Anxiety Screenings Could Become a Normal Part of Your Annual Physical

As part of an effort to address the U.S. mental health crisis, a panel of medical experts proposed a recommendation that all adults younger than 65 be screened for anxiety disorders.

The draft recommendations, made by the U.S. Preventive Services Task Force, suggest that primary care providers use questionnaires and other tools to help identify early symptoms of anxiety disorders and support patients in getting additional mental health care.

“Everyone has anxiety. It's just part of being a human,” Sanjay Mathew, MD, chief medical officer at the Anxiety and Depression Association of America, told Verywell. “The fact that it's been recommended for screening may elevate its status, if you will, to a medical symptom that is worthy of further exploration.”

Routine anxiety and depression screening could help clinicians detect mental health needs earlier on. According to one study, the median duration of delay for anxiety treatment in the U.S. is 23 years.

The draft guidance has been in the works since before the COVID-19 pandemic. But more people have been reporting high levels of anxiety, due to stressors in recent years, including the fear of illness and losing loved ones to COVID-19.

In February 2021, 41.5% of adults had recent anxiety or depressive disorder symptoms, up from 36.4% in August 2020.

The panel made a similar recommendation for anxiety screening for children and teenagers earlier this year. It also updated its 2016 recommendation to screen adults younger than 65 for depression and suicide risk.

The guidance was issued in draft form. The task force is accepting public comments until October 17 and will finalize the recommendations in the coming weeks.

What Anxiety Screening May Look Like

The task force said anxiety disorders are “characterized by excessive and persistent fear and anxiety about everyday events.” These include generalized anxiety disorder, social anxiety disorder, and agoraphobia.

In a primary care visit, providers may ask patients a series of questions to assess whether they may experience symptoms of an anxiety disorder. They may ask questions about a patient's lifestyle, whether they worry excessively and intensely, and physical manifestations of anxiety, like sweating and trembling.

There’s a chance that anxiety screening may give false positive results. Some symptoms that appear to be related to anxiety disorders may be “transient” and resolve over time, Mathew said. Besides, self-reported information may not be totally accurate.

“Unlike screening for blood pressure issues or diabetes and so on, it can be a lot more challenging to get a valid and reliable screening tool,” Matthew said.

Once a patient has received a positive screening result, they are referred to a mental health specialist who can give an anxiety disorder diagnosis and treatment.

To be diagnosed with an anxiety disorder, a patient must meet a specific set of criteria as defined in the DSM-5, the standard manual for mental health disorders. The clinician must rule out other factors, like medical conditions that could mimic the psychiatric symptoms and substance use.

Anxiety and Depression Screening Isn't Recommended for Everyone

The task force said anxiety screening is a “grade B” recommendation, meaning it will provide “moderate net benefit” to patients. While health providers aren’t required to follow the guidance, the panel’s recommendations heavily influence the standard of care across the country.

In 2016, the task force directed clinicians to screen adults, including pregnant or postpartum people, for depression. The panel said that the prevalence of depression and symptoms of depression among adults has declined as a result.

But mental health screenings in a primary care setting may not always be helpful. There wasn’t enough evidence to conclude that screening for suicide risk would be more beneficial than harmful in the general adult population, according to a draft recommendation this year.

The task force didn't recommend anxiety screening for adults older than 65 because the evidence of benefits and harms for this age group is limited. The symptoms of anxiety often look similar to symptoms of aging, such as fatigue and generalized pain.

“Certainly, this is a more medically complicated population. They may be on multiple meds, with multiple chronic illnesses, many of which are associated with anxiety already,” Mathew said.

Tackling Mental Health Disparities

Even after receiving a positive result from an anxiety or depression screening, some patients may find it challenging to receive a diagnosis and get the mental health care they need.

In some closed health systems, patients may be referred to in-house mental health practitioners. But most healthcare settings may not have the resources to deliver mental health care to all who need it. In fact, fewer than “half of the individuals who experience a mental illness will receive mental health care," the task force said.

Accessing care will be particularly important for groups that are most likely to live with a mental health disorder.

For instance, women have nearly double the risk of depression compared with men, according to the task force. Black patients are less likely to be treated for mental health conditions than White patients, and Black and Hispanic patients are more likely to be misdiagnosed.

One study showed that while overall suicide rates among young U.S. adults dropped for the first time between 2018 and 2019, the suicide rates increased for Black, Asian, and Pacific Islander young adults during this period.

During the pandemic, these needs have become even more exacerbated. Adults ages 18 to 44 were least likely to have received mental health treatment in 2019, but that trend is in reverse. In 2021, nearly one in four adults in this age group received treatment.

“There's definitely been an increased demand for mental health services in general," Mathew said. "Although these recommendations were made prior to that, they perhaps take on some more importance in this era.”