Anxiety Screenings for All? The US Preventive Services Task Force Says Yes

Back in September 2022 the US Preventive Services Task Force (USPSTF) drafted a statement recommending adults under 65 be screened routinely for anxiety, and in October published a similar recommendation for kids.

This guidance comes after the USPSTF commissioned a review looking at the screening of young people for anxiety disorders to evaluate the benefits and drawbacks, particularly in young people who don’t show any recognized signs or symptoms of the condition.

Based on the study’s findings, the USPSTF now recommends routine screenings for anxiety in children over eight years old, but the current evidence isn’t sufficient in assessing the benefits and drawbacks of routinely assessing children aged seven and under for anxiety.

The USPSTF's advice is indicative of just how real the US mental health crisis is, and holds promise for the much needed expansion of care.

Screening Young People

More research may be needed to find out how often routine screening should take place. However, repeated screenings might be best for children and adolescents with risk factors for anxiety, with opportunistic screenings better for children and adolescents who have less frequent healthcare visits. 

For young people who might have anxiety, there are a number of potential treatments. They include various psychotherapies, with cognitive behavioral therapy the most common, and medications. Duloxetine (Cymbalta), an SNRI, is the only one approved by the US Food and Drug Administration to treat generalized anxiety disorder in children aged seven or older. 

Among the reasons for screening young people is that doing so can help reduce the future burden. People who develop anxiety disorders in childhood are more likely to develop a further anxiety disorder, or depression, so addressing anxiety earlier can help in the longer term. 

These screenings aren’t meant to diagnose young people with anxiety, as such, but to identify those who might need more support. At present, there are a number of standardized questionnaires that clinicians can use to screen children and young people for mental health conditions like anxiety. They include the Screen for Child Anxiety Related Disorders and the PHQ-9 questionnaire.  

“Just like taking your car for a service to monitor safety and prevent a breakdown in the future, routine anxiety screenings would help identify early mental health warning signs,” explains Daniela Mercado Beivide, PhD, from Holly Health. “Based on screening results, primary care physicians can identify symptoms and then signpost them to an appropriate mental health professional.”

"As we know, a lot of emotional difficulties begin to emerge in childhood and so routine screenings for anxiety sound like a positive development," says Elena Touroni, PhD, a consultant psychologist and founder of The Chelsea Psychology Clinic. "The only caveat is that there are obviously different developmental stages. For this reason, it’s important to use a measure that has reached clinical thresholds and doesn’t pathologize children."

The Rise of Anxiety

This study comes after the USPSTF also recommended that adults aged under 65 get screened for anxiety. Their recommendations are designed to help clinicians identify early signs of anxiety during routine care with questionnaires and other screening tools. This is in part because anxiety disorders often go undetected.

According to the Anxiety & Depression Association of America, anxiety disorders are the most common mental illness in the US, with millions affected. In terms of children, anxiety and depression in children have increased over the last five years, both before the pandemic and after. From 2016 to 2019, anxiety in children and adolescents increased by 29%. 

There may be a number of reasons for the increases in anxiety. There had been an increase in the number of young people whose parents had quit, declined, or changed jobs, as well as an increase in the number of young people who had experienced racial or ethnic discrimination. And of course, from 2020, the pandemic would have been a factor.

“According to the World Health Organisation, the pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide,” explains Dr. Mercado Beivide. “A major trigger was the unprecedented increase in social isolation, coupled with the fear of infection and financial worries.” 

Changing How We Manage Anxiety

While the stigma around mental health conditions like anxiety hasn’t gone away, people are more open about their mental health than they perhaps used to be. As we’re more comfortable talking about things like anxiety than before, we might in turn start to become more proactive in addressing them. 

In turn, “regular mental health screenings will also help to normalize mental health and reduce the stigma around taking proactive actions to look after it—the same way we do for physical health,” says Dr. Mercado Beivide.

The only caution I would give with screening for anxiety or depression in children is, not all anxiety or depression needs medication," says Kendall Roach, MA LPC, therapist at Babylon. "Sometimes, just providing an outside, unbiased source for the child to talk to or making some positive changes in their environment can be helpful in decreasing negative symptoms and increase positive coping skills.”

More research should be carried out to determine, among other things, the ideal frequency of screenings and whether there would be any benefit to screening children under the age of eight, but with anxiety on the rise screening children and adolescents—and indeed adults—does seem as if it would be a good idea. 

At the same time, however, we should look at the causes of anxiety. What can be done to make the lives of children and young people better?