Behind the new anxiety screening recommendation : NPR

MICHEL MARTIN, HOST:

This week, a federal panel of medical experts recommended that doctors screen all adult patients under the age of 65 for anxiety. This advice comes from the U.S. Preventive Services Task Force, a panel of independent medical experts appointed by the U.S. Department of Health and Human Services. And while the recommendation doesn’t carry the force of a rules, such recommendations do carry weight and draw attention to certain health issues.

Lori Pbert is a member of the task force. She is a clinical psychologist and a professor at the University of Massachusetts Chan Medical School, and she’s with us now to tell us more about it. Professor Pbert, welcome. Thank you for joining us.

LORI PBERT: Thank you, Michel. I really appreciate your tackling this important topic.

MARTIN: You know, to that end, the word anxiety is used to describe a range of feelings and experiences. As briefly as you can for those of us who are not, you know, practitioners, how does the task force define anxiety in these recommendations?

PBERT: That’s a really good point. Many adults have fears and worries. However, anxiety disorders are mental health conditions where excessive fear or worry interferes with an individual’s normally normal daily activities. These really are including things like feeling nervous, anxious or on edge, unable to control worrying, really having trouble relaxing, feeling restless, afraid something awful might happen and feeling anxious or worried for no particular reason. And this anxiety can also involve problems with sleep and changes in eating habits. So it’s more than just the fears and worries that many adults experience.

MARTIN: So what prompted the task force to examine anxiety specifically?

PBERT: So a number of years ago, the task force received a nomination to address screening for anxiety in adults. Interestingly, this topic is coming out as a draft recommendation at just the right time.

MARTIN: And why do you say that? Tell me more about why you say that this is really the right time for this.

PBERT: I think the pandemic has taken such a tremendous toll on the mental health of youth and adults here in the United States. And we know that early in the pandemic, the percent of adults with recent symptoms of an anxiety or depressive disorder actually increased from 36 to 42%. So we know that the pandemic has certainly heightened the trend and increase in anxiety that we’ve been seeing over the past decade or so.

MARTIN: You know, you talked about that this is evidence based and it’s based on an understanding of what you’ve seen, what has shown efficacy. You know, we’ve been reporting on the fact that the medical community is already struggling to keep up with the increase in people who need help. There’s the fact that there just seems to be a capacity problem, not to mention that there’s a cost problem. And I just have to wonder whether this only exacerbates this existing problem. You know, and does it lead to more people being anxious about being told that they need help and that they can’t get it?

PBERT: You’re absolutely right. Finding mental health services can be incredibly difficult, especially in areas where we have limited access to health care and related services. So our hope, the task force’s hope is that putting forth this set of recommendations can help bring awareness of the need to create greater access to evidence-based mental health care throughout the country. We know that less than half of people who experience a mental illness will receive mental health care. And there are a number of barriers, and you’ve picked up on one very important one, and that is we have an undersized mental health care workforce. We need to expand that workforce. We need to put resources into having more resources to be able to meet the demand that we already have and the demand that could come from additional recommendations for screening.

MARTIN: So before we let you go, you know, there are those who would say that this recommendation – not to diminish people who are experiencing, you know, conditions that clearly need treatment, but there are those who would say that this takes the focus off of where it should be, which is that some people are just living hard lives that don’t need to be as hard as they are, that these are political problems, not necessarily medical problems, like people living in neighborhoods that are plagued by violence, for example, or people who are experiencing economic distress. There are those who would say these are political problems for the political system to solve and that this basically puts the onus on the individual as opposed to the systems that are supposed to address them. Have you considered that? And what do you say to that?

PBERT: Yeah, absolutely because the task force has really been grappling with this and cares deeply about health disparities and health equity. We know that structural racism and income inequalities can result in barriers to treatment due to treatment costs, lack of insurance. And then the task force is really committed to helping to address these negative impacts of systemic racism on health. It needs to be a multipronged approach. What the task force does is work on getting the best evidence and guidelines to clinicians so that they have the preventive services that they can deliver to their patients. At the same time, we need to have, as you said, political, societal change that addresses these other barriers to developing anxiety disorders as well as to treating and managing those anxiety disorders. It needs to be a multipronged approach.

MARTIN: Lori Pbert is a clinical psychologist and professor at the University of Massachusetts Chan Medical School, and she’s a member of the U.S. Preventive Services Task Force. That’s a panel of independent medical experts appointed by the Department of Health and Human Services. Lori Pbert, thanks so much for sharing this expertise with us.

PBERT: Oh, thank you so much for tackling this very important issue.

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