Recommendations for Screening for Anxiety in Adolescent and Adult Women

This week we will be reviewing and discussing an article that was recently published in the Annals of Internal Medicine titled Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative. In this article, authors Gregory and colleagues discuss the development of a recommendation to screen for anxiety in both adolescent and adult women. 

What did they do?

The Women’s Preventive Service Initiative (WPSI) evaluated results from a systematic review that examined several domains associated with screening for anxiety disorders (e.g., effectiveness, accuracy, and benefits) in adolescent girls and adult women. 

Why did they do it?          

As the authors highlight, no studies to date have directly evaluated the overall effectiveness (or possible harm) of screening for anxiety. The primary purpose of the developed recommendation is to increase detection of anxiety disorders, supporting the opportunity for early intervention and ultimately leading to optimal outcomes.

How did they do it?

As mentioned above, the authors of this study reviewed the results from a systematic review that focused on 3 primary areas related to screening for anxiety, as explained by the authors:

1. The effectiveness of screening for anxiety in improving symptoms, function, and quality of life
2. The accuracy of screening methods 
3. Potential harms of screening 

The WPSI focused primarily on gaps in current recommendations regarding screening and preventative services for girls and women aged 13 years and older. Overall, recommendations were based on benefits and possible harms of intervention services, with an intent to find a balance between both. 

What did they find?

There are two primary pieces of information to present: (1) results from the systematic review that was reviewed in this study, and (2) subsequent recommendations.

Regarding the systematic review, the authors were unable to identify any studies that directly evaluated the overall effectiveness and/or harms of anxiety screening. 27 screening instruments used across 171 studies were evaluated overall, with only 5 of those studies meeting criteria for “good quality.” All screening instruments identified were clinician or self-administered. 3 versions of the Generalized Anxiety Disorder Scale, the anxiety module of the Patient Health Questionnaire, demonstrated moderate to high accuracy. Regarding the effectiveness of treatment, cognitive-behavioral therapy (CBT) was identified as the most common treatment approach. Pharmacological therapies typically included SSRIs and SNRIs for both adolescents and adults. Some harms of treatment that were identified were specific to pharmacological intervention, including  adverse side effects such as diarrhea, dizziness, and headaches, among others.

As for the newly developed recommendations, the WPSI suggests screening for anxiety in conjunction with screening for depression - this includes individuals who are not currently diagnosed with anxiety disorders. The authors highlight that using instruments that screen for both disorders simultaneously may be particularly clinically efficient, such that this type of screener can be administered easily with virtually no additional work for the clinician or patient.

Overall, the authors explain that even with these recommendations in place, additional studies are needed to determine the absolute best methods for screening, diagnosis, and treatment, as well as the coordination of multiple systems to support each step in the clinical journey. 

What does it all mean (our take)?

The WPSI’s recommendation here is critically important. Incorporating screening as part of typical primary care visits, for example, is a necessary step to ensure that we continue to move in the direction of preventative care, rather than reactive care. This article highlights the importance of developing a system that efficiently and accurately takes patients from screening through comprehensive evaluation. Technological developments, for example those we are constantly working on here at Mindyra, appear to provide a strong avenue through which the recommendations provided by the WPSI could be carried out. We’re excited to be able to assist in this effort and are excited to see the field of behavioral health continue to progress.