Public CommentScreening for Anxiety
The Women’s Preventive Services Initiative recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum, as a preventive health service. Optimal screening intervals are unknown and clinical judgement should be used to determine when screening is warranted. Clinical judgement should be based on factors including, but not limited to, patient history, concerns and behavior in determining who to screen. Given the high prevalence of anxiety disorders, lack of recognition in clinical practice, and multiple problems associated with untreated anxiety, clinicians should consider screening women who have not been recently screened.
Clinicians may consider screening for anxiety in conjunction with screening for depression, which is a current standard of care, because of the frequent co-occurrence of anxiety and depressive disorders. Validated instruments that screen simultaneously for both disorders may be clinically efficient in practice settings, such as the EPDS (specifically for pregnant and postpartum women), PHQ-4, and the HADS in adult women and the Bright Futures Y-PSC in adolescents and young women. Several additional screening instruments demonstrate moderate to high accuracy in identifying anxiety disorders in women (e.g., GAD, HADS, BAI) and adolescents and young adult women (e.g., 5-item SCARED). Although not evaluated in research studies of adolescents, the GAD-7 and Bright Futures youth self-report PSC (Y-PSC) are commonly used in clinical practice.
Optimal screening intervals are unknown and clinical judgment should be used to determine when and how often screening is warranted. While no studies have evaluated the benefits and harms of population screening for anxiety, trials among patients with clinically diagnosed anxiety support the effectiveness management including cognitive behavioral therapy, individual therapy, and medications for reducing symptoms. When a screening tool indicates the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment. Screening should ideally be implemented in conjunction with collaborative and team-based approaches to ensure accurate diagnosis, effective treatment, and appropriate follow up.
- Studies of the overall effectiveness of screening for anxiety that report meaningful health and function outcomes.
- Studies of the potential harms of screening for anxiety including labeling, misdiagnosis, overdiagnosis, and others.
- Studies of optimal methods for screening, diagnosis, treatment, and coordination of systems to support the clinical pathway.
- Research to understand changes in the incidence and prevalence of anxiety over time and the influence of specific risk factors, triggers, mediators, and moderators to focus screening and prevention on optimal times, intervals, and population subgroups.
Abbreviations: BAI, Beck Anxiety Inventory; EPDS, Edinburgh Postnatal Depression Scale; GAD-7, Generalized Anxiety Disorder 7-item scale; HADS, Hospitalized Anxiety and Depression Scale; PHQ-4, Patient Health Questionnaire-4; PSC, Pediatric Symptom Checklist; SCARED, Screen for Child Anxiety Related Disorders; Y-PSC, Pediatric Symptom Checklist—Youth Report