Should Every Adult Be Screened for Anxiety?

Recently, a report by the U.S. Preventive Services Task Force recommended that every adult under 65 be screened for anxiety by their primary care doctors (family doctors).¹ When I first saw the headline, my initial response was, "Well, that's stupid. You go to the doctor when you're sick, and people know when they're sick." But, upon second thought, I realized this was wrong. Screening for anxiety in general doctor's appointments does make sense.

Why Screen for Anxiety? Prevalence

According to Lori Pbert, a psychologist-researcher at the University of Massachusetts’ Chan Medical School, about 40 percent of women and 25 percent of men will experience an anxiety disorder at some point in their lifetimes.¹ This makes anxiety disorders the most common kind of mental health disorder there is. (Keep in mind bouts of an anxiety disorder are often time-limited. Anxiety disorders are not necessarily lifetime conditions like bipolar disorder.)

This makes anxiety disorders more than twice as common as other illnesses we already screen for, like breast cancer (13 percent of women will get this) and prostate cancer (about 12.5 percent of men will get this).^2,3 And, of course, no one bats an eye at screening for those things. We all recognize how important it is. 

Judging by prevalence numbers alone, then, people absolutely should be screened for anxiety.

Why Screen for Anxiety? Impact

Of course, some might argue that cancer is critical to screen for because it will kill you, whereas anxiety disorders are "no big deal." I would agree that cancer can be life-threatening, and while an anxiety disorder may not be life-threatening in and of itself, it certainly can be lifestyle-threatening.

Common symptoms of anxiety include:

• Increased breathing and heart rate
• Sweating
• Trembling / shaking
• Weakness or fatigue
• Difficulty getting, or staying, asleep
• Feelings of fear
• Feelings of uneasiness or apprehension, worry
• A sense of danger, panic

Just imagine going through your everyday life with a series of the above. That's not a recipe for fun.

And that assumes that you don't have extreme anxiety. Extreme anxiety can cause the above, plus the following:

• Palpitations, pounding heart, or accelerated heart rate
• Shortness of breath; feeling of being smothered or choked
• Chest pain
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Becoming detached from oneself and the environment
• Numbness or tingling sensations
• Chills or hot flashes
• Psychologically reliving the traumatic event
• Overreacting with intense fear to anything reminiscent of the traumatic event
• Feelings of a shortened life
• Looking for and seeing danger everywhere
• Overreacting with fear when startled

And if you select some of the above plus some of the former, you can soon see how difficult life with an anxiety disorder can be.

(Read about symptoms of anxiety and extreme symptoms of anxiety.)

Why Screen for Anxiety? Ease of Screening

And let's not forget that screening for anxiety is a relatively simple process -- it involves speaking to and getting to know a patient. This requires time but no special equipment and no medical procedures. I admit many family doctors run short on time during appointments, but if we prioritize screening for anxiety during appointments, that can change.

Why Screen for Anxiety? People Don't Know When They Have an Anxiety Disorder

When I initially thought it was a stupid idea, it was because I thought people know when they're sick -- but while this might be true for the flu, this often isn't true for mental illness. People live with mental illnesses for years, not knowing that's what's happening, and this causes nothing but pain and suffering. Sure, it seems like if you were experiencing the list above, you would notice, but if you've always been that way, you don't know that there's any other way to live. Also, if symptoms creep up on you slowly, it's easy to miss them and just know that you're suffering but not know why.

Why Screen for Anxiety? Anxiety Treatment Works

The other thing about screening for anxiety is that identifying anxiety allows for its treatment and the treatment of anxiety works.

For example:

• In generalized anxiety disorder (GAD), 50-60 percent of patients respond clinically to therapy. About 30-50 percent attain remission or realize full recovery during the acute phase of treatment.⁴ (Here is a test for GAD.)
• In panic disorder, after 8 to 12 months of treatment, 85 percent of patients were free of panic attacks.⁵ (Here is a test for panic disorder.)

Treatment for anxiety is typically psychotherapy, which is sometimes combined with medication.

Yes, Let's Screen for Anxiety

In short, then, we absolutely should be screening for anxiety (and cutting it off at 65 doesn't seem to make sense). It gives us a chance to possibly improve the quality of life of thousands of people. That's an incredibly convincing reason to do anything.

Sources

1. The Associated Press. (2022, September 20). U.S. adults should get routine anxiety screening, panel says. NBC News. Retrieved September 29, 2022, from https://www.nbcnews.com/health/mental-health/us-adults-get-routine-anxiety-screening-panel-says-rcna48568 

2. Breast Cancer Statistics | How Common Is Breast Cancer? (n.d.). Retrieved September 29, 2022, from https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html

3. Key Statistics for Prostate Cancer | Prostate Cancer Facts. (n.d.). Retrieved September 29, 2022, from https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

4. Mandos, L. P. A., Reinhold, J. P. A., & Rickels, K., MD. (2020, November 16). Achieving Remission in Generalized Anxiety Disorder. Psychiatric Times. Retrieved September 29, 2022, from https://www.psychiatrictimes.com/view/achieving-remission-generalized-anxiety-disorder

5. Cassano, G. B., Rossi, N. B., & Pini, S. (2002, September 30). Psychopharmacology of anxiety disorders. Dialogues in Clinical Neuroscience, 4(3), 271–285. https://doi.org/10.31887/dcns.2002.4.3/gcassano