in identifying mental health concerns before they escalate."

Amanda Zeglis, DO

Recommended screening tools

The USPSTF statement recommended a series of tools that could be used to screen patients for anxiety, including the Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale-Anxiety subscale, Geriatric Anxiety Scale, and the Geriatric Anxiety Inventory.

“Once concerns have been identified, the next step is ensuring provisions of appropriate resources and/or referrals for care,” Dr. Zeglis said.

Treatment strategies

When anxiety has been diagnosed in a patient, potential treatments suggested in the USPSTF review include:

  • Psychotherapy (cognitive behavioral, family, interpersonal, and acceptance and commitment therapy)

  • Pharmacotherapy (antidepressants, antihistamines, beta-blockers, anticonvulsant medications, or benzodiazepines)

  • Desensitization and relaxation therapies

  •  Transdiagnostic treatments for patients who have anxiety, depression, or both conditions

About the Task Force

The US Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine that "works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services," according to its website.

The Task Force is funded, staffed, and appointed by the US Department of Health and Human Services' Agency for Healthcare Research and Quality.

What this means for you

Research shows that anxiety and mental illness have increased in the US during the COVID-19 pandemic. The USPSTF recommendations to screen all adult patients under the age of 65 for anxiety (using the suggested screening tools) are an outgrowth of this. When patients are diagnosed with having anxiety, consider implementing treatments such as psychotherapy or pharmacotherapy.

Read Next: How to address anxiety, according to health experts
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