The draft recommendations, from the US Preventive Services Task Force, are designed to help primary care clinicians identify early signs of stress during routine care using questionnaires and other screening tools. Anxiety disorders are often unrecognized and underdiagnosed in primary care: A study cited by the task force found that the median time to start treatment for anxiety is a staggering 23 years. While the task force’s initial discussions on stress screening predated the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School in Worcester. Mass. “Covid has caused a huge impact on the mental health of Americans,” Pbert said. “This is a priority issue because of its public health importance, but clearly there has been an increased focus on mental health in this country in recent years.” In April, the task force made similar recommendations for starting anxiety screening in children and adolescents, ages 8 to 18. 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 anxiety symptoms in people under 65. But the guidance, somewhat unexpectedly, does not recommend stress screening for people aged 65 and over. One reason: many common symptoms of aging, such as trouble sleeping, pain and fatigue, can also be symptoms of stress. The task force said there is not enough evidence to determine the accuracy of screening tools in older adults, which may not be sensitive enough to distinguish between stress symptoms and aging conditions. The task force advised clinicians to use their judgment in discussing anxiety with older patients. The working group also reiterated an earlier recommendation that adults of all ages be routinely screened for depression. The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, wields enormous influence, and while its advice is not binding, the panel’s recommendations often change the way doctors practice medicine in the United States . Some doctors questioned how the recommendations would work in the real world, where mental health providers say they already can’t keep up with patient demand and patients complain of waiting months for an appointment with a therapist. “Screening is great, but with a terrible shortage in the workforce, it’s complicated unless there are plans for increased funding for clinicians,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young Healthy Minds. The global prevalence of anxiety and depression rose by 25 percent in the first year of the pandemic, the World Health Organization reported earlier this year. By the end of 2021, WHO said, “the situation had improved somewhat, but today too many people remain unable to get the care and support they need for both pre-existing and newly developed mental health conditions.” Anxiety, with its telltale physical signs of tremors and gut, pounding heart, sweaty palms, can manifest itself in a number of distinct diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others. . Together, these are the most common mental illnesses in the United States, afflicting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, mainly cognitive behavioral therapy. antidepressant or anti-anxiety medications. as well as various relaxation, mindfulness and desensitization therapies, the doctors said. The team also looked at the benefits of screening patients for suicidal risk, but concluded that although suicide is the leading cause of death among adults, “there is not enough evidence about whether screening people without signs or symptoms will ultimately help prevent suicide.” However, the panel urged providers to use their own clinical judgment to determine whether individual patients should be screened for suicidal risk. For primary care physicians, already in the midst of a burnout “crisis,” pandemic-induced stress and their own mental health challenges, adding yet another screening test to a long list of clinical tasks can be burdensome. “If primary care providers are asked to screen for one more thing, we’re going to be broke without more resources,” said a nurse in Northern California, who asked not to be identified because she was not authorized by her clinic to speak. on the subject. Noting current requirements such as verifying up-to-date screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, he said all should be packaged in a 15-minute appointment, while also treating patients with complex, chronic conditions. “It’s wrong if people test positive for depression or anxiety and we don’t have the mental health support to help them,” the practitioner said. But Mahmooda Qureshi, an internal medicine physician at Massachusetts General Hospital, said additional support for patients suffering from depression or anxiety will help. “After 2020, the rare patient is not anxious,” said Qureshi, who noted that she now routinely asks patients, “How is your anxiety?” “We found that when it comes to mental health, if we don’t ask, we often don’t know.” The task force acknowledged the challenges of providing mental health care to everyone who needs it, adding that fewer than “half of people experiencing mental illness will 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 compared to other groups, and that misdiagnosis of mental health conditions occurs more frequently among black and Hispanic patients. Pbert said the latest guidance is just one step in addressing the urgent mental health needs of patients. “We hope this set of recommendations can raise awareness of the need to create greater access to mental health care across the country,” he said, as well as highlight “gaps in the evidence so funders can support critical research into them.” the sectors. .” The proposed recommendations are open for public comment until Oct. 17, after which the task force will review them for final approval.
