Should You Get Tested for Anxiety?
New recommendations state that all women and girls 13 and older should be screened for anxiety. Here's what you need to know.
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The world is trembling from two momentous, continuing events: the Covid-19 pandemic and concern and despair over racial injustice. Either one would send anxiety levels sky-high. Together they’re a perfect storm.
So it may seem uncanny that the Women’s Preventive Services Initiative just issued recommendations that all women and girls 13 and over be screened for anxiety as part of their regular healthcare. The WPSI, a national coalition of women’s health professional organizations and patient representatives brought together by the American College of Obstetricians and Gynecologists (ACOG), develops, reviews, and updates recommendations for women’s preventive healthcare services, including the official government-sponsored guidelines that often affect insurance coverage.
“The timeliness of this is unbelievable,” says WPSI chair Jeanne Conry, MD, PhD. “The recommendations were completed last year. Having it published took the next two months and in that time period exactly we look at a pandemic and at Black Lives Matter. What more anxiety-producing time have we seen in our lives?”
A recent Kaiser Family Foundation poll found that about four out of 10 Americans said that worry or stress as a result of coronavirus had negatively affected their mental health. And women were more likely than men to reveal this: 46 percent of women versus 33 percent of men.
Anxiety in women
Women are hardly the only people who feel anxious right now but, in general, they do have more anxiety than men. “Approximately 40 percent of women are affected by anxiety disorders during their lifetimes, which is twice the rate of men,” says Heidi D. Nelson MD, lead author of a review article accompanying the recommendations. “Despite this high prevalence and availability of methods for screening and treatment, only 20 percent of affected persons (men and women) seek care for anxiety.”
The rate of anxiety is even higher (56 percent) among women with major depressive disorder, the review states.
There’s no clear answer as to why anxiety rates are so high among women—there may be a number of reasons. Anxiety risk may be linked to experiences and triggers (like sexual harassment and assaults) that are more common in women, says Dr. Nelson. Anxiety is also associated with pregnancy and the postpartum period. Whatever the reason, anxiety can disrupt all aspects of your life, from school to work to social settings and personal relationships.
Recommended routine screenings for women, which can come from one of many different organizations, include blood pressure, cholesterol, breast cancer, cervical cancer, and depression, to name just a few. Until now, though, anxiety has not been on any list.
The oversight could be explained by reticence: “Women tend not to be very vocal about their anxiety,” says Dr. Conry. “They often don’t come into a health provider and say, ‘I’m really anxious.’ Women don’t bring it up.” And busy clinicians may not have pushed the issue because they’re so busy, she adds.
Every year, the WPSI asks for suggestions of additional screening steps that could improve women’s health across the lifespan. Anxiety was mentioned last year and, after careful review of all the scientific literature, it now takes on the same urgency as cholesterol and blood pressure.
Learn about the signs of an anxiety disorder.
What the recommendations say
The WPSI recommendations state that women and girls 13 and older who do not currently have a diagnosed anxiety disorder should be screened for anxiety. This includes women who are pregnant or who have just had a baby.
The recommendations don’t indicate how often these screenings should occur—they leave it up to the provider. They do, however, suggest that the anxiety screenings be done at the same time as depression screenings, such as during a well-woman visit. The WPSI had already recommended that women have at least one preventive healthcare visit each year.
(Make sure you know the difference between stress and anxiety.)
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Should all women be screened for anxiety?
Ideally, yes. “We believe that all women should be asked some screening questions regarding anxiety and not just those presenting with concerns,” says Dr. Conry. “Why? Because some women do not feel comfortable raising their worries, some may believe that it’s so common that they are ‘making a big deal out of nothing,’ and some need validation. The responsibility is on our shoulders to ask questions, and patients can decline OR ask for more information.”
The recommendations concluded that there were no significant harms to screening.
The new anxiety-screening recommendation has been adopted by the Health Resources and Services Administration (which also funded the review) and will be part of free preventive screening under the Affordable Care Act.
How screening would work
Screening for anxiety is “a simple procedure that can be integrated into routine clinical practice similar to depression screening,” says Dr. Nelson, who is also a professor of medical informatics and clinical epidemiology and medicine at Oregon Health & Science University in Portland.
Basically, a patient answers a series of questions about symptoms, and they can do it either on paper or on a touchscreen before they actually see their practitioner.
The results are then scored, and will indicate if you have anxiety and if further steps are needed, says Dr. Nelson.
The WPSI did not recommend a specific questionnaire—though it did “evaluate studies of 27 instruments and their variations and found them to be accurate indicators of anxiety,” says Dr. Nelson. The different questionnaires pertain to specific populations like adolescents, pregnant women, or older women.
Screening in a provider’s office is just the first step. If the screening identifies symptoms of anxiety, your provider should be able to refer you for additional evaluation and, if needed, treatment. Fortunately, many effective treatments are available, which is part of why the screening recommendations are now in place, says Dr. Conry. They don’t leave you stranded with no options.
Typical first-line treatments for people with anxiety include cognitive behavioral therapy as well as other forms of psychotherapy. “These effectively improve symptoms for most patients,” says Dr. Nelson.
If talk therapy doesn’t help, medication may be needed, according to the recommendations; this many include drugs such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs),. (Here are tips for managing anxiety and panic disorder.)
“For men and women, anxiety is part of life, but a treatable part of life,” says Dr. Conry.
- Annals of Internal Medicine: "Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative."
- Jeanne Conry, MD, PhD, chair, Women's Preventive Services Initiative.
- Kaiser Family Foundation: "Impact of Coronavirus on Personal Health,Economic and Food Security, and Medicaid."
- Heidi D. Nelson, MD, professor of medical informatics and clinical epidemiology and medicine, Oregon Health & Science University, Portland.
- Women's Preventive Services Initiative: "Screening for Anxiety in Adolescent and Adult Women— Systematic Review for the Women's Preventive Services Initiative."
- U.S. Preventive Services Task Force: "High Blood Pressure in Adults: Screening."
- American College of Obstetricians and Gynecologists: "Cholesterol and Women's Cardiovascular Health."
- American Cancer Society: "American Cancer Society Guidelines for the Early Detection of Cancer."
- U.S. Preventive Services Task Force: "Cervical Cancer: Screening."
- U.S. Preventive Services Task Force: "Depression in Adults: Screening."
- Women's Preventive Services Initiative: "Well-Woman Chart."