For the First Time, Anxiety Screening Recommended for All Adults Under 65

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Adults aged 19 to 64 should undergo screening for anxiety disorders, according to a new recommendation by a group of independent medical experts. Their proposal, based on new evidence published in the Journal of the American Medical Association (JAMA), is the first time the U.S. Preventive Services Task Force (USPSTF) has suggested such screenings in adults, including pregnant and postpartum women.

This new development indicates a notable shift in the understanding and recognition of anxiety disorders as a public health concern. The recommendation may influence insurance plans and guide doctors’ decisions. Insurance coverage plays a significant role in determining access to health care services, including screenings and subsequent treatment. The inclusion of anxiety disorder screenings in health coverage may facilitate timely diagnosis and intervention for people who may be experiencing anxiety.

According to the U.S. Centers for Disease Control and Prevention (CDC), there was a notable rise in symptoms associated with anxiety and depressive disorders among adults from August 2020 to February 2021 due to the COVID-19 pandemic. The most significant increases were observed among individuals aged 18 to 29 years. A more recent analysis of the Census Bureau’s Household Pulse Survey found that in 2023, half of adults ages 18 to 24 reported anxiety and depression symptoms, compared to about one-third of adults overall. In general, an estimated 31.1 percent of American adults will experience an anxiety disorder at some point in their lives.

Anxiety disorders manifest through persistent and excessive worry regarding activities or events and a tendency to avoid certain situations. Physical symptoms may include sweating, trembling, and rapid heartbeat. This chronic apprehension can lead to significant distress and impairment in daily functioning.

Anxiety screening recommendations can also aid doctors in identifying patients who may require treatment for both anxiety and depression. While these two conditions are distinct, they frequently overlap in individuals, emphasizing the importance of comprehensive care.

According to a cohort study mentioned in the JAMA publication, a significant overlap was observed between depressive and anxiety disorders, with 67 percent of individuals with a depressive disorder also presenting a current anxiety disorder. Furthermore, the study revealed that 75 percent of individuals with a depressive disorder had a lifetime history of comorbid anxiety disorder.

Depression has been steadily increasing in the United States, according to a recent Gallup survey. Notably, cases of depression experienced a significant surge during the COVID-19 pandemic. The report highlights that nearly 29 percent of adults reported being diagnosed with depression at some point in their lives, representing an increase of nearly 10 percentage points compared to the figure in 2015.

The Diagnostic and Statistical Manual of Mental Disorders, the diagnostic tool published by the American Psychiatric Association, recognizes various types of anxiety disorders commonly found in adults, including generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition.

What Is the Screening Process Like?

The task force recommends that health care professionals use questionnaires and scales to screen adults for anxiety disorders. These screening tools involve asking individuals about their mood, feelings, and concentration during daily activities.

If a person tests positive for anxiety disorder symptoms, a clinical evaluation is recommended to confirm the severity of their symptoms and identify any additional psychological concerns. Moreover, patients should receive appropriate follow-up care.

On the other hand, it is essential to consider potential harms associated with screening, such as false positives, which may result in unnecessary appointments or treatment. Additionally, labeling and stigma can be potential negative consequences.

However, the task force asserts that screening and receiving appropriate care for most individuals can effectively reduce symptoms of anxiety disorders and depression.

In an editorial accompanying the new recommendation, Dr. Murray Stein and Dr. Linda Hill from the University of California emphasized the need for a clinical evaluation for suicidal intent following a positive screen result for anxiety. However, this aspect is not explicitly mentioned in the USPSTF Recommendation Statement. According to them, adopting these new anxiety screening recommendations should serve as a catalyst and an opportunity for primary care clinicians to enhance their confidence in diagnosing and treating anxiety disorders, potentially necessitating supplementary training.

“Anxiety disorders can be distressing and disabling, and appropriate recognition and treatment can be life-altering and, in some cases, lifesaving, for patients,” they wrote.