The U.S. has seen major attempts to reduce the stigma of mental health in recent years, and a new recommendation from an expert panel may help normalize screening for anxiety disorders.
A draft recommendation released Tuesday from the U.S. Preventive Services Task Force (USPSTF), is urging that all adults under the age of 65 be screened for anxiety. The group also reiterated that adults should be screened for depression, though it did not recommend the same widespread screening as it did for anxiety disorders.
“The COVID pandemic has just taken such a tremendous toll on people’s mental health, and I think people are acknowledging that they are struggling a bit more,” USPSTF Member Lori Pbert, PhD, professor in the department of population and quantitative health sciences at the University of Massachusetts Chan Medical School, told Health. “We need to have clinicians be able to screen for these conditions so that we can identify these disorders early and get people the care that they need.”
Here's what we know about the recommendation, why experts felt like the measure is needed now, and how it could impact healthcare going forward.
Staggering Rates of Mental Health Issues in the U.S.
Reported rates of anxiety have been increasing in the U.S. for a number of years now, which has medical professionals concerned. Between 2008 and 2018, anxiety rates jumped from 5.12% to 6.68% in adults, with the biggest increase among young adults.
And, during the COVID-19 pandemic, anxiety issues in the U.S. only seemed to get worse. Between August and December 2020, people experienced more symptoms of anxiety and depression as COVID cases in their area grew in number. Globally, COVID prompted a 25% increase in anxiety and depression, the World Health Organization said. The widespread nature of this issue is what encouraged the USPSTF to act, Pbert said.
“It was nominated and prioritized as a topic because of its high public health importance,” she explained. “We know that anxiety disorders are really under-identified and under-recognized within the primary care setting.”
The median time that it takes for those with anxiety disorders to be treated is 23 years, the USPSTF said in their statement. This is why it’s so important that people get screened as soon as possible and be encouraged to access care, Pbert said.
"A lifetime prevalence of anxiety disorders is 26% in men, and 40% in women, so we know this is a very common disorder," Pbert said. "When we looked at all the evidence available, we found that screening for anxiety in adults younger than 65—and that includes those who are pregnant and postpartum—screening can help identify anxiety early so that they can be connected to the care they need."
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What Would Widespread Screening Look Like?
This recommendation from the USPSTF is just a draft, and the document is open for public comment until October 17. And, even though the group is supported by the Department of Health and Human Services (HHS), its findings are independent from the U.S. government and are not binding.
They are still heavily influential for doctors across the country, however, according to the New York Times.
If this recommendation were to be widely adopted, patients would simply be asked to fill out a questionnaire about their moods or worries the next time they visit their primary care physician. If the doctor is concerned that the person may have an anxiety disorder, they would refer them to a mental health professional to talk about a diagnosis or treatment options. For now, this would probably be a one-time thing, unless a medical professional has a specific concern.
"There isn't enough evidence, but a reasonable approach would be to do it that way, sort of a two-tiered [approach] where you would do screening of all adults who haven't been screened previously," Pbert explained. "And then using clinical judgment to determine whether additional screening would be beneficial."
Though this measure seems fairly simple, it's a great tool to catch anxiety early.
“[Anxiety] can be misinterpreted as simply stress or normalized as benign because many have developed and coped with anxiety since childhood,” Sheehan Fisher, PhD, an associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, told Health in a statement. “In addition, anxiety is more socially accepted to have as a mental illness, so people are more inclined to endorse anxiety symptoms when screened by a professional.”
The recommendation, though it applies to a huge swath of people, does not cover everyone.
The USPSTF did not find enough evidence to support recommending anxiety screening for people over 65, Pbert said, though seniors should still get screened if their provider thinks it would be helpful. Additional research also needs to be done about anxiety screening as it relates to different groups along the lines of race, ethnicity, gender, and sexual orientation, the draft recommendation also added.
Similarly, there also wasn’t enough information to make the same sweeping recommendation for depression screening or suicide screening, even though the latter is a leading cause of death for adults in the U.S., Pbert explained. The USPSTF is calling for more research in all of these areas, it said.
And of course, the screening recommendation is only in reference to those who do not already have a diagnosed mental illness.
"Anyone who's showing signs or symptoms, or has concerns about anxiety, depression, or suicidal thoughts should be assessed and connected to appropriate care," Pbert said. "Someone who's having difficulties, is expressing concern—please talk with your healthcare professional."
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Screening Uncovers the Issue, But Barriers to Treatment Endure
Though the screenings should hopefully catch more cases of anxiety disorders in the general population, the recommendation only addresses one step of mental health care: diagnosis.
After a person gets screened, they need treatment—but that next step may not always happen in a timely manner.
A March 2022 study published in JAMA Network Open revealed disparities in depression diagnoses and treatment rates. Among a group of patients who received care at Veterans Health Administration primary care clinics across the southwestern U.S. between 2015 and 2019, only 32% who screened positive for depression received a timely follow-up care within three months.
The barriers to mental health treatment are wide-ranging and varied. Cost, for example, can play a big role in deterring people from seeking follow-up care. In a 2021 survey from the National Alliance on Mental Health, 41% of people named cost as a barrier to getting the mental health services they wanted or needed.
"Funding mental health services can just be incredibly difficult, and it's especially difficult in areas that have limited access to healthcare and related services," Pbert said.
The U.S. also does not have enough mental health professionals available to assist everyone who needs help, and communities of color and rural communities oftentimes have an even harder time accessing services.
There's a disconnect between primary care providers and mental health professionals, Pbert added, that needs to be rectified, too.
“The data says that less than half of people who experience a mental illness will receive mental health care,” said Pbert. “So we absolutely need to expand our mental health services so that people who are identified as having a mental health condition can be appropriately diagnosed and treated.”
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Normalizing Anxiety Screening
Even though the recommendation won't fix everything, it's certainly a step in the right direction when it comes to addressing the prevalence of mental health issues in the U.S.
"The recommendation to screen for anxiety is an important step forward to support public health and wellbeing," Fisher said. "Identification of anxiety can be a start to discovering or better understanding other conditions. Anxiety can influence all parts of one's life, including interpersonal relationships, decision making, and work performance, so it is costly if untreated."
In addition to the direct benefits that those with undiagnosed anxiety disorders might receive, Pbert hopes that more widespread screening will help mental health care feel more like just regular old healthcare.
"You get screened for high blood pressure, you get screened for high blood sugar—these are things that we kind of got used to and expect. And what we would love to see is that mental health conditions are given the same respect and attention," Pbert said. "By incorporating it into the routine care that is being provided, it really makes this a standard of care."