‘Anxiety Screening Recommended for All Women’ – ACOG-Linked Group

Young women ages 13 and up, including those who are pregnant or have just given birth, should be screened for anxiety at routine visits, according to a Women’s Preventive Services Initiative (WPSI) recommendation released Monday.
In the 10 systematic reviews used to form the evidence base of this recommendation, there was sufficient evidence supporting the accuracy of screening tools and the efficacy of available anxiety treatments, including cognitive behavioral therapy and pharmacologic therapies, reported Heidi Nelson, MD, MPH, and other colleagues at WPSI.

However, no studies looked at the overall effectiveness and harms of anxiety screening, they wrote in the new guideline published in the Annals of Internal Medicine.
“Even though we estimate 40% of women experience anxiety throughout their lifetime, only 20% of men and women actually seek care,” Nelson told MedPage Today. “There is really a gap between the experience of screening and the treatment of anxiety.”
Led by the American College of Obstetricians and Gynecologists, the WPSI is a national program in partnership with the federal Health Resources and Services Administration and involvement from other medical groups. It develops recommendations on clinical issues that have not been addressed by groups like the U.S. Preventive Services Task Force (USPSTF).
The USPSTF currently recommends screening all adults and adolescents ages 12-18 for depression, but similar recommendations do not exist for anxiety.
Although anxiety is also diagnosed in about 20% of men, the WPSI determined that women have unique needs because they experience anxiety triggers such as sexual harassment or eating disorders at higher rates, Nelson said.

Rates of anxiety are rising nationally amid the COVID-19 pandemic, amplifying the need for increased screening and treatment, Nelson added.
“What’s nice about these types of instruments is that they can be done online with a remote appointment,” Nelson said. “Asking a few extra questions … and opening that door reveals many other things that can help people cope with the situation we are under now.”
In the evidence review of studies conducted in community, primary care, and obstetrics clinics, most screening tools showed moderate to high accuracy in good or fair quality studies, Nelson and co-authors reported, noting that for some tools, the short version fared equally well as longer versions, including the Generalized Anxiety Disorder 2-item questionnaire versus the 7-item questionnaire (GAD-2 vs GAD-7).
Moreover, some tools worked just as well in children and adults, including the GAD-7 and the Hospital Anxiety and Depression Scale, researchers reported.

“Use of the most brief and universal, yet effective, instruments could facilitate integration of anxiety screening into routine clinical practice,” Nelson and co-authors wrote.
However, the jury is still out on whether anxiety screening can be effectively implemented, commented Kim Smolderen, PhD, and Matthew Burg, PhD, both of Yale University in New Haven, Connecticut, in an accompanying Annals editorial.
A total of 27 screening tools were identified in the review, and “clearer directives for how to approach screening could promote uptake of the guidelines in real-world clinical settings,” Smolderen and Burg noted.
Also, “when promoting screening, it is important to reflect on what happens when anxiety is detected,” they wrote.
Namely, women may experience long-term side effects of pharmacologic agents commonly used to treat anxiety, which not only include benzodiazepines but also SSRI/SNRI antidepressants. Medications need to be monitored particularly closely in pregnant or postpartum women, the editorialists noted.

In the evidence review, adverse events were not documented with CBT, but they were common in drug trials. For example, in one high-quality trial, 63% of adults on SSRIs and SNRIs reported at least one adverse event, including sexual dysfunction, weight gain, nausea, and fatigue, researchers reported.
Patients who screen positive for anxiety may also have trouble accessing affordable CBT, wrote Smolderen and Burg, adding that women of color, sexual minorities, and women residing in rural areas disproportionately face obstacles in obtaining mental health care.
“Implementation of mental health screening is most likely to be effective within a collaborative care context, in which well-organized paths are in place to care for those identified with a condition,” they wrote. “Without such a collaborative care context, it is not apparent that the act of screening in itself would provide benefit.
https://www.medpagetoday.com/psychiatry/anxietystress/86950