Anxiety screening recommended for all adults under 65, highlighting connection between physical and mental health

With Americans experiencing mental health challenges at unprecedented rates, a national panel of experts has recommended that physicians screen all adults under age 65 for anxiety.

The recommendation Tuesday by the U.S. Preventive Services Task Force, an independent committee supported by the Department of Health and Human Services, was in development before the pandemic, but is coming to fruition at an opportune time.

The pandemic exacerbated anxiety and depression for some, while others experienced new mental health challenges. Nearly 42% of adults reported experiencing anxiety or depression in February 2021, up from about 36% in August 2020. Between 2001 and 2004, about 19% of adults reported experiencing anxiety in the past year, according to the task force.

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The number of people who received mental health treatment also increased between 2019 and 2021.

Last month, the Centers for Disease Control and Prevention said that life expectancy in the U.S. declined for a second consecutive year, citing suicide as one of the main causes.

But it can take years, or even decades, to get treatment for an anxiety disorder. The task force aims to improve access by having doctors screen for anxiety.

“We want to get these individuals who are not yet showing recognized signs and symptoms [of anxiety] connected to care,” said task force member Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School in Worcester, Mass.

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The panel found that screening tools, such as a commonly used seven-question survey, do a good job of identifying anxiety at its early stages among adults under age 65.

And treatments, including cognitive-behavioral treatment and psychotropic medications, can improve symptoms of anxiety.

This is the first time that the advisory panel has recommended anxiety screenings for adults. It previously recommended anxiety screenings for teens and depression screenings for adults. The group said there is not enough evidence to recommend anxiety screening for people over the age of 65.

The recommendation is now subject to a period of public comment until October 17.

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Everyone experiences anxiety sometimes, and recently people have had a lot to be anxious about — the pandemic, inflation, and gun violence in Philadelphia.

But there is a point when anxiety becomes harmful to health, says Kelly Gilrain, a licensed clinical psychologist director of behavioral medicine and psychological services at Cooper University Health Care.

“It becomes problematic when it’s impacting your day-to-day functioning,” she said.

When anxiety affects sleep, changes eating habits, leads to isolation or risky behaviors, it can be a serious health problem and impediment to overall well-being. It is also harmful when anxiety becomes chronic and coping mechanisms fail, she said.

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Over the past decade, Gilrain said she has seen an increase in medical providers asking about mental and behavioral health. Her job, as a hospital-based psychologist, demonstrates how health systems are increasingly making the connection between physical and mental health.

But mental health services aren’t accessible for many — there’s a shortage of providers, long wait times for appointments and visits can be expensive if patients can’t use health insurance to offset the cost.

The new screening recommendations may mean more people are identified as needing help. That will only translate to better care if doctors have somewhere to send them, said Rachel Kishton, a physician who is board certified in both family medicine and psychiatry and works at the University of Pennsylvania.

“What we really need to focus on is how do we get that scientific knowledge into practical use in our communities,” Kishton said.

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Menachem Leasy, a family medicine physician at Temple University, is concerned that screening every patient for anxiety may create a time crunch for his office. Mental health is a sensitive topic that can’t always be handled briefly in addition to the physical issue that brought the patient in, and he typically has a packed waiting room of patients needing his time.

But overall, Leasy thinks that including anxiety screening as part of every exam could be a good thing.

“It allows for dialogue to talk about mental health,” he said.