Can We Screen for Anxiety, Depression and Suicide?

We humans aren’t always the most proactive when it comes to our health. That goes double when it comes to our mental health. Heck, it often takes a real shake-up before we even talk about things like anxiety or depression. Addressing something along the lines of, say, suicide, well, that usually takes a full-scale meltdown.

Or worse.

Much, much worse.

The United States Preventive Services Task Force wants to change all that though. In fact, they’ve just released a pair of rather thorough Recommendations attesting to just that fact. One of those alerts concerns anxiety; the other addresses depression and suicide. And both advocate early screening for everyone.

You can read all about it on the Task Force’s site, as well as within the pages of the Journal of the American Medical Association (JAMA). Or you can scan our pair of overviews right here and now.

Ready?

Final Recommendation Statement: Screening for Anxiety Disorders in Adults

On June 20th, 2023 (natch), the U.S. Preventive Services Task Force released a final recommendation statement concerning screening for anxiety disorders in adults. The gist? Simple. Screening can help identify anxiety disorders in adults younger than 65, including those who are pregnant and postpartum.

What’s that mean for adults over the age of 65? Well, the Task Force didn’t say. It did say that more research is needed before they could recommend for or against screening for anxiety disorders in older adults. Or you could simply lie about your age.

The takeaway is that the USPSTF is recommending that pretty much everyone be screened for anxiety disorder. Why? Well, because anxiety disorders are incredibly common. And because they often go unrecognized, even in primary care settings. That can lead to years-long delays in treatment.

Among the anxiety disorders cited by the USPSTF are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias and selective mutism. It also left a space for “anxiety not otherwise specified”.

Most puzzling though was the Task Force’s findings were based upon data collected from 2001 to 2002. Granted they found a anxiety disorders were prevalent in 26.4% of the men and 40.4% of the women, but a whole heap of things have gone down over the last two decades, including a pandemic.

Using such dated data is especially puzzling considering the reason the Task Force held off on older age recommendations was because “the data was outdated”.

Judge Not…

Who are we to judge though? Wiki says the “independent panel [is made up] of experts in primary care and prevention [who] systematically reviews the evidence of effectiveness and [then] develops recommendations for clinical preventive services”. Wiki also says it includes ops “from internal medicine, pediatrics, family medicine, obstetrics and gynecology, nursing, and psychology [with backgrounds in] epidemiology, biostatistics, health services research, decision sciences, and health economics.”

Add the fact that the USPSTF “is funded, staffed, and appointed by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality” and well, you’ve got a pretty much foolproof program.

It should also be noted that the Task Force is “independent of the U.S. government.” It should also be noted that their findings and recommendations “should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.”

Got it? Good.

Final Recommendation Statement: Screening for Depression and Suicide Risk in Adults

The findings vis-a-vis depression pretty much echo those concerning anxiety. To wit:

The USPSTF recommends screening for depression in all adults regardless of risk factors. Risk factors for depression include a combination of genetic, biological, and environmental factors such as a family history of depression, prior episode of depression or other mental health condition, a history of trauma or adverse life events, or a history of disease or illness (eg, cardiovascular disease).

Prevalence rates vary by sex, age, race, ethnicity, education, marital status, geographic location, poverty level, and employment status.1,23 Women have twice the risk of depression compared with men. Young adults, multiracial individuals, and Native American/Alaska Native individuals have higher rates of depression.

Risk factors for perinatal depression include life stress, low social support, history of depression, marital or partner dissatisfaction, and a history of abuse.

Anxiety, Depression, Suicide: Chicken and Egg?

Oddly enough, CNN Health’s coverage leads and ends with anxiety. So does NBC News and The Washington Post. Not there’s anything wrong with covering anxiety, mind you. But when the story arc also includes depression and suicide, we should probably also get to hear from depression and suicide, After all, don’t they deserve to be heard as well? Of course they do.

So why the pause? Does anxiety make for a sexier headline than depression or suicide? Is it perhaps a more palatable subject?

Then again, perhaps the reticence was due to the dates of the data.

Nitpicking?

We at Healing Properties don’t mean to nitpick; at the same time we can’t let anxiety get all the attention. Sure, the disorder is probably much more prevalent. It’s also probably a lot easier to treat (or at least mitigate). And unless someone’s anxiety reaches Tony Soprano proportions, it’s also probably much, much easier to live with.

Not so depression, especially if said depression also includes suicide ideation. So we truly hope that doctors consider these screening recommendations as a complete set. It’d be heartbreaking to see a new mental health initiative overlook the most dire disorders.

It’d also be heartbreaking to see doctors err on the side of more prescriptions. Yes, if folks have issues they should get medicated. But that doesn’t mean folks should be rushing to get medicated. If COVID taught is anything, it’s that telehealth can be a boon for all the wrong reasons.

Anyway, it’d be disingenuous to say we’re not excited to see more and more Americans will be getting the help they need. We are excited. We just don’t want to see another large swath of the population suddenly dependent upon pills. After all, everyone between the ages of 19 and 64 is a whole lotta people.

You don’t need to be a very bright drug dealer to see it’s also a very tempting potential marketplace.