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New recommendations for early detection, treatment of unrecognized anxiety disorders in women, adolescent girls

OHSU study informs national clinical screening guidelines for anxiety disorders, which have worsened since the COVID-19 pandemic began
woman, wearing a mask, riding on a bus and looking out window, looking anxious
Screening women and teens for anxiety and depression is important, as they are twice as likely to struggle with anxiety at some point in their lifetime. Anxiety disorders have only become worse since the COVID-19 pandemic began. (Getty Images)

Nearly 40% of women are affected by anxiety disorders, mental health conditions characterized by excessive, uncontrollable worry, during their lifetimes. This is twice the rate of men. Despite this high prevalence and availability of methods for screening and treatment, only 20% of affected people seek care for these conditions.

To improve detection of unrecognized anxiety, the Women’s Preventive Services Initiative, or WPSI, has issued new guidelines recommending medical professionals routinely screen for anxiety disorders in adolescent girls and women, including those who may be pregnant or postpartum, beginning at age 13.

Heidi D. Nelson, M.D., M.P.H.
Heidi D. Nelson, M.D., M.P.H.

An evidence review, led by Heidi D. Nelson, M.D., M.P.H., MACP, FRCP, professor of medical informatics and clinical epidemiology and medicine in the OHSU School of Medicine, and colleagues guided the development of these recommendations. The review is published online in the Annals of Internal Medicine.

“Anxiety disorders impair function in school, work, social settings and personal relationships, and often occur with other conditions, such as depression and posttraumatic stress disorder,” says Nelson. “The goal of screening is to increase detection and achieve earlier diagnosis, initiate appropriate treatment, and ultimately improve the health, function and well-being of women and girls.” 

According to Nelson, screening for anxiety involves a brief clinician- or self-administered questionnaire that describes symptoms of anxiety. This could be accomplished using intake forms during routine clinical visits when screening for depression, which is a current standard of care.  Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency, she says.

When screening suggests the presence of anxiety, further evaluation is necessary to establish a clinical diagnosis and determine appropriate treatment and follow-up. Depending on the severity of symptoms and co-occurrence of other conditions, patients may need a referral to behavioral health specialists.

To develop the recommendation, Nelson and colleagues evaluated previously published studies of the diagnostic accuracy of 27 screening instruments and systematic reviews of hundreds of randomized trials of behavioral and medical treatments. While no studies examined the overall effectiveness and harms of screening for anxiety, the researchers found strong evidence that screening instruments accurately identify women with anxiety, and that behavioral therapies and antianxiety medications effectively improve anxiety symptoms.

“Anxiety disorders have only become worse since the COVID-19 pandemic began,” says Nelson.  “Although the WPSI recommendation is specifically intended for women during routine clinical care, screening for anxiety and depression may be even more important during these extraordinary and uncertain times.”

The WPSI guidelines, adopted by the Health Resources and Services Administration, also were published today in the Annals of Internal Medicine. The recommendation will be incorporated into the summary of covered benefits for preventive services, at no cost to patients, as required by the Patient Protection and Affordable Care Act.

This work is supported by the Health Resources and Services Administration, of the U.S. Department of Health and Human Services (UH0MC29440).


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