The benefits and harms of screening for anxiety disorders in asymptomatic adults

In a recent study published in the JAMA Journal, researchers examined the different aspects of screening for anxiety disorders in adults.

Study: Screening for Anxiety Disorders in Adults. Image Credit: tomertu/Shutterstock.com

Background

Anxiety disorders are prevalent mental health conditions and include generalized anxiety disorder, panic disorder, social anxiety disorder, separation anxiety disorder, selective mutism, phobias, and anxiety not otherwise specified.

Notably, anxiety disorders frequently go unnoticed in primary care settings, leading to significant delays in treatment initiation. Anxiety disorders can involve long-term conditions that involve periods of recurrence and remission. However, complete recuperation is possible.

About the study

A systematic review was conducted by the US Preventive Services Task Force (USPSTF) to assess the advantages and disadvantages of screening for anxiety disorders among asymptomatic adults.

Ten studies were conducted to assess the precision of screening anxiety disorders using various instruments such as Generalized Anxiety Disorder (GAD), Geriatric Anxiety Scale (GAS), Patient Health Questionnaire-Panic Disorder, or Edinburgh Postnatal Depression Scale (EPDS) anxiety subscale. The GAD-2 and GAD-7 were the most frequently researched instruments.

A total of 24 randomized controlled trials and eight systematic reviews were conducted to evaluate the effectiveness of psychological interventions in treating anxiety disorders.

Out of the 24 trials, 14 were conducted in mixed populations of individuals with depression or anxiety disorders, while the remaining ten trials were conducted in individuals with anxiety symptoms or disorders.

Results

The studies were conducted on older adults aged 65 years or older, pregnant patients, and adults from primary care. The ten studies included participants with a mean age range of 29 to 75 years and a higher proportion of women than men were represented.

Six studies reported race and/or ethnicity, with three studies performed in mainly White participants, one study in South Korean participants, and one study in Hispanic/Latino participants.

The GAD-2 and GAD-7 tests have shown sufficient specificity and sensitivity in identifying generalized anxiety disorder. The GAD-2’s ability to identify generalized anxiety disorder was reported in three studies conducted among general adult populations.

The GAD-2 has a pooled sensitivity of 0.94 and a pooled specificity of 0.68 for detecting generalized anxiety disorder at a cutoff of two or higher. The pooled sensitivity and specificity were 0.81 and 0.86, respectively, at a cutoff of 3 or higher.

The GAD-7 test accuracy was reported in three studies using different cutoff scores: eight or greater, nine or greater, and ten or greater. The study found that the pooled sensitivity to identify generalized anxiety disorder was 0.79, with a pooled specificity of 0.89 when using a cutoff of 10 or greater.

The studies’ sensitivity ranged between 0.67 and 0.89, while their specificity ranged between 0.82 and 0.95. Lower cutoffs resulted in higher sensitivity but lower specificity. Overall, the GAD-7 performed equally or superiorly to the GAD-2.1.

A study on pregnant individuals found that the GAD-2 test had a sensitivity of 1.0 and a specificity of 0.60 in detecting generalized anxiety disorder when a cutoff of one or higher was used. The sensitivity and specificity to identify generalized anxiety disorder were 0.69 and 0.91, respectively, at a cutoff of three or greater.

The screening tool utilized in this study of pregnant individuals exhibited comparable performance features to the screening tool employed in a general adult population, mostly under 65 years. The USPSTF extended the findings on the precision of the GAD-2 in younger individuals to persons who are pregnant or have recently given birth.

The available proof on older adults is insufficient. Most studies lacked accurate information related to screening tools in older individuals. A recent study on elderly individuals assessed the effectiveness of GAS in identifying anxiety disorders.

The study used cutoffs ranging from more than nine to greater than 16. A cutoff value of over nine showed the best balance between specificity and sensitivity.

Psychological interventions were found to have a slight yet statistically significant effect on reducing the severity of anxiety symptoms in primary care patients having anxiety disorders. However, this effect was not observed in mixed populations of depression or anxiety disorder patients.

Improved depressive symptom severity and quality of life were observed in general adult populations receiving psychological treatment. Similar results were found for perinatal individuals.

Conclusion

The team noted limited evidence on the advantages of anxiety disorder screening programs. Screening for anxiety disorders in individuals younger than 65 years and perinatal persons was beneficial.

Screening tools have demonstrated accuracy in identifying generalized anxiety disorder, and treatment for generalized anxiety disorder patients has been supported by evidence.