Doctors should be checking for the common mental health condition
By Rachel Nania, AARP /Published September 22, 2022 / Updated June 20, 2023
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If you’re under 65, your next check-up could include a new screening — one for anxiety.
A panel of medical experts is, for the first time, recommending that adults under the age of 65 get screened annually by their primary care physician for the increasingly common mental health condition, even if they don’t have symptoms.
Doing so can help identify an anxiety disorder early on so people can be connected to care, U.S. Preventive Services Task Force member Lori Pbert said in a Sept. 20, 2022 statement, when the group’s draft recommendation was first posted. The recommendation was finalized on June 20, 2023, and published in the medical journal JAMA.
“This is, I think, sorely needed and sorely overdue,” says Robert Hudak, M.D., a psychiatrist at University of Pittsburgh Medical Center Western Psychiatric Hospital.
Anxiety disorders are the most common mental health issue in the United States. Over 15 percent of adults reported experiencing symptoms of anxiety in 2019, according to the Centers for Disease Control and Prevention (CDC). Earlier federal data shows roughly 20 percent of U.S. adults have an anxiety disorder. And the pandemic has only aggravated the issue, sending cases soaring above these estimates, both in the U.S. and abroad, studies show.
“I really think the COVID pandemic shined a light on the impact that daily stress and anxiety can cause on people,” says Lauren Gerlach, a geriatric psychiatrist and assistant professor in the department of psychiatry at the University of Michigan Medical School.
One CDC report found that between August 2020 and February 2021, the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4 percent to 41.5 percent.
The numbers have declined some since the height of the pandemic, says Gail Saltz, M.D., a clinical associate professor of psychiatry at New York-Presbyterian Hospital/Weill Cornell Medical College and a psychoanalyst at the New York Psychoanalytic Institute in New York City. But there are still plenty of lingering stressors that can impact anxiety levels, like loss of a loved one from COVID-19 or economic hardships, she says.
Despite its prevalence, anxiety is often unrecognized in primary care settings, the U.S. Preventive Services Task Force says, and few providers screen for it. But checking for warning signs in patients who aren’t exhibiting clear symptoms could “substantially increase the likelihood that patients receive treatment in a timely manner, potentially saving years of suffering,” the USPSTF says.
If left untreated, anxiety disorders can lead to a number of other health issues. For example, individuals may have trouble functioning normally at home, at work, or in their relationships, Saltz points out. “And leaving that go for long periods of time obviously has real ramifications for a person’s ability to stay engaged in their family, with friends, with work, career development, all of that,” she says.
Untreated anxiety can also lead to clinical depression and can have an impact on everything from blood pressure to peptic ulcer disease to chronic pain disorders. What’s more, it can cause high levels of cortisol, a stress hormone, to circulate in the body. “And we know that chronic high levels of circulating cortisol have damaging effects on the body and the brain,” Saltz says. (Overexposure to cortisol can increase a person’s risk for heart disease and memory and concentration problems, according to the Mayo Clinic.)
“[Anxiety] affects such large numbers of people, and the ramifications of lack of identification and therefore treatment are so substantial that this could make a public health impact,” Saltz said about the recommendations.
What about people 65 and older?
The screening recommendations exclude a large portion of the population — adults 65 and older. And while youth and younger adults have seen a notable increase in anxiety in recent years, older adults are not immune.
In fact, a recent survey conducted by AARP found that 61 percent of participants age 50 and older experienced some level of anxiety in the past year; 45 percent said they were bothered by anxiety. And a 2021 report from the University of Michigan’s National Poll on Healthy Aging found that 28 percent of adults ages 50 to 80 experienced worse anxiety or worry during the pandemic.
Even years before COVID-19 hit, nearly 1 in 10 adults age 60 and older had an anxiety disorder in the previous year, federal data shows.
“I see many older adults who are struggling with anxiety disorders and significant stress who would benefit from treatment. So I feel like this is a population where it’s very important to screen for anxiety,” Gerlach says.
