Anxiety disorders are the most common mental illnesses, affecting up to 40% of women and 20% of men in the course of their lifetimes. Women and adolescent girls are at particularly high risk for the development of anxiety disorders, due to differences in their brain chemistry, psychosocial contributors such as childhood sexual abuse, as well as the hormonal effects of estrogen and progesterone. Since anxiety disorders are so common among women and girls, could early detection lead to improved outcomes?
The US expert recommendations
In a recent clinical guideline, the Women’s Preventive Service Initiative (WPSI) recommends screening all women and adolescent girls ages 13 and older for anxiety disorders, including pregnant and postpartum women. The WPSI is a national coalition of 21 health professional organizations and patient representatives that researches and disseminates evidence-based recommendations for women’s preventive health care services. Their universal screening recommendations are based on a systematic review that demonstrates moderate to high accuracy of screening tools, but clearly acknowledges that no studies have evaluated the effectiveness or harms of screening. While these new guidelines recommend a wider net for screening, as a practicing psychiatrist I believe we should not recommend further screening until the potential harms have been evaluated.
Why are the recommendations changing?
Although the US Preventive Services Task Force (USPSTF) recommends routine screening for depression in adolescents and adults, no recommendations for the screening of anxiety disorders have previously been made. The WPSI’s recommendations are based on studies demonstrating the accuracy of screening instruments, as well as confirmation of the benefits of treatment of anxiety disorders with cognitive behavioral therapy and medications.
Are anxiety disorders on the rise?
According to the media, it seems that anxiety disorders have been increasing in recent years, attributed to various causes: the COVID-19 pandemic, greater performance stress at school or work, social media use, etc. However, we do not have robust epidemiologic data suggesting that the prevalence rate for anxiety disorders has truly increased, due to the imprecision of data collected before the introduction of psychiatric classification systems. Studies conducted with the same population and same methodology over time, such as the National Comorbidity Survey and data from the European Union, have not demonstrated an increase in anxiety disorders. We do know, however, that more individuals are seeking treatment for anxiety, and that more people are willing to speak about their anxiety. We also know that prevalence rates in different countries