US health task force calls for routine screening for anxiety in adults

In a nod to the country’s pressing mental health crisis, an influential group of medical experts is recommending for the first time that adults under the age of 65 be screened for anxiety.

The draft recommendations, from the US Task Force on Preventive Servicesare designed to help primary care clinicians identify early signs of anxiety during routine care, using questionnaires and other screening tools.

Anxiety disorders are often unrecognized and under-detected in primary care: one study cited by the task force found that the median time to start treatment for anxiety is staggering. 23 years.

While the task force’s initial deliberations on screening for anxiety predated the coronavirus pandemic, the new guidelines come at a critical time, said task force member Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School in Worcester, Mass.

“Covid has had a huge impact on the mental health of Americans,” Pbert said. “This is a priority topic for its importance to public health, but it is clear that there has been increased attention to mental health in this country in recent years.”

In April, the task force made similar recommendations for starting anxiety screening in children and adolescentsaged 8 to 18. The proposal announced on Tuesday focuses on young and middle-aged adults, including those who are pregnant or postpartum, citing research showing screening and treatment can improve anxiety symptoms in those under 65. .

But the advice, somewhat surprisingly, stops short of recommending screening for anxiety for people aged 65 and over.

One reason: Many common symptoms of aging, such as trouble sleeping, pain, and fatigue, can also be symptoms of anxiety. The task force said there was not enough evidence to determine the accuracy of screening tools in older adults, who may not be sensitive enough to distinguish between symptoms of anxiety and symptoms. aging conditions.

The task force advised clinicians to use their judgment when discussing anxiety with elderly patients. The working group also reiterated an earlier recommendation that adults of all ages be routinely screened for depression.

The task force, an independent group of experts appointed by the Agency for Healthcare Research and Quality, wields enormous influence, and although its advice is not binding, the group’s recommendations often change the way whose physicians practice medicine in the United States.

Some doctors wondered how the recommendations would play out in the real world, where mental health providers say they already can’t keep up with patient demand, and patients complain of waiting months for an appointment. you with a therapist.

“Screening is great, but with a severe labor shortage, it’s puzzling unless there are plans to increase funding for clinicians,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital. and executive director of the Clay Center for Healthy Young Minds.

Global prevalence of anxiety and depression rose 25% in first year of pandemic, says World Health Organization reported earlier this year. At the end of 2021, the WHO said “the situation had improved somewhat, but today too many people remain unable to get the care and support they need for mental health problems. pre-existing and newly developed”.

Anxiety, with its telltale dread and heartbreaking, throbbing, sweaty physical signs, can manifest as a number of distinct diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others.

Together, these constitute the the most common mental illnesses in the United States, affecting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, including cognitive behavioral therapy; antidepressant or anxiolytic drugs; as well as various relaxation, mindfulness and desensitization therapies, the doctors said.

The committee also considered the benefits of screening patients at risk of suicide, but concluded that even though suicide is a leading cause of death in adults, there is “insufficient evidence to know whether screening people without signs or symptoms will ultimately help prevent suicide.”

Still, the panel urged providers to use their own clinical judgment in determining whether individual patients should be screened for suicide risk.

For primary care physicians, already plagued by a “crisis” burnout, pandemic-related stress, and their own mental health issues, adding another screening test to a long list of clinical tasks can seem daunting.

“If primary care providers are asked to screen for one more thing, we will break without more resources,” said a Northern California nurse practitioner, who asked not to be named because she had no his clinic’s permission to speak. On the question.

Checking off current requirements, such as checking for up-to-date screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, she said everything had to be packed into a 15-minute appointment, while treating patients with complex chronic conditions.

“It’s not okay if people test positive for depression or anxiety, and we don’t have the mental health support to help them,” the practitioner said.

But Mahmooda Qureshi, an internal medicine physician at Massachusetts General Hospital, said extra support for patients with depression or anxiety would be helpful.

“After 2020, he’s the rare patient who isn’t anxious,” said Qureshi, who noted that she now regularly asks patients, “How’s your stress?” “We’ve found that when it comes to mental health, if we don’t ask, often we don’t know.”

The task force acknowledged the challenges of providing mental health care to all who need it, adding that less than “half of people with mental illness will receive mental health care.”

The panel also cited “racism and structural policies” that disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services compared to other groups, and that misdiagnoses of mental health conditions occur more often among blacks and Hispanics. the patients.

Pbert said the latest guidelines are just one step in addressing the urgent mental health needs of patients. “Our hope is that this set of recommendations can raise awareness of the need to create better access to mental health care across the country,” she said, while pointing out “gaps in the evidence so that donors can support much-needed research in these areas. .”

The proposed recommendations are open to public comment until October 17, after which the working group will review them for final approval.

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