In a recent study published in the JAMA Journal, researchers from the United States (U.S.) reviewed the risks and benefits of anxiety screening and treatment.
The study evaluated the accuracy of the tools and instruments used to identify anxiety among adult primary care patients.
Study: Evidence Report and Systematic Review for the US Preventive Services Task Force. Image Credit: panitanphoto/Shutterstock.com
Recent studies indicate that anxiety is prevalent among the U.S. adult population, with household survey statistics from 2019 reporting the incidence of mild to severe anxiety ranging between 9.5% and 2.7%.
Furthermore, while there is a shortage of national-level data on the incidence of anxiety disorders, the impact of anxiety disorders on the quality of life and the economic burden associated with anxiety is well known.
Previous studies have reported that the annual health burden of anxiety disorders in Organization for Economic Co-operation and Development (OECD) countries is over one billion dollars.
An effective method of routinely screening for anxiety could help in the timely detection of anxiety disorders and initiation of treatment, reducing the number of years spent in distress and potentially decreasing the economic burden.
About the study
In the present study, the researchers reviewed data on the effectiveness of existing screening and treatment methods regarding risks and benefits.
The study evaluated the current screening methods' accuracy to help the U.S. Preventive Services Task Force (USPSTF) make recommendations for primary care patient anxiety screening.
The study followed an analytical framework that addressed key questions related to screening for anxiety, depression, and suicide risk, formulated in consultation with the USPSTF.
Various data sources and online databases were screened for studies that fit the different eligibility criteria for each key question included in the framework.
For the key questions that addressed the risks and benefits of anxiety screening, the researchers included randomized clinical trials that comprised adult primary care patients, not excluding pregnant individuals, and examined the harms and benefits of anxiety screening programs.
All efforts to screen members of a specific group for anxiety, with the understanding that positive results would progress to clinical treatment, were considered valid screening programs. Even those programs that included referrals for support or recommendations for managing anxiety were included in the review.
The researchers addressed the key question on the accuracy of the screening methods by reviewing studies that evaluated the diagnostic accuracy of specific screening tools such as the Patient Health Questionnaire anxiety scale, Generalized Anxiety Disorder Scale (GAD), etc.
Additionally, examining the risks and benefits of the treatment options for anxiety included a review of randomized clinical trials that evaluated the efficacy of pharmacological, psychological, and combination therapies against controls such as placebos, attention control conditions, or usual care.
Using various statistical analyses, the cumulative strength of evidence was scored for each key question based on factors such as study quality, the precision of the results, consistency in findings between various studies, and limitations of the studies included in the review.
The researchers also assessed whether the findings could be applied to the primary care populations and healthcare settings in the U.S.
Although the results were inconclusive about the harms and benefits of the anxiety screening programs in the U.S., they did indicate that initiation of treatment for anxiety had significant benefits and that some of the methods for screening anxiety among primary care adult patients were reasonably accurate in detecting generalized anxiety disorders.
The effective treatment methods included pharmacological treatment options such as benzodiazepines, anti-depressants, and cognitive behavioral therapy.
The various GADs were found to be effective in detecting generalized anxiety disorders but did not seem to perform very accurately for other anxiety disorders.
However, the researchers discussed the importance of sensitivity over specificity in evaluating these screening tools since other disorders such as obsessive-compulsive disorder, post-traumatic stress disorder, depression, attention deficit hyperactivity disorder, and autism-spectrum disorders can manifest as anxiety symptoms, and detection of these, albeit at low specificity can still be beneficial.
Most of the studies that examined the harmful effects of treatment options for anxiety covered the use of anti-depressants, and there was very little evidence of the risks associated with other pharmacological treatment methods for anxiety.
Additionally, no studies had reported misuse or addictive behavior linked to benzodiazepines, and one systematic review that reported suicidal behavior associated with benzodiazepine use lacked quality and therefore was not included in the review and meta-analyses.
Overall, the findings indicated insufficient evidence to form conclusions about the risks and benefits of anxiety screening, but there were obvious benefits to initiating treatment for anxiety.
Furthermore, various anxiety screening methods were found to be effective in screening for generalized anxiety method.
Given that other disorders also manifest as anxiety symptoms, anxiety screening is beneficial in the early detection of mental health disorders, despite the low specificity.