For now, the advice from experts is to stay tuned. Screening recommendations for this age group could come in the near future. The USPSTF is holding off on making recommendations for people 65 and older now because there “just simply isn’t enough evidence” to show that the benefits of screening older adults outweigh any potential downsides, Hudak says.
One such risk is that older adults could be placed on medications that do more harm than good. For example, benzodiazepines are a common class of anti-anxiety medications (Xanax is one example). But in older adults, these drugs can cause side effects like impaired cognition and an increased risk of falls, the National Institutes of Health says.
Another potential concern is that some symptoms of anxiety — take sleep disruption or pain, for example — are more common among older adults, and a screening tool could end up capturing people who have these symptoms for other reasons, not due to anxiety, and could funnel them down the wrong treatment path, Saltz explains.
USPSTF member Gbenga Ogedegbe, M.D., said said in a statement when the recommendations were first proposed, “In the absence of evidence, health care professionals should use their judgment based on individual patient circumstances when determining whether or not to screen.”
Meanwhile, the task force is recommending that all adults — including those 65 and older — continue to be routinely screened for depression.
Recognizing signs of anxiety
Of course, you don’t have to wait for your annual checkup to talk to your doctor about anxiety, especially if you start to notice symptoms. These might include a general sense of worry, panic or feeling like your mind is racing, Gerlach says. Irritability and inability to concentrate can also be warning signs, Saltz adds.
Anxiety often triggers physical symptoms too, notes Hudak, like heart palpitations or shortness of breath. People can also experience an upset stomach, tingling in their hands and fingers and difficulty sleeping. “So certainly, having new unexplained physical symptoms is at least a potential red flag for anxiety,” Hudak says. “And then the other issue is a change in functioning. If you find yourself not going out and being able to do the kinds of things you normally would like to do, that can be a sign of anxiety as well.”
Common Signs and Symptoms of Anxiety
- Feeling nervous or restless
- A sense of impending danger, panic or doom
- Feeling irritable
- Headaches, muscle aches or unexplained pains
- An increased heart rate
- Breathing rapidly
- Sweating
- Trembling
- Feeling weak or tired
- Trouble concentrating or thinking
- Trouble sleeping
- Gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
Sources: Mayo Clinic, National Institute of Mental Health
One thing to note: Everyone experiences anxiety from time to time. It can creep up during a particularly stressful time in life and it can happen during ordinary moments. “If you didn’t have anxiety, you wouldn’t bother to look both ways before you crossed the street,” Hudak says. And this can make recognizing an anxiety disorder difficult. “When it becomes abnormal, it’s hard to point your finger and say, ‘Aha! This is excessive anxiety.’ ”
A telltale sign is just feeling “really bad,” depressed even, Hudak says.
Provider shortage could hamstring efforts
Treatment options for anxiety disorders run the gamut, Gerlach says, and may involve seeing a mental health specialist or therapist who can teach you various tools and techniques to help manage your anxiety. Medications may also be prescribed.
However, some patients could find it difficult to get help right away. Experts argue that one potential downside of the new recommendation is the stress it could add to an already strapped system. (More than 150 million Americans currently live in areas where there’s a shortage of mental health professionals.) Even people who have access to providers may find themselves on long wait lists.
“We don’t have enough mental health professionals in this country now. And if you want to screen people and double the patient population — and there’s a lot of people out there who really, really need treatment — where are they going to go? It’s a real problem,” Hudak says.
Primary care physicians, who are also in short supply, can often help get anxiety treatments started, Gerlach says. But for people experiencing more severe symptoms, a referral to a behavioral health professional or psychiatrist may be best.
“It certainly is a concern that if we have a lot of people screening positive, we want to make sure that we have adequate resources to actually treat and provide the help that patients need,” Gerlach says.
Editor’s note: This story, first published Sept. 22, 2022, has been updated to reflect the finalized recommendations.
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.
