Primary Care Experts Recommend Screening for Anxiety in Adults Under 65

Elizabeth O’Connor, PhD

A draft recommendation posted this week by the US Preventive Services Task Force (USPSTF) recommended for the first time that adults under age 65 receive anxiety screenings due to net benefits.

This independent task force of disease prevention and medical experts, first appointed by the US Department of Health and Human Services (HHS), found in their research that treatments for anxiety and depression are available and may be necessary based on the evidence observed.

Depression and anxiety, as well as both conditions’ effects on health and wellbeing, have increased during the COVID-19 pandemic according to recent CDC reports. This led to investigators researching the benefits of treatment and early screening.

The panel’s investigators, led by Elizabeth O’Connor, PhD, and Michelle Henninger, PhD, wrote that both “direct and indirect evidence support depression screening in primary care settings, including during pregnancy and postpartum.”

Research and Methods

The USPSTF panel reviewed 1176 articles against a priori inclusion criteria and assessed 20,543 abstracts. They included around 8.5 million individuals’ data, gathered from 173 studies which included 90 primary studies and 83 existing systematic reviews (ESRs). The investigators included English language research studies of screening or treatment, as well as screening instrument test accuracy.

The investigators varied their study design by both key question and condition, with smaller bases for evidence using primary trials and studies regarding test accuracy, and larger bases for evidence using ESRs. The drawbacks of pharmacotherapy used observational studies and ESRs.

Two investigators for the USPSTF panel worked on critical appraisal independently, and data extraction from the studies were reviewed by one investigator and then examined by a second one. The investigators used random effects meta-analysis on primary research evidence. Effect modification was examined by subgroup analysis and meta-regression.

Panel Findings

The panel’s investigators covered 5 primary questions regarding suicide risk, anxiety, and depression, with both direct and indirect evidence drawn from the study to indicate the need for depression screenings. One caveat found by the investigators was that benefits for screening elderly adults for depression were not generally seen.

“We found clear evidence that there are effective treatments available to treat anxiety, particularly CBT, antidepressants, and benzodiazepines, but the direct evidence for screening for anxiety was extremely limited and did not suggest a benefit,” they wrote. The researchers added that screening tool diagnostic accuracy was not replicable for anxiety disorders outside of generalized anxiety disorder.

The investigators noted the net benefits of screening for anxiety, however, as patients screened for other conditions could potentially also face an anxiety disorder. This recommendation for screening is labeled under the “B” classification, due to the moderate benefit.

The panel identified evidence that anxiety treatment may be beneficial, and some limited evidence suggesting the acceptable use of certain anxiety screening instruments to identify generalized anxiety disorder.