Whom to screen for anxiety and depression: Updated USPSTF recommendations

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doi:doi: 10.12788/jfp.0519

Practice Alert

Whom to screen for anxiety and depression: Updated USPSTF recommendations

J Fam Pract. 2022 December;71(10):423-425,434 | doi: 10.12788/jfp.0519

By

Doug Campos-Outcalt, MD, MPA

New guidance is offered concerning anxiety in children, adolescents, and adults. Advantages of particular screening tests are reviewed.

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References

1. USPSTF. Screening for anxiety in adults. Draft recommendation statement. Published September 20, 2022. Accessed November 22, 2022. https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening

2. USPSTF. Screening for depression and suicide risk in adults. Updated September 14, 2022. Accessed November 22, 2022. https://uspreventiveservicestaskforce.org/uspstf/draft-update-summary/screening-depression-suicide-risk-adults

3. USPSTF. Anxiety in children and adolescents: screening. Published October 11, 2022. Accessed November 22, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents

4. USPSTF. Depression and suicide risk in children and adolescents: screening. Final recommendation statement. Published October 11, 2022. Accessed November 22, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents

5. Kessler RC, Petukhova M, Sampson NA, et al. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169-184. doi: 10.1002/mpr.1359

6. Misri S, Abizadeh J, Sanders S, et al. Perinatal generalized anxiety disorder: assessment and treatment. J Womens Health (Larchmt). 2015;24:762-770. doi: 10.1089/jwh.2014.5150

7. O’Connor E, Henninger M, Perdue LA, et al. Screening for depression, anxiety, and suicide risk in adults: a systematic evidence review for the US Preventive Services Task Force. Accessed November 22, 2022. www.uspreventiveservicestaskforce.org/home/getfilebytoken/dpG5pjV5yCew8fXvctFJNK

8. Sapra A, Bhandari P, Sharma S, et al. Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus. 2020;12:e8224. doi: 10.7759/cureus.8224

9. Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092-1097. doi: 10.1001/archinte.166.10.1092

10. Viswanathan M, Wallace IF, Middleton JC, et al. Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022;328:1445-1455. doi: 10.1001/jama.2022.16303

11. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire‐2: validity of a two‐item depression screener. Med Care. 2003;41:1284‐1292. doi: 10.1097/01.MLR.0000093487.78664.3C

12. Viswanathan M, Wallace IF, Middleton JC, et al. Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022;328:1543-1556. doi:10.1001/jama.2022.16310

In September 2022, the US Preventive Services Task Force (USPSTF) released 2 sets of draft recommendations on screening for 3 mental health conditions in adults: anxiety, depression, and suicide risk.^1,2 These draft recommendations are summarized in TABLE 1^1-4 along with finalized recommendations on the same topics for children and adolescents, published in October 2022.^3,4

The recommendations on depression and suicide risk screening in adults are updates of previous recommendations (2016 for depression and 2014 for suicide risk) with no major changes. Screening for anxiety is a topic addressed for the first time this year for adults and for children and adolescents.^1,3

The recommendations are fairly consistent between age groups. A “B” recommendation supports screening for major depression in all patients starting at age 12 years, including during pregnancy and the postpartum period. (See TABLE 1 for grade definitions.) For all age groups, evidence was insufficient to recommend screening for suicide risk. A “B” recommendation was also assigned to screening for anxiety in those ages 8 to 64 years. The USPSTF believes the evidence is insufficient to make a recommendation on screening for anxiety among adults ≥ 65 years of age.

The anxiety disorders common to both children and adults included in the USPSTF recommendations are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety type not specified. For adults, the USPSTF also includes substance/medication-induced anxiety and anxiety due to other medical conditions.

Adults with anxiety often present with generalized complaints such as sleep disturbance, pain, and other somatic disorders that can remain undiagnosed for years. The USPSTF cites a lifetime prevalence of anxiety disorders of 26.4% for men and 40.4% for women, although the data used are 10 years old.⁵ The cited rate of generalized anxiety in pregnancy is 8.5% to 10.5%, and in the postpartum period, 4.4% to 10.8%.⁶

The data on direct benefits and harms of screening for anxiety in adults through age 64 are sparse. Nevertheless, the USPSTF deemed that screening tests for anxiety have adequate accuracy and that psychological interventions for anxiety result in moderate reduction of anxiety symptoms. Pharmacologic interventions produce a small benefit, although there is a lack of evidence for pharmacotherapy in pregnant and postpartum women. There is even less evidence of benefit for treatment in adults ≥ 65 years of age.¹

How anxiety screening tests compare

Screening tests for anxiety in adults reviewed by the USPSTF included the Generalized Anxiety Disorder (GAD) scale and the Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale.¹ The most studied tools are the GAD-2 and GAD-7.

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