In this video, Tracey Marks, MD, a forensic psychiatrist and author of Why Am I So Anxious? Powerful Tools for Recognizing Anxiety and Restoring Your Peace, breaks down the benefits and challenges of implementing the draft recommendation from the U.S. Preventive Services Task Force (USPSTF) on screening for anxiety in adults.
The following is a transcript of her remarks:
In September of this year, the U.S. Preventive Services Task Force produced [draft] recommendations based on their research that all adults under age 65 should be screened for anxiety, and one of the things that prompted this was that they noticed an increase in the prevalence of anxiety and depression of about 6% between 2020 and 2021.
What’s interesting about these findings is that the data was based on people in a primary care setting. These are not people going to see psychiatrists or therapists; these are people seeing their general practitioners.
The Task Force found that there were a few [screening tools] that were already available that were good enough at detecting or picking up on people who have generalized anxiety or panic disorder. So what this might look like is physicians, or primary care doctors [PCPs], giving you a questionnaire that you fill out either before your appointment, or they may send it to you via email or online, that you complete and give to your doctor before your appointment.
I love these recommendations. I love the fact that attention is being brought to mental health and the importance of recognizing disorders in people, and helping the individual patient recognize that they’re having trouble when they may not recognize it. This kind of screen helps bring that into the doctor’s office.
However, a tricky part to this is, what do we do with this information? If someone shows signs of anxiety with these questionnaires — if someone shows by the questionnaire that they probably are suffering with anxiety — the doctor has to go a further step of actually asking enough questions to render a diagnosis.
I’m not sure what the training is in this day and time, but back when I was training 20-plus years ago, behavioral health was just not a priority in general training. Certainly [for] psychiatrists, that’s what we do. But in an internal medicine residency program — maybe family medicine may have more exposure to behavioral health — there’s just not a lot of training for diagnosing anxiety or mental health disorders, much less what you do about treating them.
Now that said, PCPs often are on the frontlines of treating mental health disorders like depression and anxiety. More people see their PCP for depression and anxiety than they do see a psychiatrist, because that’s an additional step. So although PCPs are often in the position of prescribing medication for patients who are suffering with anxiety, going the further step of doing some type of therapy or a non-medication intervention is usually beyond the scope of what their training provided them.
The people who conducted the research were from the Kaiser Permanente system. If there is any system that is set up well to handle what comes from screening and then treatment, it’s a system like Kaiser where it’s very all contained; it’s multispecialty so it’s much easier for the PCP to hand off this person who needs further treatment to another clinician within the same system. That’s not the case necessarily for the independent practitioner, solo practitioner, or even someone with a couple of doctors in their practice, and they’re seeing 20 to 30 people a day. They don’t have the time to do a half an hour of therapy with someone, much less feel equipped to even do that kind of therapy.
Will they now have to hire therapists in their practice? Will they refer people out to therapists? So there are some details that will need to be worked out once PCPs determine that they have a patient who has some need for treatment for anxiety. I think an easy thing that PCPs can do to help their patients, without themselves feeling overloaded or overburdened with — “Oh, now I have to do something else. I’ve got to manage something else” — is come up with a list of self-help tools.
On the one hand, they could come up with a list of referrals of people that, if it looks like their patient needs further help, they can say “Here, here’s where you can go.” Another option though is to have a list of self-help tools, like the books, and apps, and things like that in a handout form to give their patients to be able to help them manage some of these symptoms outside of the office.
Even though I’m a little skeptical about how we’re actually going to implement these recommendations by this Task Force, I still think if nothing else comes out of it — I think great things will come out of it — but if nothing else comes out of it, it helps make the topic of mental health a regular part of conversation; that’s a place we definitely need to start. This isn’t something that you should have to whisper about or be ashamed that you experience. Being able to have this be something that’s expected, and that a clinician is going to ask you about, helps set the foundation that mental health is a basic part of your overall health.
You don’t have any problems telling the doctor you have a headache, and saying “Help me.” You shouldn’t have to feel ashamed or embarrassed or have any kind of reluctance to bring up feeling anxious or depressed with your doctor.