U.S. Task Force Releases New Mental Health Screening Recommendations

June 26, 2023

In an effort to identify and treat anxiety disorders early on, clinicians should screen adults ages 19 to 64 in primary care settings, according to a new recommendation by the U.S. Preventive Services Task Force released in June and published in JAMA.^{1, 2} The task force also recommended routine screenings for major depressive disorder among adults, including pregnant and postpartum people.

It was the first time the task force, an independent panel of clinicians whose recommendations influence doctors’ standard practices and insurance plans, called for anxiety screenings in adults. The recommendations will help clinicians identify and provide, or refer treatment, for adults who do not appear to exhibit recognized signs of depression or anxiety.

The task force said that anxiety and depression often overlap, citing one study’s findings in which 67% of individuals with a depressive disorder also had an anxiety disorder. Yet a lack of “underdetection appears to be common,” the task force said. Only 11% of adults with an anxiety disorder started treatment with the first year of onset; the median time of treatment initiation was 23 years, according to the task force. Women, Black and non-Hispanic people, as well as those in poor socioeconomic conditions, were more likely to experience higher rates of anxiety, the task force said.³

Screening for Anxiety and Depression

Evidence-based screening recommendations were made for the following groups:

• For anxiety: Adults aged 19 to 64, including those who are pregnant or postpartum
• For depression: Adults aged 19 or older, including older adults over the age of 65 and those who are pregnant or postpartum

The task force also reviewed the evidence on suicide risk screening in adults and older adults in primary care but did not make a recommendation.

The statements on suicide risk and depression remain consistent with those released in 2014 and 2016, respectively. In its previous and updated recommendations, the task force found fair evidence to support depression screenings for the general adult population (“B” grade), but not enough to screen for suicide risk (“I” statement). A systematic review commissioned by the task force cited critical gaps in research, including the potential harms of suicide risk interventions and the need for treatment studies in populations with positive screening results.⁴ Suicide is the tenth leading cause of death for adults in the U.S.⁵

The Impact on Adults with ADHD

Adults with ADHD are at an increased risk for developing comorbid depression and anxiety.⁶ As a result, clinicians should give special attention to identifying and differentiating the symptoms of each condition during healthcare screenings and in follow-up care. This is especially true for women who commonly go undiagnosed or misdiagnosed, which may be due in part to internalizing or masking their ADHD symptoms.⁷

In a survey of 1,542 people conducted by ADDitude in 2022, more than half of adults reported feelings of depression, mood changes, and excessive worry. More than 70% reported diagnoses of anxiety, depression, or both. Yet more than one-third (35%) said they were not receiving mental health care to address these symptoms. Time restraints (including wait lists) and high costs were most often cited as barriers to care.

Depression and anxiety also disproportionately affect pregnant women with ADHD, who are six times more likely to experience postpartum anxiety and five times more likely to experience postpartum depression than women without ADHD.⁸

Implications and Additional Recommendations

In the latest task force recommendations, adults who test positive in depression and anxiety screening results should be followed up with diagnostic assessments and evidence-based care. Anxiety disorders reviewed include generalized anxiety disorder, social anxiety disorder, and panic disorder.

Treatments for anxiety disorders and depression can include cognitive behavioral therapy and antidepressant medication. If left untreated, anxiety and depression disorders can interfere with daily living.

If you are experiencing thoughts of suicide, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988, or by visiting https://988lifeline.org/.

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