Last year for the first time ever, the nation's top panel of preventive health experts, the U.S. Preventive Services Task Force, or USPSTF, recommended that doctors routinely screen all adult patients under 65 for anxiety disorder. Evidence shows that anxiety screening can help those patients find peace of mind, as the USPSTF said in recommendations that were published in the Journal of the American Medical Association in June of 2023.
The Task Force found for patients age 19 to 64 evidence is robust that screening leads to a reduction of symptoms of anxiety, which of course also benefits overall quality of life. The Task Force also reiterated its longstanding recommendation that all adults receive regular depression screening.
USPSTF vice-chair Silverstein wrote, "We were able to identify effective practices to screen the adult population for common and serious mental health disorders. The good news is that screening for depression and anxiety can identify these conditions early. When this screening is linked to quality mental health care, patients benefit.”
However, the task force did not recommend anxiety screening for seniors because in the population 65 and older, the USPSTF didn't see the same quality of evidence that spoke to those outcomes.
The American Psychiatric Association president Dr. Petros Levounis also contributed to the JAMA report, noting that “the pandemic highlighted the importance of mental health care for Americans. The global prevalence of anxiety and depression increased by 25% in the first year of the pandemic, according to a 2022 scientific brief from the World Health Organization. Depression and anxiety disorders are prevalent in the United States—it's estimated that one in five people could have an anxiety disorder at any given point—and it's gotten worse since COVID. Often depression and anxiety disorders go undetected, and if a mental health disorder goes untreated it can get worse."
Evidence shows that two simple screening tools were accurate in screening for generalized anxiety disorder, the USPSTF said. One of the tools, the GAD-2, contains just two questions: “Over the last two weeks have you been feeling nervous, anxious or on edge?” and “Have you been unable to stop or control worrying?” The longer tool, GAD-7, contains a list of seven similar questions. Clinicians conducting screenings have training so they can follow-up on positive screens with a few questions, such as the duration of symptoms, degree of distress and impairment, and current or previous treatment history, to better determine clinical significance and the need for treatment. This initial assessment and treatment planning has been shown to improve outcomes.
Likely all of us seniors have younger people in our lives who seem more anxious, more time-constrained and more pessimistic about the future than we are. We are all living together in this hard and scary time, however older folks have the benefit of appreciating the long arc of the lifespan. At age 20 or 30 or even 40, I truly had absolutely no understanding of what life inside a nearly 70-year old body would be like. The body part can be challenging! But mentally and emotionally I feel so much more mellow, accepting and interested in de-escalating tense conversations – a trait I share with most of my fellow elder folk. Because our time on earth is short now, each day and each moment becomes more precious. Our attitudes come more under our control so we have a choice as to how to respond to our fellow humans at the grocery store or in a board meeting or online. I used to think that thoughtful, kind people were just born that way. Likely they put in the extra effort to become part of the solution to a hectic and unpeaceful world.
I propose that we seniors take extra care to recognize that coming up in the world now often feels overwhelming or even terrifying for younger adults, who may well see fewer possibilities to get established and create a secure basis for personal development. We all deserve to live our best lives—and younger people are not always appreciating the path forward. Let’s be forgiving and generous and kind—because that feels really good.`
This is not to say that seniors can’t get depressed or feel anxious. Please reach out for help if you are troubled. But if you see an opportunity to smile, to share soup or a hug—do it. A well known psychological fact is that helping others is one of the very best ways to feel better, through satisfying the deep need for connection. Seniors get that—that’s why we tend to be super-volunteers and super-voters. Take a risk – connect more!
Emily Kane is a naturopathic doctor based in Juneau. Contact her online at http://www.dremilykane.com.
