USPSTF Recommends Screening Adults For Anxiety Disorders

For the first time, the United States Preventive Services Task Force (USPSTF) has recommended that clinicians screen adults aged 19 to 64 years of age for anxiety disorders. This recommendation includes those who are pregnant and postpartum.^1,2

According to the USPSTF, anxiety disorders are commonly occurring mental health conditions, which include generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety not otherwise specified.

To arrive at their final recommendation, the USPSTF commissioned a systematic review that evaluated the benefits and harms of screening for anxiety disorders in adults who are asymptomatic. Many of the studies commonly used the GAD-2 and GAD-7 to screen for anxiety disorders, which the USPSTF explained, “demonstrated adequate sensitivity and specificity to detect generalized anxiety disorder.”

In its final recommendation, the USPSTF noted that adequate systems and clinical staff are needed to sufficiently screen patients, and positive screening results should be further confirmed by diagnostic assessment. Additionally, positively confirmed patients should be provided or referred to evidence-based care.

Overall, while evaluating several clinical trials that examined the benefits of early detection and treatment, the USPSTF found that there was “adequate indirect evidence of the benefit of screening for anxiety disorders in adults younger than 65 years and perinatal persons” as the screening tools used were accurate in detecting generalized anxiety disorder. However, the USPSTF noted that there was limited direct evidence to support the benefits of anxiety disorder screening programs.

Further research needs to be conducted to address several critical evidence gaps including the accuracy of screening tools in older adults, the prevalence of anxiety disorders, and the barriers to establishing adequate systems of care related to anxiety disorders.

In an accompanying editorial³, Murray B. Stein, MD, MPH and Linda L. Hill, MD, MPH both of the Herbert Wertheim School of Public Health at the University of California, San Diego, noted that a positive screen result for anxiety should be immediately followed with clinical evaluation for suicidality. Although not covered in the final USPSTF recommendation, the authors of the editorial also noted that a positive screening for anxiety could be an indication of posttraumatic stress disorder. Indeed, clinicians in the primary care setting should be prepared to ask additional follow-up questions about their patients’ traumatic experiences, provide an adequate a referral for the patient, or both.

“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,” they concluded in their editorial. “Anxiety disorders can be distressing and disabling, and appropriate recognition and treatment can be life-altering and, in some cases, lifesaving, for patients.”

Reference:

1. Anxiety disorders in adults: screening. US Preventive Services Task Force. June 20, 2023. Accessed June 22, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening#fullrecommendationstart
2. US Preventive Services Task Force. Screening for anxiety disorders in adults. JAMA. Published online June 20, 2023. doi:10.1001/jama.2023.9301
3. Stein MB, Hill LL. Are there reasons to fear anxiety screening? JAMA. Published online June 20, 2023. doi:10.1001/jama.2023.7239