The U.S. Preventive Services Task Force (USPSTF) on Tuesday released draft recommendations saying all adults under the age of 65 should be screened for anxiety. But some providers argue the recommendations aren't practical given the shortage of mental health providers.
In the recommendations, USPSTF noted that anxiety disorders are commonly unrecognized and under-detected in primary care. One study cited by the task force found the median time for a patient initiating treatment for anxiety was 23 years.
USPSTF recommended that all adults under the age of 65 get screened for anxiety, and that providers continue screening all adults "including those who are pregnant and postpartum" for depression. The task force also said additional research on suicide risk screening in adults is "critically needed." However, there isn't enough evidence to determine whether screening patients who are asymptomatic would help prevent suicide.
The panel elected not to recommend anxiety screenings for people ages 65 and older, in part because many of the common symptoms of aging—including trouble sleeping, pain, and fatigue—could also be misconstrued as symptoms of anxiety.
As a result, USPSTF said there wasn't enough evidence to determine how accurate anxiety screening tools are in older adults. Instead, the panel recommended providers use their judgment when talking about anxiety with older patients.
The panel also referenced the "racism and structural policies" that disproportionately affect people of color, noting that Black patients are less likely to receive mental health services than other groups and that Black and Hispanic patients are more likely to have their mental health conditions misdiagnosed.
The recommendations are open for public comment through Oct. 17.
Lori Pbert, a clinical psychologist, professor at the University of Massachusetts Chan Medical School and member of USPSTF, said that standardizing anxiety screenings for all adults could help fight the effects of racism, bias, and other structural problems in the medical field.
Pbert added that, while USPSTF's recommendations were being discussed before the Covid-19 pandemic, the guidance now comes at a critical time.
"Covid has taken a tremendous toll on the mental health of Americans," Pbert said. "This is a topic prioritized for its public health importance, but clearly there's an increased focus on mental health in this country over the past few years."
However, some experts said that, while screening for anxiety is important, many providers can't meet patient demand, and many patients have to wait months to see a therapist.
"Screening is great, but with a dire shortage in the workplace, it's perplexing unless there are plans for increased funding of clinicians," said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young Health Minds.
A nurse practitioner from Northern California who spoke to the Washington Post on condition of anonymity, said that adding another screening test to the list of screenings primary care providers already do could feel burdensome.
"If primary care providers are asked for one more thing, we are going to break without more resources," the nurse practitioner said. "It just feels wrong if people are positive for depression or anxiety, and we don't have the mental health support to help them," she added.
At a time when the United States is "short on mental health resources at all levels—psychiatrists, psychologists, and therapists—that's a real concern," said Jeffrey Staab, a psychiatrist and chair of the department of psychiatry and psychology at the Mayo Clinic.
"We can screen lots of people, but if that's all that happens, it's a waste of time," he added.
Staab also expressed concerns that increasing screenings could lead to an increase in prescriptions. "When providers say, 'You must have a disorder, here, take this,' we could face an overprescribing problem," he said. "But the opposite scenario is that we have lots of people suffering who shouldn't be. Both outcomes are possible." (Zimmerman, Washington Post, 9/20; Baumgaertner, New York Times, 9/20; Ravipati, Axios, 9/20; Weixel, The Hill, 9/20)
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