Anxiety Screening in Women: Recommendation from the Women’s Preventive Service Initiative

The Women’s Preventive Service Initiative (WPSI) has developed recommendations on screening for anxiety in adolescent and adult women to improve earlier detection and treatment to enhance the health, function, and overall well-being of patients. The recommendations were published in Annals of Internal Medicine.¹

The WPSI recommends screening all women for anxiety beginning at age 13, including women who are pregnant or have just given birth. Anxiety disorders, including generalized anxiety, panic disorders, and social or school anxiety, are the most common mental health disorder in the United States, affecting approximately 40% of women during their lifetimes, noted the authors of a systemic review also published in Annals of Internal Medicine.²

The WPSI recommends that clinicians use their judgment on the frequency of screening; however, if a patient has not been recently screened, clinicians should consider these candidates as high priority for screening due to the high prevalence of anxiety disorders, lack of recognition in clinical practice, and multiple comorbidities associated with untreated anxiety.¹ The authors of the review article noted that shorter screening instruments (with as few as 2 questions) are as effective as longer instruments and are “particularly suitable for routine screening in primary care settings.”²

To determine the recommendations, researchers conducted an evidence review of studies that assessed the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women.² The researchers used MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health and Psychosocial Instruments for studies that enrolled adolescent girls and adult women not currently diagnosed with anxiety disorders.

A total of 33 studies and 2 systematic reviews evaluated the diagnostic accuracy of 27 screening instruments and their variations against a clinical diagnosis or another instrument; most studies demonstrated a moderate to high accuracy for adults, pregnant and postpartum women, and adolescents. Five systematic reviews found that anxiety symptoms improved with cognitive behavioral therapy (individual, group, and telehealth), and 3 reviews found that improvement in anxiety was found following the use of selective serotonin reuptake inhibitors, and selective serotonin and norepinephrine reuptake inhibitors.

The systematic review identified no studies that directly evaluated the overall effectiveness or harms of screening. Additional studies are needed to warrant optimal methods for screening, diagnosis, treatment, and coordination of systems to support the steps of this clinical pathway.

“Standardized screening for anxiety in routine clinical practice, particularly as part of a preventive health care visit in combination with depression screening, could identify adolescent and adult women with anxiety and initiate diagnostic evaluations and treatment,” concluded the authors.¹

References

1. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: a recommendation from the Women’s Preventive Services Initiative. Ann Intern Med. 2020;173(1):48-56.
2. Nelson HD, Cantor A, Pappas M, Weeks C. Screening for anxiety in adolescent and adult women: a systematic review for the Women’s Preventive Services Initiative. Ann Intern Med. 2020;173(1):29-41.

This article originally appeared on Clinical Advisor