New Recommendations for Anxiety Screening: What Nurses Need to Know
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A national panel of medical experts has recommended preventive anxiety screenings for millions of U.S. adults — a move that requires insurers to cover the procedure.
The United States Preventive Services Task Force (USPSTF) in June determined that all adults ages 64 years or younger, pregnant people, and those in the postpartum phase should be screened for anxiety disorders. The recommendation was recently announced in the medical journal JAMA. The task force offered a "B" recommendation for anxiety screenings in these populations — a grade that, according to USPSTF, requires that "a group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum, provide coverage for and shall not impose any cost sharing requirements for" the service.
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"There was adequate indirect evidence of the benefit of screening for anxiety disorders in adults younger than 65 years and perinatal persons, as screening tools demonstrated accuracy in detecting generalized anxiety disorder and evidence supported treatment for adults with generalized anxiety disorder," task force members wrote in the JAMA report.
As a result, some nurses, particularly advanced practice registered nurses (APRNs), may experience an uptick in anxiety screenings.
While anxiety screenings typically consist of a straightforward questionnaire, here are some steps nurses can take to ensure effective screenings procedures and optimized access to preventive screenings and mental health care.
Data collected from 2001 to 2002 shows the lifetime prevalence of anxiety disorders in adults:
- Men: 26.4%
- Women: 40.4%
- Pregnant: 8.5% to 10.5% (generalized anxiety)
- Postpartum: 4.4% to 10.8% (generalized anxiety)
The task force found insufficient evidence to screen older adults 65 years or older. Some community-based studies suggest low rates of anxiety disorders among older adults aged 65-79. However, the task force acknowledged that the evidence was outdated and called for new studies.
This new recommendation may eventually be implemented in primary care settings, where clinicians, specifically APRNs, may need to revisit whether or how they screen for anxiety.
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Anxiety disorders are defined as “disproportionate and constant fear over everyday events accompanied by behavioral and somatic complaints.” Somatic complaints may include, but are not limited to:
- Sleep problems
- Other physical ailments such as headaches or digestive problems
Anxiety disorders are prevalent among mental health conditions.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnostic tool used by licensed psychiatrists and psychiatric nurse practitioners (NPs), defines several types of anxiety disorders, including:
- Generalized anxiety disorder
- Social anxiety disorder
- Panic disorder
- Specific phobias
- Separation anxiety disorder
- Selective mutism
- Substance/medication-induced anxiety disorder
- Anxiety disorder due to another medical condition
- Anxiety not otherwise specified
Stressful life events, parental history, smoking and alcohol use, sociodemographic factors, and psychosocial factors can elevate patients' risk for developing anxiety disorders. Black persons and individuals of non-Hispanic ethnicity are at higher risk, which has been linked to social, rather than biological, causes.
Anxiety disorders often go undiagnosed in primary care settings, leading to delayed treatment. The JAMA study of 965 primary care patients found that only 41% of people with anxiety received treatment for their disorder.
Best Practices for Anxiety Screenings
The USPSTF recommends that nurse practitioners, clinicians, nurses, and other mental health providers assess for anxiety disorders in people who have never been screened before using widely available, evidence-based screening tools.
These tools are quick and easy to administer. Many practices prefer the Generalized Anxiety Disorder 7-Item (GAD-7). For example, the first question from the screening tool is: “In the past two weeks, how often have you felt nervous, anxious, or on edge?”
Clinicians should also assess patients for depression and suicide risk, as anxiety disorders often overlap with depressive disorders.
Various treatment approaches can be effective in treating anxiety disorders.
One option is psychotherapy, provided by psychiatric NP, psychiatrists, psychologists, social workers, and counselors.
Pharmacotherapy is another common option, with different drugs and combinations varying widely based on the patient and the diagnosis.
Other interventions include:
- Desensitization therapies
- Transdiagnostic treatment
When prescribing anxiety and or depression medications to pregnant patients, clinicians must carefully weigh potential benefits and risks.
The USPSTF does not consider costs when recommending anxiety disorder assessment and treatment.
Incorporating anxiety disorder assessment into primary care settings can significantly impact patients affected by anxiety disorders. Anxiety disorders are common and can be debilitating. Healthcare providers have the ability and tools to capture key patient information that might have otherwise been overlooked.
Page last reviewed on June 30, 2023
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