USPSTF recommends anxiety, and depression screening in most adults
USA: In its two final recommendations statements, the USPSTF (US Preventive Services Task Force) has recommended screening for depression and anxiety in most adult populations.
The Task Force said, "All adults, including those who are pregnant, 65 and older, and postpartum, should be screened for major depressive disorder (grade B recommendation)," in its one recommendation statement published in JAMA (Journal of the American Medical Association).
The USPSTF concludes that the current evidence is inadequate to evaluate the balance of harms and benefits of screening for suicide risk in the adult population, including postpartum and pregnant persons and older adults. (I statement).
This recommendation applies to adults 19 years or older, including pregnant and postpartum persons, who do not have a diagnosed mental health disorder and are not showing recognized signs or symptoms of anxiety disorders. Older adults are defined as people aged 65 years or older.
In a separate recommendation statement, the USPSTF recommended screening for anxiety disorders in adults, including postpartum and pregnant persons. It did not recommend screening adults 65 and older for anxiety due to insufficient evidence to assess the balance of benefits and harms. It did not recommend screening adults 65 and older for anxiety due to insufficient evidence on its harms and benefits (grade I statement).
This recommendation applies to adults 19 or older with no diagnosed mental health disorder, recognizable symptoms, or signs of suicide risk or depression. Older adults are defined as those 65 years or older. This recommendation focuses on screening for major depression disorder (MDD) and does not address screening for other depressive disorders, such as dysthymia or minor depression.
According to the task force, the final recommendations are consistent with its 2016 recommendations on major depressive disorder screening and recommendations on suicide risk from 2014.
The USPSTF states, "To achieve the benefit of screening for anxiety disorders and reduce disparities in anxiety disorder--associated morbidity, it is imperative that persons who screen positive are assessed further for diagnosis and, if suitable, are provided or referred for evidence-based care."
The USPSTF's recommendations were based on data from two evidence reports published in JAMA.
For the recommendations on depression screening, 105 studies were included in the review, including 73 systematic reviews and 32 original studies.
Data showed that screening interventions, many of which included other components beyond screening, were associated with a lower prevalence of depression or clinically acute depressive symptoms after 6 to 12 months (pooled odds ratio 0.60), Elizabeth A. O'Connor, PhD, of Kaiser Permanente Center for Health Research in Portland, Oregon, and colleagues reported.
They noted that several tools were found to have adequate accuracy, including the 9-item Patient Health Questionnaire at a cutoff of 10 or greater, with a pooled sensitivity of 0.85 and a specificity of 0.85.
For suicide risk screening, data did not reveal improvement over usual care. One randomized clinical trial of a suicide risk screening intervention showed no difference in suicidal ideation after two weeks between primary care patients who did and did not receive the screening.
Forty original studies and 19 systematic reviews were included for anxiety. Two screening studies demonstrated no benefit, and few studies evaluated test accuracy. But according to O'Connor and colleagues, Generalized Anxiety Disorder (GAD)-2 and GAD-7 screening instruments were revealed to have adequate accuracy for anxiety detection based on data from three studies, with the GAD-7 at a cutoff of 10 having a pooled sensitivity of 0.79 and a specificity of 0.89.
Their evidence also revealed that psychological interventions were tied to a small pooled standardized mean difference of -0.41 in anxiety symptom severity in primary care patients with anxiety in 10 randomized trials.
References:
(1) US Preventive Services Task Force. Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. Published online June 20, 2023. doi:10.1001/jama.2023.9301
(2) US Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057–2067. doi:10.1001/jama.2023.9297
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