Task Force recommends anxiety screening for adults under 65

Older population requires further review

In June, the U.S. Preventive Services Task Force issued its final recommendation to support screening for anxiety disorders in adults younger than 65, including people who are pregnant or postpartum.

Previously, the organization recommended screening for depression in adults but found insufficient evidence for or against screening for suicide risk.

The statements and evidence summaries are published online in the “Journal of the American Medical Association (JAMA).

According to Task Force Vice Chair Michael Silverstein, M.D., M.P.c, the recommendations apply to people who are not showing obvious signs or symptoms of these conditions.

“When patients are presenting with low energy or sadness, for example, saying things like they are feeling sad or feel life is no longer worth living, then primary care providers must act definitely and aggressively,” said Silverstein, who is a professor of health services, policy, and practice at Brown University School of Public Health in Rhode Island and director of its Hassenfeld Child Health Innovation Institute.

The Task Force found insufficient evidence to recommend for or against screening for anxiety disorders in adults 65 or older. However, Silverstein noted that all recommendations are re-visited approximately every five years and the panel has called for new research in that older adult population.

Silverstein hopes when anxiety screening is reviewed again, there will be enough evidence to make a recommendation for that age group.

He explained that a previous, separate recommendation was published calling for anxiety screenings for children and adolescents ages eight to 18.

“Primary care providers and patients know best what is best for them and we leave it to those in the primary care community to implement these guidelines,” Silverstein said.

Silverstein said during the year between when the draft and then final recommendation went out, some clarifications were made. These changes involved emphasizing anxiety disorders are a collection of disorders rather than one single anxiety condition and better explaining the lack of evidence involving the older adult population.

The final version also clarified what is called the “pathway to benefit,” with Silverstein noting, “Screening for anxiety disorders is really just the starting point. If (patients) have symptoms consistent with anxiety disorders, this needs to be confirmed, a diagnosis has to be made, and the patient must be linked to the most appropriate and individualized care.”

Silverstein said the Task Force welcomes input from professional groups, individual professionals, and concerned people, no matter their background.

Comments from the public are sought whenever a new or old topic is put forth in draft form as a recommendation for review, Silverstein said.

But psychologists and others can get involved even earlier in the process by providing feedback when the organization is asking how to look for evidence.

“Before we put out our plan is the most important time to provide comments,” Silverstein said. “We read every single comment and we try to incorporate that into our plan in order to make it more inclusive, stronger and more applicable to the public.”

Silverstein said the Task Force reviews a wide range of 80 topics including mental health and behavioral issues like substance use as well as cancer screening and healthy pregnancies.

The group is an independent, volunteer panel of national experts in prevention and evidence-based medicine whose charge is to improve the public’s health by making recommendations for services including screening, counseling, and preventive medications.

“Every year we prioritize and re-prioritize what we’re going to address based on new evidence and a variety of factors,” Silverstein said. “We’re always scanning across topics.”