Health panel recommends anxiety screening for all adults under 65


“Our only hope is that our recommendations shine a light on the need to create better access to mental health care – and urgently.”

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A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under the age of 65 for anxiety, advice that highlights the extraordinary levels of stress that have plagued the United States since the start of the pandemic.

The advisory group, called the US Preventive Services Task Force, said the guidelines aim to keep mental health disorders from going undetected and untreated for years, if not decades. He made a similar recommendation for children and teens earlier this year.

The committee, appointed by a branch of the federal Department of Health and Human Services, has been preparing 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 is part of the task force. Americans have reported outsized levels of anxiety in response to a confluence of stressors including inflation and crime rates, fear of disease and the loss of loved ones to COVID-19.

“It’s a crisis in this country,” Pbert said. “Our only hope is that our recommendations shine a light on the need to create better access to mental health care – and urgently.”

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

The guidelines have been published in draft form. The panel will finalize it in the coming months after considering public feedback. Although the committee’s recommendations are not binding, they strongly influence the standard of care among primary care physicians across the country.

In response to the recommendations, mental health care providers emphasized that screening programs are only useful if they lead patients to effective solutions. At a time when the country lacks mental health resources at all levels – psychiatrists, psychologists and therapists – this is a real concern,” said Dr. Jeffrey Staab, psychiatrist and director of the Department of Psychiatry and Psychology at the Mayo Clinic in Rochester, Minnesota.

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

Psychiatrists, while pleased with the attention to mental health, also stressed that standardized screening is only the first step towards a diagnosis, and that providers should beware of assuming that a screening result positive indicates a clinical disorder.

For many Americans, screening might just reveal a period of temporary distress and a need for additional support.

“When providers say, ‘You must have a disorder, here take this,’ we could be facing an overprescribing problem,” Staab said. “But the reverse scenario is that we have a lot of people suffering when they shouldn’t be. Both outcomes are possible. »

The rise in mental health problems is not unique to the United States. Anxiety and depression increased by 25% worldwide in the first year of the pandemic, according to the World Health Organization, and have only partially improved since.

According to the task force, about a quarter of men and about 40% of women in the United States face an anxiety disorder in their lifetime, although most of the data is outdated. Women have nearly double the risk of depression compared to men, studies show, and the recommendation pays particular attention to screenings for pregnant and postpartum patients.

Doctors typically use questionnaires and scales to investigate mental health disorders. According to the recommendations, positive screening results would lead to further assessments at the discretion of the provider, depending on underlying health conditions and other life events.

Some primary care physicians have expressed concern about adding additional responsibility to their extensive checklist for brief patient appointments.

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

She also said the task force’s rigorous review of available studies found that people of color are often underrepresented in mental health research, which, if left unaddressed, could contributing to a cycle of inequality.

Mental health disparities are endemic in the United States, where black patients are less likely to be treated for mental health issues than white patients, and black and Hispanic patients are both more frequently misdiagnosed. From 2014 to 2019, the suicide rate among black Americans increased by 30%, the data shows.

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

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

The working group will accept public comments on the draft recommendation until October 17.

This article originally appeared in The New York Times.


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