Draft Recommendation to Screen for Anxiety Open for Comment
USPSTF Draft Calls for Screening Most Adults
October 3, 2022, 2:40 p.m. News Staff — As the importance of mental and behavioral health continue to gain attention, the U.S. Preventive Services Task Force for the first time has issued a draft recommendation that adults younger than 65 years be screened for anxiety, including those who are pregnant or postpartum. For adults 65 and older, however, evidence on the benefits and harms of screening remains inconclusive.
Family physicians and others can help shape the final recommendation by commenting on the draft recommendation statement and draft evidence review by 11:59 ET Oct. 17.
The task force is also accepting comments on a draft recommendation statement and draft evidence review on screening for depression and suicide risk in adults through Oct. 17.
The draft recommendation on anxiety, which is graded “B” for the younger population and “I” for the older one, applies to adults 19 years and older who do not have a diagnosed mental health disorder or are not showing recognized signs or symptoms of anxiety.
“To address the critical need for supporting the mental health of adults in primary care, the Task Force reviewed the evidence on screening for anxiety, depression and suicide risk,” task force member Lori Pbert, Ph.D., said in a USPSTF bulletin. “The good news is that screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety can help identify these conditions early so people can be connected to care.”
“Unfortunately, evidence is limited on screening adults 65 or older for anxiety and screening all adults for suicide risk, so we are urgently calling for more research,” added task force member Gbenga Ogedegbe, M.D., M.P.H. “In the absence of evidence, health care professionals should use their judgment based on individual patient circumstances when determining whether or not to screen.”
Story Highlights
Anxiety disorders are extremely common. According to the National Institute of Mental Health, just over 31% of American adults experience an anxiety disorder at some point, and the World Health Organization estimates that the global prevalence of anxiety and depression increased by 25% in the first year of the COVID-19 pandemic.
Evidence for Effective Treatment
In drafting a recommendation, the USPSTF relied on the anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, including
- generalized anxiety disorder,
- social anxiety disorder,
- panic disorder,
- agoraphobia,
- specific phobias,
- separation anxiety disorder,
- selective mutism,
- substance/medication-induced anxiety disorder,
- anxiety disorder due to another medical condition and
- anxiety not otherwise specified.
Overall, the task force found that while the direct evidence for anxiety screening was extremely limited and did not suggest a benefit, it focused on just a limited number of widely used screening tools, many initially designed for other purposes. The task force also pointed out that screening tools alone are insufficient to diagnose anxiety without confirmation from diagnostic assessment and follow-up.
There was broad evidence that treatment for anxiety is effective, with cognitive behavioral therapy shown to reduce the severity of symptoms in some patients. Antidepressants and benzodiazepines also improved anxiety and other outcomes; in particular, antidepressants appeared to help people with generalized anxiety disorder, social anxiety disorder and panic disorder.
While there were no harms associated with screening, and limited evidence on harms associated with treatment, the task force also noted that in 2020 the FDA warned that benzodiazepines can lead to misuse, abuse and addiction, even at recommended doses. The FDA issued a separate warning in 2016 on the dangers of combined use of benzodiazepines with opioid medicines and other central nervous system depressants, which can result in slowed breathing, difficult breathing and death.
Resources for Family Physicians and Patients
Along with the draft recommendation, the USPSTF developed a consumer guide on screening for anxiety, depression and suicide risk in adults.
The AAFP also offers members several resources on anxiety and other mental health issues specifically for family physicians, including a collection of American Family Physician journal articles on anxiety disorders and a patient care webpage on mental health and well-being that addresses depression, suicide prevention and more.
Physicians can also find materials to share with patients on familydoctor.org, including articles on generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and social phobia.
Data Gaps on Populations and Benefits
The task force called for more research on
- the effects of screening and treatment in other populations as defined by sex, race and ethnicity, sexual orientation and gender identity;
- the accuracy of screening tools, especially for older adults and those who are pregnant or postpartum;
- the effectiveness of treatments in older adults and those who are pregnant or postpartum; and
- the direct benefits and harms of screening compared with no screening or usual care.