A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under the age of 65 for anxiety, a guideline that reflects the extraordinary stress levels that have hit the United States since the start of the pandemic.
The advisory group, called the US Preventive Services Task Force, said the guidelines were intended to help prevent mental health problems from going undiagnosed and untreated for years or even decades. It made a similar recommendation for children and teenagers earlier this year.
The panel, appointed by a division of the Department of Health and Human Services, has been preparing guidance since before the disaster. The recommendations come at a time of “critical need,” said Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School, who serves on the task force. Americans have been reporting high levels of anxiety about dealing with a host of stressors, including inflation and crime rates, fear of illness and losing loved ones from Covid-19.
“It is a crisis in this country,” Dr. Peter said. “Our only hope is that our recommendations shed light on the need to create greater access to mental health care — and quickly.”
From August 2020 to February 2021, the percentage of adults with recent symptoms of anxiety or depression increased to 41.5 percent from 36.4 percent, according to one study cited by the task force.
The guidance was issued in draft form. The panel will finalize it in the coming months after reviewing public comments. Although the panel’s recommendations are not binding, they significantly affect the standard of care among primary care physicians across the country.
In response to these recommendations, mental health providers emphasized that screening programs are only necessary if they lead patients to appropriate solutions. At a time when the country “has a shortage of mental health resources at all levels – psychiatrists, psychologists, and therapists – that is a real concern,” said Dr. Jeffrey Staab, a psychiatrist and chairman of the department of psychiatry and psychiatry at the Mayo Clinic. is in Rochester, Minn.
“We can filter many people, but if that’s all that happens, it’s a waste of time,” said Dr. Staab, who is not on the task force.
Psychiatrists, while pleased with the focus on mental health, also emphasized that standardized testing is only the first step toward diagnosis, and that providers will need to guard against assuming that a positive test result indicates a medical problem.
For many Americans, a diagnosis may only reveal a temporary period of stress and a need for additional support.
“When providers say, ‘You must have problems, here, take this,’ we can run into an overprescribing problem,” Dr. Staab said. “But the opposite is that we have a lot of people suffering who shouldn’t be. Both outcomes are possible.”
The rise of mental health issues is not unique to the United States. Anxiety and depression increased by 25 percent worldwide during the first year of the epidemic, according to the World Health Organization, and has only partially recovered since then.
About a quarter of men and about 40 percent of women in the United States experience an anxiety disorder in their lifetime, according to the task force, although much of the data is out of date. Women have almost twice the risk of depression compared to men, studies show, and the proposal paid special attention to screening for pregnant and postpartum patients.
Doctors usually use questionnaires and scales to research mental health problems. According to the recommendations, a positive screening result will lead to additional evaluations at the provider’s discretion, depending on underlying health conditions and other life events.
Some primary care physicians expressed concern that adding an additional role to their extensive list of short patient appointments is not feasible.
Dr. The task force’s Pbert said that those providers should “do what they already do every day: Juggle and prioritize.”
He also said the task force’s rigorous review of available studies revealed that people of color are often underrepresented in mental health research, which, if left untreated, can contribute to a cycle of inequality.
Mental health disparities are extreme in the United States, where Black patients are less likely to be treated for mental health conditions than white patients, and both Black and Hispanic patients are misdiagnosed more often. From 2014 to 2019, the suicide rate among Black Americans it increased by 30 percent, statistics show.
Standardizing screening for all patients can help combat the effects of racism, implicit bias and other systemic issues in the medical field, Dr. Peter said.
The task force panel did not expand its screening recommendations to patients age 65 and older. It said there is no clear evidence about the effectiveness of screening tools in older adults because symptoms of anxiety are similar to normal signs of aging, such as fatigue and general aches and pains. The panel also said there is no evidence whether screening for depression among adults who do not show obvious symptoms of the disorder will ultimately prevent suicide.
The task force will accept public comments on the draft recommendations until October 17.