US Health Task Force calls for routine anxiety screening in adults

In a sign of the country’s pressing mental health crisis, an influential group of medical experts recommended for the first time that adults under the age of 65 undergo an anxiety screening test.

draft recommendations, from US Preventive Services Task ForceTo help primary care physicians identify early signs of anxiety during routine care, using questionnaires and other screening tools.

Anxiety disorders often go unrecognized and inadequately detected in primary care: One study cited by the staff found the average time to start anxiety treatment to be staggering. 23 years.

While the task force’s initial deliberations on anxiety screening predate the coronavirus pandemic, the new guidance comes at a critical time, said task force member Laurie Burt, a clinical psychologist and professor at the University of Massachusetts Chan School of Medicine in Worcester, Massachusetts.

“Covid has taken a huge toll on the mental health of Americans,” Papert said. “This is a topic that has been prioritized for its importance to public health, but there has clearly been an increased focus on mental health in this country over the past few years.”

In April, the task force made similar recommendations to start worrying Examination of children and adolescents, between the ages of 8 and 18 years. The proposal announced Tuesday focuses on young and middle-aged adults, including pregnant or postpartum women, citing research showing that screening and treatment can improve anxiety symptoms in those under 65.

But the guidance, somewhat surprisingly, did not recommend anxiety screening for people 65 and older.

One reason: Many of the common symptoms of aging, such as sleep problems, pain, and fatigue, can be symptoms of anxiety. The task force said there was insufficient evidence to determine the accuracy of screening tools in older adults, which may not be sensitive enough to distinguish between anxiety symptoms and geriatric conditions.

The task force advised clinicians to use their judgment in discussing anxiety with older patients. team work Also repeat an earlier recommendation that adults of all ages have routine screening for depression.

The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, has tremendous influence, and while its advice is not prescriptive, the committee’s recommendations often change the way physicians practice medicine in the United States.

Some doctors have wondered how to implement the recommendations in the real world, and where Mental health service providers They say they can’t actually fulfill a patient’s demand, and patients complain of waiting months for an appointment with a therapist.

Eugene Berezin, MD, a psychiatrist at Massachusetts General Hospital and CEO of Clay Center for Healthy Young Minds.

The global prevalence of anxiety and depression increased by 25 percent during the first year of the epidemic, WHO mentioned earlier this year. By the end of 2021, the WHO said, “the situation has improved somewhat, but today many people are still not able to get the care and support they need for both pre-existing and newly developing mental health conditions.”

Anxiety, with its excruciating fear, painful physical signs, heart palpitations, and sweaty palms, can manifest in a number of distinct diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder and others.

Together, these make up a file Most common mental illness In the United States, it affects 40 million adults each year, according to the American Anxiety and Depression Association. Treatment can include psychotherapy, in particular cognitive behavioral therapy; Antidepressant or anti-anxiety medications. Plus many relaxing, mindfulness, and desensitizing treatments, doctors said.

The committee also considered the benefits of screening patients for suicide risk but concluded that Although suicide is the leading cause of death in adults, there is “insufficient evidence as to whether screening people without signs or symptoms will ultimately help prevent suicide.”

However, the panel urged providers to use their clinical judgment to determine whether individual patients should be screened for suicide risk.

For primary care physicians, already in the midst of a “crisis” From the exhaustion and stress of the pandemic and their own mental health challenges, adding another screening test to a long list of clinical tasks can feel overwhelming.

“If primary care providers are asked to screen for something else, we will stop without further resources,” said a nurse practitioner in Northern California, who asked not to be named because she did not have permission from her clinic to speak. about the issue.

Judging by current requirements, such as checking recent screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence and alcohol and tobacco use, she said everything should be packed into a 15-minute appointment, while also treating patients with complex and chronic illnesses.

“It feels wrong if people test positive for depression or anxiety, and we don’t have mental health support to help them,” the practitioner said.

But Mahmoud Qureshi, MD, an internal medicine physician at Massachusetts General Hospital, said additional support for patients suffering from depression or anxiety would help.

“After 2020, the rare non-anxious patient,” Qureshi said, noting that she now routinely asks patients, “How is your stress?” “We’ve found that when it comes to mental health, if we don’t ask, we often don’t know.”

The task force acknowledged the challenges of providing mental health care to all in need, adding that less than “half of individuals with mental illness will receive mental health care.”

The panel also cited “racism and structural policies” that disproportionately affect people of color. The committee noted that black patients are less likely to receive mental health services than other groups, and that misdiagnosis of mental health conditions occurs more often in blacks and Latinos. The patients.

Pbert said the latest guidance is just one step in addressing patients’ urgent mental health needs. “We hope that this set of recommendations will raise awareness of the need to increase access to mental health care across the country,” as well as highlight “gaps in the evidence so that funders can support much-needed research in these areas,” she said. .”

The proposed recommendations are open to general comment Until October 17, after which the task force will consider final approval.

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