https://immattersacp.org/weekly/archives/2020/06/09/2.htm

Screen all teen, adult women for anxiety, new guideline says

According to a systematic review, brief screening instruments are effective for anxiety screening, but the optimal screening interval is uncertain.


A national coalition recommends screening for anxiety in women and adolescent girls ages 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women.

The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed the guideline to improve detection of anxiety, achieve earlier diagnosis and treatment, and improve health, function, and well-being. The guideline is intended to inform clinical practice and coverage of services. The target audience includes all clinicians providing preventive health care to women, particularly in primary care settings. The guideline, a systematic review, and an editorial were published June 9 by Annals of Internal Medicine.

The systematic review found no studies that evaluated the overall effectiveness or harms of anxiety screening, but 33 studies and two systematic reviews (171 studies; 112,574 participants) that evaluated the diagnostic accuracy of 27 screening instruments and their variations against a clinical diagnosis or other instruments. Most demonstrated moderate to high accuracy for adults (Generalized Anxiety Disorder scale: sensitivity, 70% to 97%; specificity, 50% to 89%), pregnant and postpartum women (Edinburgh Postnatal Depression Scale: sensitivity, 74%; specificity, 64%), and adolescents (Screen for Child Anxiety Related Emotional Disorders: sensitivity, 64% to 74%; specificity, 64% to 73%). The review found that anxiety symptoms improved with cognitive behavioral therapy (246 randomized controlled trials; 17,209 participants) and antianxiety medications (126 randomized controlled trials; 8,225 participants).

The guideline authors wrote that optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.

The systemic review said that “Brief instruments with as few as 2 questions are as accurate as longer instruments and are particularly suitable for routine screening in primary care settings.” Women with anxiety may benefit from cognitive behavioral therapies with or without pharmacologic therapies, depending on severity of symptoms and preferences, the review said. Antianxiety medications have proven effectiveness, are widely used, are generally well tolerated, and are also effective for depression, which often accompanies anxiety, it noted. “Although trials of the overall effectiveness of screening for anxiety disorders are lacking, studies of the accuracy of screening methods and effectiveness and harms of treatment provide evidence supporting essential steps in the clinical pathway,” the authors wrote.

An accompanying editorial said, “The staggering lifetime prevalence of anxiety disorders for women—up to 40%—indicates that anxiety is a significant public health problem.” It also asked “Why are so many women across age groups in countries like the United States struggling with anxiety? Efforts are needed to understand and address modifiable factors to prevent anxiety disorders.”