USPSTF Recommends Anxiety Screening in Adults Younger Than 65

Megan Brooks

September 20, 2022

The US Preventive Services Task Force (USPSTF) today posted for public comment draft recommendations on screening for anxiety, depression, and suicide risk in adults.

For the first time, the task force is recommending screening all adults aged 64 and younger for anxiety — including pregnant and postpartum women.

This "B" recommendation reflects "moderate certainty" evidence that screening for anxiety in this population has a moderate net benefit, the task force notes in a draft recommendation statement posted on its website.

The recommendation applies to adults aged 19-64 years who do not have a diagnosed mental health disorder or are not showing recognized signs or symptoms of anxiety.

Anxiety disorders are common and often go unrecognized in primary care, leading to long delays in treatment, the task force writes. They add that more evidence is needed to identify ideal screening intervals for all populations. 

"A pragmatic approach in the absence of data might include screening all adults who have not been screened previously and using clinical judgment in consideration of risk factors, comorbid conditions, and life events to determine if additional screening of high-risk patients is warranted," they write.

For adults aged 65 and older, the task force found "insufficient" evidence on the benefits and potential harms of screening for anxiety.

"Evidence on the accuracy of screening tools and the benefits and harms of screening and treatment of screen-detected anxiety in older adults is lacking, and the balance of benefits and harms cannot be determined," they write.

Jury Out on Screening for Suicide Risk

The task force is continuing to recommend screening all adults for depression. This "B" recommendation reflects moderate-certainty evidence that screening for major depression in adults has a moderate net benefit.

However, they note there is not enough evidence to recommend for or against screening for suicide risk in all adults.

They therefore issued an "I" statement, indicating that the balance of benefits and harms cannot be determined at present.

"To address the critical need for supporting the mental health of adults in primary care, the Task Force reviewed the evidence on screening for anxiety, depression, and suicide risk," task force member Lori Pbert, PhD, UMass Chan Medical School, Worcester, Massachusetts, said in a news release.

"The good news is that screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety can help identify these conditions early so people can be connected to care," Pbert said.

"Unfortunately, evidence is limited on screening adults 65 or older for anxiety and screening all adults for suicide risk, so we are urgently calling for more research," added task force member Gbenga Ogedegbe, MD, MPH, founding director of the Institute for Excellence in Health Equity at NYU Langone Health, New York City.

Ogedegbe, also a professor at NYU Grossman School of Medicine, noted that "in the absence of evidence, healthcare professionals should use their judgment based on individual patient circumstances when determining whether or not to screen."

The public comment period for the draft recommendations runs until
October 17.

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