Anxiety disorders are often unrecognized and underrecognized in primary care: A study cited by the task force found the median time to start anxiety treatment is a staggering 23 years.
While the task force’s initial deliberations on anxiety screening preceded the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, clinical psychologist and professor at the University of Massachusetts Chan Medical School in Worcester, Mass .
“Covid has taken a tremendous toll on Americans’ mental health,” Pbert said. “This is an issue that is being prioritized because of its importance to public health, but in recent years there has clearly been a strengthening of mental health in this country.”
In April, the task force made similar recommendations to begin anxiety screening in children and adolescents ages 8 to 18. The proposal, announced Tuesday, focuses on young and middle-aged adults, including pregnant or postpartum women, and cites research showing that screening and treatment may improve anxiety symptoms in those under 65.
But the guidance is somewhat surprisingly limited to recommending anxiety screening for people 65 and older.
One reason: Many common signs of aging, such as trouble sleeping, aches and pains, and fatigue, can also be symptoms of anxiety. The task force said there was insufficient evidence to determine the accuracy of screening tools in older adults, who may not be sensitive enough to distinguish between anxiety symptoms and age conditions.
The task force advised physicians to use their judgment when discussing anxiety with older patients. The task force also reiterated a previous recommendation that adults of all ages should undergo routine screening for depression.
The Task Force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, wields tremendous influence, and while its advice isn’t mandatory, the panel’s recommendations often change the way physicians in the United States practice medicine.
Some doctors questioned how the recommendations would play out in the real world, where mental health providers say they are already unable to meet patient demand and patients complain that they wait months to see a therapist.
“Screening is great, but given the severe labor shortage, it’s confusing unless there are plans for increased funding for clinicians,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young Healthy Minds.
The global prevalence of anxiety and depression rose 25 percent in the first year of the pandemic, the World Health Organization reported earlier this year. By the end of 2021, the WHO said: “The situation had improved somewhat, but today too many people are still unable to access the care and support they need for both pre-existing and newly developing mental illnesses. “
Anxiety, with its telltale fear and heart-pounding, heart-pounding, sweaty physical signs, can manifest itself in a number of different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others.
Together, these make up the most common mental illnesses in the United States, affecting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, particularly cognitive behavioral therapy; antidepressants or anti-anxiety medications; as well as various relaxation, mindfulness and desensitization therapies, doctors said.
The panel also considered the benefits of screening patients for suicide risk, but concluded Although suicide is one of the leading causes of death in adults, there is “insufficient evidence that screening people with no signs or symptoms will ultimately help prevent suicide.”
Still, the panel urged providers to use their own clinical judgment to determine whether individual patients should be evaluated for suicidal risk.
For GPs already in a “crisis” of burnout, pandemic-related stress, and their own mental health challenges, adding another screening test to a long list of clinical tasks can feel tedious.
“If GPs are asked to look into one more thing, we will stop with no more resources,” said a nurse in Northern California, who asked not to be named because she didn’t have permission from her clinic to speak about the issue .
She ticked current requirements, such as reviewing current screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, and said everything needed to be packed into a 15-minute appointment to treat patients with complex, chronic diseases diseases.
“It just feels wrong when people respond positively to depression or anxiety and we don’t have the psychological support to help them,” the practitioner said.
But Mahmooda Qureshi, an internal medicine physician at Massachusetts General Hospital, said additional support will be helpful for patients suffering from depression or anxiety.
“After 2020, it’s the rare patients who aren’t afraid,” said Qureshi, noting that she now routinely asks patients, “How’s your stress?” know if we don’t ask.”
The task force recognized the challenges in providing mental health care to all in need, adding that less than “half of people with a mental illness receive mental health care.”
The panel also cited “racism and structural policies” that disproportionately affect people of color. The panel found that black patients are less likely to seek mental health services compared to other groups and that black and Hispanic patients are more likely to be misdiagnosed with mental illness.
Pbert said the latest guidance is just one step in addressing the urgent mental health needs of patients. “We hope this set of recommendations can raise awareness of the need to increase access to mental health care across the country,” she said, and “highlight gaps in the evidence for funders to support much-needed research in these areas.” be able .”
The proposed recommendations are open for public comment until October 17, after which the task force will review them for final approval.
