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A bundle of nerves

Medical experts have determined that we need to screen everyone for anxiety − and I mean everyone

A bundle of nerves

In September 2022, the United States Preventive Services Task Force (USPSTF) recommended that doctors screen all adult patients under 65 for anxiety, with the goal of helping prevent mental health disorders from going undetected and untreated for years or even decades.

It made a similar recommendation for children and teenagers earlier this year. Although the guidance is still in its draft form and won’t be finalised for a few more months, it is expected to be extremely influential in changing the course of mental health screening in the US.

Now, to make sure that there’s no ambiguity about how colossal a screening shift this is, there are basically 200 million Americans between the ages of 18 and 65. Typical USPSTF screening recommendations are, frankly, less ambitious in their scope. Screening for breast cancer or prostate cancer, as examples, are usually confined to certain genders, certain age groups and/or those with underlying comorbidities who might be considered high risk.

Decisions like this are reached after a careful examination of the data; the task force cited one study from August 2020 to February 2021, showing that the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased to 41.5% from 36.4%. By any measure, absolute or relative, the increase is jaw-dropping and represents about 10 million de novo positive screens. Importantly, a positive screen may not translate into a clinical disorder requiring intensive pharmacological or counselling therapy. As experts have pointed out, a positive screen may simply represent a moment of time in a person’s life that is particularly stressful.

Either way, the already busy primary care physicians are going to get a lot busier. Where are they going to find the time to add an anxiety screen into their regular workflow?

The answer is that they’re not. They will surely try their best. They will prescribe anxiolytics where none are required. And there will be missed diagnoses and underdiagnoses.

You could make a reasonably strong argument that, other than cancer and diabetes, mental health illnesses have received a tremendous amount of mainstream media coverage, resulting in increased awareness and a better understanding of symptoms and warning signs. You could argue that all of this may have even led to a lowering of social taboos and social stigmas around mental health illness.

You might even be able to argue that it has resulted in more funding dollars flowing towards mental health research and development.

But none of this means we’re doing a better job at treating anxiety, depression and other common mental health disorders. Mainstream media coverage and articles in widely read periodicals are great. But they don’t correlate to improved clinical care. Or outcomes.

The USPSTF guidance serves as a stark reminder at how little progress we’ve made on the important dimensions of mental health illness: making people feel better. It sounds overly simplistic, but if we’d done a better job, wouldn’t the numbers be going down and not up? It also serves to remind us that global pandemics, the rise of authoritarian regimes, financial woes and distant wars (distant for those in North America; not for those in Europe) are drivers of anxiety and depression. But their natural conclusion, whenever that day comes, will not result in the disappearance of our anxiety. Because our societal anxiety is rooted in something else.

But the USPSTF draft recommendations and the ensuing publicity around it did accomplish one thing: it gave many people a sense of belonging.

Yes, that is a weird concept. Especially in the context of mental illness.

But it has allowed people to feel normal about their anxiety. It has allowed people to reflect and say: ‘Hey, it’s not just me. There are millions of other people like me too.’ Intuitively, we know there are millions of people out there with anxiety and depression. Just like we know there are millions of people with cancer and diabetes. But sometimes having other people validate it for us is comforting.

From a public health and policy perspective, the morbidity associated with mental health illnesses is well established. Screening 200 million more people is going to be a tall mountain to climb. There will be missteps along the way. People will fall through the cracks and the healthcare professionals who deal with these patients will be severely tested.

The USPSTF recommendations and draft guidance about anxiety put this issue (back) on the front burner.

The trick will be keeping it there.

Rohit Khanna, MBA, MSc, MPH is the Managing Director of Catalytic Health, a leading healthcare communication, education & strategy agency. He can be reached at: or you can learn more about him at

2nd February 2023

From: Healthcare


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