Adults Should Be Regularly Screened for Anxiety Disorders, According to New Recommendations

Screening for anxiety may soon become routine practice during regular check-ups for adults, according to new recommendations issued by the United States Preventive Services Task Force.

The guidelines, published recently in JAMA, recommend that all adults under age 65, including pregnant and postpartum people, be screened for anxiety disorders through questionnaires in primary care settings. The recommendations, based on studies conducted by the Task Force, apply to asymptomatic people who have not been diagnosed with a mental health condition.

“This is a critical step in ensuring that mental health is accounted for, has greater visibility, and is top of mind when assessing a person’s overall health,” says Dr. Rachel E. Ginsberg, a psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

Anxiety disorders affect about 40 million people in the United States, according to the Anxiety & Depression Association of America, making them the most common mental health illnesses. While they are treatable, only 36.9% of people receive treatment for an anxiety disorder. Conditions include generalized anxiety disorder, social anxiety disorder, and panic disorder. Often, they co-occur with other mental health conditions, such as major depressive disorder, which affects over 21 million people in the U.S.

The COVID-19 pandemic also exacerbated psychological distress for many. In the first year of the pandemic, there was a 25% increase in the prevalence of anxiety and depression worldwide, according to the World Health Organization.

“People faced stressors such as unemployment, housing, financial and food insecurity, balancing work and family, health-related fears, social isolation, and developmental and career setbacks, among other obstacles,” says Dr. Ginsberg. “Returning to post-pandemic life, with the expectations of returning to a fast-paced, high-demand, and chaotic world, can kindle and worsen underlying anxiety. We also know that anxiety and depression affect physical systems and may contribute to worsening of medical conditions.”

“The hope is that the recommendations may generate opportunities for early detection and intervention and become a catalyst for connecting people to mental health treatment that would otherwise be missed,” says Dr. Ginsberg.

If the screening indicates the potential for an anxiety disorder, further evaluation for diagnosis will be recommended. One of the screening tools, the Generalized Anxiety Disorder-7 (GAD-7), is a seven-item scale that helps to identify symptoms of generalized anxiety disorder, and assesses for symptoms such as persistent worry, irritability, restlessness, and difficulty relaxing.

The screening can “help to open up a discussion regarding the impact of anxiety symptoms and how they might be interfering with health and quality of life,” says Dr. Ginsberg. “Based on responses to the screening questionnaire and subsequent discussion with a provider, patients and providers can decide collaboratively on next steps.”

She adds: “Sometimes anxiety might be a product of a recent stressor that can resolve on its own, but other times it is pervasive, chronic, or acute (such as in postpartum anxiety) and, if left untreated, can worsen over time, and make life more difficult to manage. Having standardized entry points for screening can open the door to opportunities for providers to identify anxiety as a symptom akin to a physical health symptom and inform comprehensive treatment planning.”

In October 2022, the Task Force recommended anxiety screening to begin at age 8 for children. Anxiety is one of the most common mental health disorders in kids, affecting about one in 11 children ages 3 to 17 in the U.S. But for anxiety in the adult population, the Task Force’s recommendation is a first.

“We are getting better at transforming behavioral healthcare by understanding and highlighting the interplay of physical and mental health and addressing the full spectrum of needs. Your body feels what your mind feels,” says Dr. Ginsberg. “The recommendations from the Task Force help to substantiate and normalize conversations related to mental health between patients and providers. This will create the potential to strengthen compassionate, patient-centered care, with the hope of bridging patients to resources and supports that could be profoundly helpful.”

Rachel E. Ginsberg, Ph.D., is the quality director at the Department of Psychiatry Faculty Practice Organization and assistant director at Columbia University Clinic for Anxiety and Related Disorders (CUCARD) – Westchester. She is also an assistant professor in medical psychology in psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and regularly provides trainings and workshops in evidence-based treatments. In addition to providing clinical services as a psychologist, she specializes in the evaluation and treatment of adults, emerging young adults, adolescents, and children with mood, anxiety, and related disorders.

Dr. Ginsberg is trained in evidence-based treatments such as cognitive behavioral therapy, exposure and response prevention, acceptance and commitment therapy, and interpersonal therapy, and has worked in a variety of settings, including pediatric and adult clinics, as well as partial hospital and inpatient hospital settings.