New recommendation calls for anxiety disorder screening in adults
The US Preventive Services Task Force (USPSTF) has issued a new recommendation stating that adults aged 19 to 64 in the United States should undergo screening for anxiety disorders.
This marks the first final recommendation from the task force regarding anxiety disorder screening in adults, including pregnant and postpartum individuals.
However, the USPSTF found insufficient evidence to support screening for anxiety in older adults.
The recommendation also aligns with the task force’s previous guidance from 2016, which advised screening all adults for major depressive disorder, including pregnant or postpartum individuals and older adults.
The USPSTF is an independent group of medical experts whose recommendations influence doctors’ decisions and insurance plans.
In recent years, the prevalence of clinical depression has been steadily increasing in the United States, but it experienced a significant surge during the COVID-19 pandemic.
According to the US Centers for Disease Control and Prevention (CDC), approximately one in six adults will experience depression.
Although depression and anxiety are distinct conditions, they often coexist.
Consequently, screening recommendations can help clinicians identify patients who may require treatment for both conditions or either one.
The USPSTF researchers emphasized the need for more robust screening, as most individuals with anxiety disorders do not receive treatment within the first year of symptoms, or sometimes ever.
Only 11% of US adults with an anxiety disorder sought treatment within the first year of onset, according to research by the USPSTF.
The median time to treatment initiation was 23 years.
In a study involving 965 primary care patients, only 41% of those with an anxiety disorder received treatment.
Medical professionals can perform screening for anxiety disorders using questionnaires and scales that evaluate symptoms like feeling on edge, uncontrollable worrying, and difficulty relaxing.
Similarly, screening for depression includes questions about feeling hopeless, having trouble concentrating, losing interest in daily activities, or having thoughts of self-harm.
Major depressive disorder is diagnosed when an individual experiences at least two weeks of persistent sadness or a lack of interest in everyday activities.
If there’s a positive screening result, it should be confirmed through a diagnostic assessment to determine symptom severity and identify any additional psychological concerns.
Subsequently, health experts said appropriate care should be provided to patients.
The USPSTF said it acknowledges that potential harms of screening include false positives, which may lead to unnecessary appointments or treatment.
However, for most adults, screening and subsequent care can alleviate symptoms associated with anxiety disorders and depression.
Effective treatments for anxiety disorders encompass psychotherapy (talk therapy) with a therapist, medications like antidepressants or beta blockers, and relaxation or stress management therapies.
Treatment options for depression include antidepressant medication, psychotherapy, or a combination of both.
The USPSTF’s recommendation emphasizes that if left untreated, major depressive disorder can hinder daily functioning and increase the risk of cardiovascular events, exacerbate comorbid conditions, or lead to higher mortality rates.
Only about half of individuals with major depression are correctly identified.
Research also indicates that anxiety disorders and depression may be associated with suicidal thoughts, suicide attempts, and other self-destructive behaviors.
However, the new USPSTF recommendations state that there is currently insufficient evidence to recommend screening specifically for suicide risk in adults who are not displaying signs or symptoms.
This stance aligns with the task force’s previous recommendation from 2014, and the USPSTF has called for further research to understand suicide risks among asymptomatic individuals better.
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