Americans live such nerve-wracking, glum, stressful lives that not only young people but also adults up to age 65 would benefit from regular screening during their doctor visits for anxiety and depression.
That’s the draft recommendation, newly issued and up for public comment, by the U.S. Preventive Services Task Force, an independent, blue-ribbon group that provides influential guidance to the federal government on medical tests and treatments.
As the New York Times and other media outlets have reported, the task force recommendations on anxiety and depression screening for most regular folks in this country were in the works before the coronavirus pandemic hit. The advisory has only taken on greater urgency as the pandemic worsened what already were grave concerns about the nation’s mental health.
Lori Pbert, a clinical psychologist, a professor at the University of Massachusetts Chan Medical School, and a task force member, told the New York Times this about the soaring problems of anxiety and depression:
“It’s a crisis in this country. Our only hope is that our recommendations throw a spotlight on the need to create greater access to mental health care — and urgently.”
The Washington Post reported this about how widespread, common, and debilitating mental health problems have become for Americans, including in the time before the pandemic:
“Anxiety, with its telltale dread and gut-wrenching, heart-pounding, palm-sweating physical signs, can manifest in a number of distinct diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others. Together, these make up the most common mental illnesses in the United States, afflicting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment can include psychotherapy, notably cognitive behavioral therapy; antidepressant or anti-anxiety medications; as well as various relaxation, mindfulness and desensitization therapies, physicians said.”
Mental health experts welcomed the task force recommendation — with a key caveat: It likely will not be enough to screen patients for anxiety and depression. What’s to be done for those with warning signs of problems? Provision of mental health care lagged badly before the pandemic. It has worsened, considerably, since. Screenings in primary care doctors’ offices can be helpful, but, as the New York Times reported:
“Physicians typically use questionnaires and scales to survey for mental health disorders. According to the recommendations, positive screening results would lead to additional assessments at the provider’s discretion, depending on underlying health conditions and other life events. Some primary care physicians expressed concern that adding an additional responsibility to their wide-ranging checklist for brief patient appointments is implausible. Dr. Pbert of the task force said that those providers should ‘do what they already do on a daily basis: Juggle and prioritize.’”
The Washington Post also described primary care doctors’ quandary:
“For primary care physicians, already in the throes of a ‘crisis’ of burnout, pandemic-driven stress and their own mental health challenges, adding yet another screening test to a long list of clinical tasks may feel burdensome. ‘If primary care providers are asked to screen for one more thing, we are going to break without more resources,’ said a nurse practitioner in Northern California, who asked not to be named because she didn’t have permission from her clinic to speak about the issue. Ticking off current requirements, like verifying up-to-date screenings for cervical, colon, and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, she said everything must be packed into a 15-minute appointment, while also treating patients with complex, chronic conditions.”
Anxiety and depression may be episodic and short-lived, with doctors helping patients through problems with compassionate listening, brief prescribing of helpful prescription medications, and providing useful information on improving diet, sleep, exercise, and work-life balance, the Associated Press reported. The recognition by the influential task force of the magnitude of anxiety and depression also may be helpful, the AP said:
“In April, the group issued similar draft guidance for children and teens, recommending anxiety screening but stating that more research is needed on potential benefits and harms of suicide screening kids with no obvious signs. Guidelines from the task force often determine insurance coverage, but anxiety is already on the radar of many primary care doctors. In 2020, a group affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls starting at age 13.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal with the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
It became crystal clear well before and during the pandemic that this nation also has neglected the fast-rising and dire need for mental health care, with such services, since the Obama Administration, supposedly put on parity with medical care in this country. We have a far way to go to realize this admirable goal, the pandemic has shown. We have far too few, trained, experienced, and practicing mental health care professionals at all levels. Mental health care, alas, struggles far too much with stigmatization — backwards and unacceptable views held by too many in the 21st century.
The task force’s screening recommendation calls for doctors to use existing, short written and observational tools requiring minimal time on the part of practitioners and patients. Seniors have been exempted from the mental health guidance because age-related matters may skew screening outcomes, as the New York Times reported:
“The [expert panel] did not extend its screening recommendations to patients 65 and older. [They] said there was no clear evidence regarding the effectiveness of screening tools in older adults because anxiety symptoms are similar to normal signs of aging, such as fatigue and generalized pain. The panel also said it lacked evidence on whether depression screening among adults who do not show clear signs of the disorder would ultimately prevent suicides.”
We have much work to do to detect, diagnose, and treat mental health disorders like anxiety and depression, as well as to recognize how much they affect so many of our lives. We cannot stigmatize this care and we must continue to push to significantly improve its access, affordability, safety, efficiency, and excellence.