USPSTF newly recommends screening adults for anxiety

The U.S. Preventive Services Task Force (USPSTF) recently recommended screening for anxiety disorders in adults ages 19 to 64 years, including pregnant and postpartum patients (moderate certainty, B recommendation) but also found insufficient evidence to assess benefits and harms of screening for adults ages 65 years and older (I statement). It is the first time the USPSTF has made recommendations on this topic.

Screening for anxiety disorders in adults has a moderate net benefit, according to the recommendations, published June 20 by JAMA. However, an accompanying evidence review noted clear evidence that treating anxiety is beneficial, adding that limited evidence indicates that some anxiety screening instruments have acceptable accuracy to detect generalized anxiety disorder.

According to the recommendation, the lifetime prevalence of anxiety disorders in adults has been found to be 26.4% for men and 40.4% for women. Anxiety disorders typically begin in childhood and early adulthood, and symptoms appear to decline with age, it said.

Brief tools that to screen for anxiety disorders that are available for use in primary care include the Generalized Anxiety Disorder (GAD) scale, Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale, Geriatric Anxiety Scale (GAS), and the Geriatric Anxiety Inventory (GAI).

Some instruments that are used for screening for anxiety disorders were developed for reasons other than screening, such as supporting diagnoses, assessing severity, or evaluating response to treatment, the recommendation statement noted. Anxiety screening tools alone are insufficient to diagnose anxiety disorders, so a confirmatory diagnosis should be done, according to the recommendation.

The USPSTF cited critical evidence gaps for which studies are needed, including accuracy of screening tools in older adults as well as populations defined by sex, race and ethnicity, sexual orientation, and gender identity; direct benefits and harms of screening for anxiety disorders in primary care settings (or similar settings) compared with no screening or usual care; and barriers to establishing adequate systems of care related to anxiety disorders.

An accompanying editorial noted the reality that there are too few mental health specialists available to manage the care of all patients with anxiety disorders. “The uptake of these new anxiety screening recommendations should provide an impetus and an opportunity for primary care clinicians to become more comfortable with diagnosing and treating anxiety disorders, which may require additional training,” it stated. “Anxiety disorders can be distressing and disabling, and appropriate recognition and treatment can be life-altering and, in some cases, lifesaving, for patients.”