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Pushing primary care physicians to screen all patients for anxiety will lead to overdiagnosis and overprescription, as well as exacerbate existing mental health resource shortages, a psychologist has said.
“It’s the wrong solution at the wrong time,” said clinical professor Dr Jonathan Shedler. of psychiatry at the University of California, San Francisco, told Fox News. “You can’t just cut the world out of the Troubles and think you’re doing an adequate job of figuring out someone’s mental health needs.”
Earlier this month, the U.S. Preventive Services Task Force recommended that all adults under age 65 be screened for anxiety, as more Americans report symptoms of mental health issues as a result of the COVID-19 pandemic. The advisory group, which released the guidelines in draft form, said the aim was to help prevent mental health conditions from being detected and left untreated.
“It’s just terrible care to give someone a seven-question questionnaire in the office and write a prescription based on that without going into the big picture,” said Shedler, who authored more of 100 academic and scientific articles in psychology.
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More than 30% of adults reported symptoms of an anxiety or depressive disorder this summer, estimates the National Center for Health Statistics. The share of adults who received mental health treatment rose to nearly 23% in 2021, from 19% in 2019, according to the Centers for Disease Control and Prevention.
Shedler worries that mass screening could lead to misdiagnosis, forcing doctors to prescribe anti-anxiety medication to patients who may not need it.
“Primary care is not the place to get mental health care,” Shedler said. “Doctors don’t have the time. They don’t have the resources. They don’t have the training.”
The psychologist pointed to a similar recommendation made by the panel in 2002 to standardize screenings for depression, which was followed by an increase in the number of people diagnosed and prescribed antidepressants. In 1996, about five million people were taking antidepressants. This number has steadily increased to reach 13 million in 2015, according to a study by Frontiers in Psychiatry.
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A member of the federal task force, American Psychological Association CEO Arthur C. Evans, told the Wall Street Journal that the group’s recommendation “is a really important step forward” in the nation’s ongoing battle against mental health. “Screening for mental health issues is critical to our ability to help people as early as possible,” he said.
Shedler, who has done extensive research on these types of standardized screening tests, said they are ineffective in identifying mental health disorders.
“Psychiatric difficulties don’t exist in a vacuum,” the psychologist told Fox News. “I think for a lot of people the world is feeling more and more dangerous and unpredictable.”
“There is a difference between anxiety and fear,” he added. “On the screening questionnaires, there is no distinction.”
Shedler said he was concerned that simplified screenings could yield false positives.
“This type of screening is going to diagnose a lot of people with a disorder and a good number of them are going to find themselves on a lifelong path of one drug and one treatment after another,” said doctor. “When, in fact, they are reacting to realistic circumstances in the world.”
“There are a lot of things going on in society, in the culture, financially, politically, that leave people feeling extremely vulnerable,” Shedler told Fox News. He said fear often stems from these external dangers, while anxiety “is a response to internal dangers, psychological dangers.”
“If it’s not anxiety, but fear of something out there, psychological treatment won’t be the answer,” he said.
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Also, as mental health issues increase, doctors worry about the lack of resources for those who seek help.
“We have a chronic shortage of psychiatrists, and it’s going to continue to grow,” said Saul Levin, MD, CEO and medical director of the American Psychiatric Association during a briefing in May. “People can’t get care. It affects their lives, their ability to work, socialize or even get out of bed.”
By 2024, the United States will be short of between 14,280 and 31,109 psychiatrists, and psychologists, social workers and others will also be overstretched, according to to a study published in Psychiatry Online.
Shedler said the lack of proper mental health care will only get worse if the federal task force recommendation is finalized, as the number of patients seeking treatment will increase without proportionally adding mental health professionals.
He also pointed out that health insurers often do not cover mental health treatment. When they do, it’s often only shoddy care that’s covered, creating another hurdle for those seeking treatment, according to Shedler.
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“A competent and qualified mental health professional has the expertise to sort out what is a psychological difficulty that we can treat in psychotherapy, where is medication a reasonable part of a comprehensive treatment and when is it not. not,” he told Fox News.
“That’s what we’re doing. That’s not what a primary care physician can do with a seven-question questionnaire,” Shedler said.
The draft guidelines are open for public comment until October 17.