Testing article 2

Clinical Recommendations

The Women’s Preventive Services Initiative recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum. Optimal screening intervals are unknown and clinical judgement should be used to determine screening frequency. 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.

Implementation Considerations

Clinicians may consider screening for anxiety in conjunction with screening for depression, which is recommended by the USPSTF, 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 instruments include 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.

While no studies have evaluated the benefits and harms of population screening for anxiety, trials among patients with clinically diagnosed anxiety support the effectiveness of treatment with cognitive behavioral therapy, medications, or both. When screening suggests 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.

Research Recommendations

  1. Studies of the overall effectiveness of screening for anxiety that report meaningful health and function outcomes.
  2. Studies of the potential harms of screening for anxiety including labelling, misdiagnosis, overdiagnosis, and others.
  3. Studies of optimal methods for screening, diagnosis, treatment, and coordination of systems to support the clinical pathway.
  4. 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.

How I Practice: Screening for Anxiety

Learn how WPSI members implement WPSI recommendations into clinical practice. In the How I Practice: Screening for Anxiety video Dr. Julia Skapik talks about the prevalence of anxiety in the US and ways to implement screening for anxiety in your practice!

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

*These are the recommendations of the WPSI and not necessarily of any individual participating organization.