US task force guides adults to be screened for anxiety for the first time

A panel of American medical experts on Tuesday recommended for the first time that healthcare professionals check all adult patients under the age of 65 for anxiety, guidance that highlights the extraordinary levels of stress that have plagued the United States since the beginning of the pandemic.

The advisory group, called the US Preventive Services Task Force, said the guidance is intended to help prevent mental health disorders from going unnoticed and untreated for years or even decades. He made a similar recommendation for children and teens earlier this year.

The panel, appointed by a branch of the Federal Department of Health and Human Services, has been in charge of guidance since before the pandemic. The recommendations come at a time of “critical need,” said Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan School of Medicine who serves on the task force.

Americans have reported high levels of anxiety in response to a confluence of stressors such as inflation and crime rates, fear of illness and the loss of loved ones from Covid-19.

“There is a crisis in this country,” Pbert said. “Our only hope is that our recommendations highlight the need to provide greater access to mental health care, and urgently.”

From August 2020 to February 2021, the percentage of adults with recent symptoms of anxiety or depressive disorder increased from 36.4% to 41.5%, according to a study cited by the task force.

The guidance was issued in draft form. The panel will be finalized in the coming months after reviewing public comments. While the panel’s recommendations are not binding, they strongly influence the standard of care of primary care physicians across the country.

In response to the recommendations, mental health professionals emphasized that screening programs are only useful if they provide patients with effective solutions.

At a time when the country is “under-resourced for mental health at all levels — among psychiatrists, psychologists and therapists — this is a real concern,” said Jeffrey Staab, psychiatrist and chair of the department of psychiatry and psychology at the Mayo Clinic. in Rochester, Minnesota.

“We can check a lot of people, but if that’s all that happens, it’s a waste of time,” said Staab, who is not part of the task force.

Psychiatrists, while pleased with the attention given to mental health, also stressed that standardized screening is only the first step towards a diagnosis, and that providers will need to avoid the assumption that a positive screening result indicates a clinical disorder.

For many Americans, screening may simply reveal a temporary period of distress and the need for extra support.

“When providers say, ‘You must have a disorder, take this,’ we can face an over-prescription problem,” Staab said. “But the opposite scenario is that we have a lot of people suffering who shouldn’t be. Both outcomes are possible.”

Growing mental health problems are not unique to the US. Anxiety and depression increased by 25% globally during the first year of the pandemic, according to the WHO (World Health Organization), and have only partially improved since then.

About 25% of men and 40% of women in the country face an anxiety disorder in their lives, according to the task force, although much of the data is out of date.

Women have nearly twice the risk of depression compared to men, studies show, and the recommendation paid particular attention to checking pregnant and postpartum patients.

Doctors often use questionnaires and scales to research mental health disorders. As per the recommendations, positive screening results would lead to further assessments at the discretion of the provider, depending on underlying health conditions and other life facts.

Some primary care physicians have expressed concern that it is impossible to add accountability to their extensive checklist for quick patient consultations.

Pbert said these providers should “do what they already do on a daily basis: juggle and prioritize.”

She also said that the task force’s rigorous review of available studies revealed that people of color are often underrepresented in mental health research, which, if not addressed, can contribute to a cycle of inequality.

Disparities in mental health are stark in the US, where black patients are less likely to be treated for mental health issues than white patients, and black and Hispanic patients are more often misdiagnosed. From 2014 to 2019, the suicide rate among black Americans increased by 30%, data show.

Standardizing screening for all patients could help combat the effects of racism, implicit bias and other systemic problems in the medical field, Pbert said.

The task force panel did not extend its screening recommendations to patients age 65 and older. He said there is no clear evidence on the effectiveness of screening tools in the elderly because symptoms of anxiety are similar to normal signs of aging, such as fatigue and generalized pain. The panel also said there was no evidence on whether screening for depression among adults who do not show clear signs of the disorder would ultimately prevent suicides.

The task force will accept public comment on the draft recommendation until October 17.

Translated by Luiz Roberto M. Gonçalves