Anxiety disorders in primary care are often underdiagnosed and underrecognized: a study cited by the task force found that the average time to start treatment for anxiety is a staggering 23 years,
While the task force’s initial deliberations on anxiety screening predicted the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pubert, a clinical psychologist at the University of Massachusetts Chan Medical School, Worcester. , is a professor in Mass.
“Covid has had a tremendous impact on the mental health of Americans,” Pubert said. “This is a priority topic for its public health importance, but clearly the focus has been on mental health in this country over the past few years.”
In April, the task force made similar recommendations to start the concern Screening in children and adolescents8 to 18 years of age. The proposal announced Tuesday focuses on young and middle-aged adults, including those who are pregnant or postpartum, citing research showing that screening and treatment can improve symptoms of anxiety in people younger than 65.
But the guidance, somewhat surprisingly, falls short of recommending anxiety screening for people 65 and older.
One reason: Many of the common signs of aging, such as trouble sleeping, pain, and fatigue, can also be symptoms of anxiety. The task force said there was not enough evidence to determine the accuracy of the screening tool in older adults, who may not be sensitive enough to differentiate between anxiety symptoms and aging conditions.
The task force advised physicians to use their judgment to discuss concern with older patients. task Force also reiterated an earlier recommendation that adults of all ages undergo regular screening for depression.
The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, exerts much influence, and while its advice is not mandatory, the panel’s recommendations often change the way doctors practice medicine in the United States. .
Some doctors questioned how the recommendations would apply in the real world, where mental health provider say they can’t meet patient demand in advance, and patients complain of waiting months to visit a physician.
“Screening is great, but with a huge staff shortage, it’s puzzling unless there is a plan to increase funding for physicians,” said Eugene Beresin, psychiatrist and executive director of Massachusetts General Hospital. Clay Center for Young Healthy Minds,
World Health Organization, global prevalence of anxiety and depression increased by 25 percent during first year of pandemic informed of earlier this year. By the end of 2021, the WHO said, “there had been some improvement in the situation, but today many people are unable to receive the care and support they need for pre-existing and newly developed mental health conditions.”
Anxiety, with its telltale fear and gut-wrenching, heart-pounding, palm-sweating physical signs, can manifest in many different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder and more.
together they make most common mental illness In the United States, 40 million adults are afflicted each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, especially cognitive behavioral therapy; antidepressant or anti-anxiety drugs; As well as various relaxation, mindfulness and desensitization therapies, the physicians said.
The panel also considered the benefits of screening patients for suicide risk but concluded that Even though suicide is a leading cause of death in adults, “there is not enough evidence that screening people without signs or symptoms will ultimately help prevent suicide.”
Nevertheless, the panel urged providers to use their own clinical judgment to determine whether individual patients should be screened for suicide risk.
For Primary Care Physicians, Already in One’s Throat “Problem” Because of burnout, pandemic-induced stress, and their own mental health challenges, adding another screening test to the long list of diagnostic tasks can seem cumbersome.
“If primary care providers are asked to screen for one more thing, we’re going to brake without more resources,” said a nurse practitioner in Northern California, who asked not to be named because She was not allowed to speak to her clinic about the issue.
Keeping in mind the current requirements such as verifying food insecurity, domestic violence, alcohol and tobacco use, along with up-to-date screening for cervical, colon and breast cancer, he said everything is within a 15-minute appointment. while also treating patients with complex, chronic conditions.
“It just feels wrong if people are positive for depression or anxiety, and we don’t have mental health support to help them,” the therapist said.
But Mahmuda Qureshi, an internal medicine physician at Massachusetts General Hospital, said additional support for patients suffering from depression or anxiety would help.
“After 2020, it’s the rare patient who isn’t worried,” said Qureshi, who noted that she now regularly asks patients, “How’s your stress?” “We’ve found that when it comes to mental health, if we don’t ask, often we don’t know.”
The task force acknowledged the challenges of providing mental health care to all those who would, “less than half of those who experience mental illness receive mental health care.”
The panel also cited “racism and structural policies” that disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services than other groups, and misdiagnosis of mental health conditions occurs more frequently in Black and Hispanic patients.
Pubert said the latest guidance is just one step in addressing the immediate mental health needs of patients. “Our hope is that this set of recommendations can bring awareness to the need for greater access to mental health care across the country,” she said, as well as “highlight gaps in the evidence so that funds are critically important in these areas.” to support the necessary research.” ,
Proposed recommendations are open to public comment Till October 17, after which the task force will consider them for final approval.