USPSTF finalizes recommendations on depression, anxiety, suicide risk screening in adults

Key takeaways:

• It is the first time that the USPSTF recommended anxiety screening for all adults aged younger than 65 years.
• The evidence was insufficient to recommend screening for anxiety among older adults.

Physicians should screen all adults for depression and adults aged younger than 65 years for anxiety disorders, according to final recommendation statements from the U.S. Preventive Services Task Force.

This is the first time that the task force is recommending universal anxiety screening in this population, according to a press release.

The final recommendation on depression aligns with the task force’s previous decision. Both recommendations are B grades.

“Amid the mental health crisis in the United States, the task force worked to provide primary care professionals and their patients with recommendations on evidence-based screening,” Michael Silverstein, MD, MPH, vice chair of the task force and George Hazard Crooker University Professor of Health Services, Policy and Practice at the Brown University School of Public Health, said in a press release. “Fortunately, screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety disorders is effective in identifying these conditions so adults can receive the care they need.”

The USPSTF also released two I-grade recommendation statements, indicating there is not enough evidence to recommend for or against the measures. Although suicide is a leading cause of death among adults, according to the USPSTF, the evidence is insufficient to make a decision on whether screening those who do not have signs or symptoms will ultimately help prevent suicide. Additionally, the task force determined that there was not yet enough evidence to recommend screening for anxiety disorders in adults aged 65 years and older.

The USPSTF emphasized that the recommendations apply only to those not showing symptoms of the conditions.

“We are urgently calling for more research to determine the effectiveness of screening all adults for suicide risk and screening adults 65 and older for anxiety disorders,” Gbenga Ogedegbe, MD, MPH, a USPSTF member and professor of medicine and population health at the NYU Grossman School of Medicine, said in the release. “The task force deeply cares about the mental health of people nationwide and hopes that future research can help us provide health care professionals with evidence-based ways to keep their patients healthy.”

The recommendations are based on evidence reviews from Elizabeth A. O’Connor, PhD, a behavioral health psychologist at Kaiser Permanente, and colleagues that evaluated 105 studies on depression, 59 on anxiety and 27 on suicide risk.

In a related editorial, Murray B. Stein, MD, MPH, a psychiatrist and professor at the University of California, San Diego (UCSD), and Linda L. Hill, MD, MPH, a clinical professor in the department of family medicine and public health at UCSD, wrote that uptake of the new anxiety screening recommendations “should provide an impetus and an opportunity for primary care clinicians to become more comfortable with diagnosing and treating anxiety disorders,” although they noted that may require additional training.

“Anxiety disorders can be distressing and disabling, and appropriate recognition and treatment can be life-altering and, in some cases, lifesaving, for patients,” they wrote.

In another editorial, Gregory E. Simon, MD, MPH, and colleagues wrote that screening to identify suicide risk can now include more than questionnaires as health systems explore and implement prediction models that use records data to identify people at high risk for suicidal behavior.

“Clinicians who are unprepared to assess or address risk of self-harm may respond to reports of suicidal ideation either with silence or fearful overreaction,” they wrote. “Patients encountering either of those extremes may be less likely to disclose risk or collaborate in effective treatment. Specific training resources, such as those developed by the Zero Suicide initiative from the National Action Alliance for Suicide Prevention, can support more effective responses.”

References:

• OConnor EA, et al. JAMA. 2023;doi:10.1001/jama.2023.7787.
• OConnor EA, et al. JAMA. 2023;doi:10.1001/jama.2023.6369.
• Simon GE, et al. JAMA. 2023;doi:10.1001/jama.2023.7241.
• Stein MB, et al. JAMA. 2023;doi:10.1001/jama.2023.7239.
• USPSTF. JAMA. 2023;doi:10.1001/jama.2023.9297.
• USPSTF. JAMA. 2023;doi:10.1001/jama.2023.9301.
• U.S. Preventive Services Task Force issues final recommendation statements on screening for anxiety disorders, depression, and suicide risk in adults. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/sads-adults-final-rec-bulletin.pdf. Published June 19, 2023. Accessed June 19, 2023.