The battle for better mental health care might have gotten a big boost as the U.S. Preventive Services Task Force (USPSTF) issued drafts of two separate but related recommendations: one on depression and suicide, and one on anxiety.
Though depression has been on the task force’s radar since 2009, this is the first time the panel has made a recommendation about screening for anxiety. All adults under 65 should be screened for depression and anxiety, the panel says, and adults 65 and older should also be screened for depression.
“Anxiety disorders are commonly occurring mental health conditions,” the recommendation states. “Anxiety disorders include generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism and anxiety not otherwise specified. Anxiety disorders are often unrecognized in primary care settings and years-long delays in treatment initiation occur.” The task force unveiled the recommendations Tuesday.
The task force, which is under the purview of the Department of Health and Human Services, began work on the updated recommendations before the COVID-19 pandemic hit, with the draft research plan being posted in May 2020. The pandemic didn’t alter the process or timing of the task force’s review, but it did place a stronger emphasis on mental health care and the need for depression and anxiety screening. Public comments on the draft recommendations will be accepted through Oct. 17 and can be made here.
The task force comprises volunteer primary care experts who assign letter grades A, B, C, D or I for certain preventive services. An A or a B grade means that the service is recommended because evidence shows that it is beneficial. Screenings for anxiety and depression are B recommendations, and the task force says that the screenings should be done mostly by primary care physicians.
“Many brief screening tools have been developed that may screen for depression and are appropriate for use in primary care,” the recommendation states. “All positive screening results should lead to additional assessments to confirm the diagnosis, determine symptom severity, and identify comorbid psychological problems.”
About anxiety, the recommendation states: “Some instruments that are used for screening for anxiety were initially developed for purposes other than screening, such as supporting diagnosis, assessing severity, or evaluating response to treatment. Additionally, anxiety screening tools alone are not sufficient to diagnose anxiety. If the screening test is positive for anxiety, a confirmatory diagnostic assessment and follow-up are needed.”
About depression and suicide, the recommendation states: “Suicide is the second-leading cause of death in individuals ages 10 to 34 years. Eighty-three percent of individuals who died by suicide were seen in primary care in the previous year; 24% of individuals had a mental health diagnosis in their medical records in the month prior to death.”
The recommendations mean that already busy primary care physicians will have another task to deal with. A spokesperson with the American Academy of Family Physicians (AAFP) tells Fierce Healthcare that “behavioral health integration in the primary care setting is a hot topic for the AAFP.”
The AAFP, which represents 127,600 physicians and medical students nationwide, wants to review the evidence. “The AAFP may or may not provide comment to USPSTF; there are 700 pages to review, so we aren’t sure yet,” says the AAFP spokesperson. “Once the USPSTF’s recommendations are final and released, the AAFP Commission on Health of the Public and Science will review again and determine whether to support the recommendation as written or develop our own. It’s a long process at the AAFP.”
The task force says anxiety disorders usually become noticeable in childhood or adolescence but decrease in older adults and are lowest among individuals 65 to 79 years old. Demographics play a part in the diagnosis and treatment for anxiety.
“Racism and structural policies have contributed to wealth inequities in the United States, which also affects mental health in underserved communities,” the recommendation states. “For example, wealth inequities may result in barriers to receiving mental health services, such as treatment costs and lack of insurance, which tend to have a greater impact on Black persons and other racial and ethnic groups than on White persons. The misdiagnosis of mental health conditions occurs more in Black and Hispanic/Latino patients compared with White patients.”