Screening for Anxiety Disorders in Adults

A 34-year-old patient (gravida 2, para 2) presents for a well-woman examination and Papanicolaou smear. She feels healthy and has no significant medical history, aside from her uncomplicated pregnancies, which did not include postpartum depression or anxiety. She reports increased stress at home due to an upcoming move and some difficulty sleeping.

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation, which one of the following is advised for this patient?

• A. Screen for anxiety disorder.
• B. Assess her anxiety in 6 months.
• C. Refer her to an obstetrician-gynecologist for postpartum anxiety screening.
• D. Recommend melatonin.
• E. Refer her to a behavioral health professional for sleep management.

2. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), which of the following can be categorized as anxiety disorders?

• A. Generalized anxiety disorder.
• B. Obsessive-compulsive disorder.
• C. Separation anxiety disorder.
• D. Social anxiety disorder.

3. Which one of the following populations should be screened for anxiety disorders, according to the USPSTF recommendation?

• A. People already diagnosed with anxiety or another mental health disorder.
• B. People younger than 18 years.
• C. People older than 65 years.
• D. People with no recognized signs or symptoms of anxiety disorders.

1. The correct answer is A. The USPSTF recommends screening all adults 19 to 64 years of age for anxiety disorder, including those who are pregnant and postpartum. The USPSTF notes there is little evidence for the ideal timing and frequency of anxiety screening for perinatal and general adult populations.¹ However, clinical judgment, particularly considering risk factors, comorbid conditions, and life events, can determine whether additional screening of high-risk patients is warranted. There is a lack of evidence on screening rates for anxiety disorders. Underdetection appears to be common. Patients with anxiety disorders may present with other concerns, such as sleep disturbances or somatic issues.
2. The correct answers are A, C, and D. The DSM-5 recognizes the following types of anxiety disorders: generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias, separation anxiety disorder, selective mutism, substance or medication-induced anxiety disorder, anxiety disorder due to another medical condition, and anxiety not otherwise specified.² Obsessive-compulsive disorder is not considered an anxiety disorder.
3. The correct answer is D. The USPSTF recommendation statement applies to adults (defined as those 19 to 64 years of age), including people who are pregnant or postpartum, who do not have a diagnosed mental health disorder and are not showing recognized signs or symptoms of anxiety disorders.² For people 65 years or older, the USPSTF concludes that the evidence is insufficient to recommend for or against screening for anxiety disorders.

The views expressed in this work are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the U.S. Department of Defense, or the U.S. government.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening.