Screening For Anxiety In Women Research Articles

All Women Should be Screened for Anxiety, Federal Panel Says

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAll Women Should be Screened for Anxiety, Federal Panel SaysKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:13 Aug 2020https://doi.org/10.1176/appi.pn.2020.7b6AbstractAPA was integral to the Women’s Preventive Services Initiative’s first recommendation for universal screening for anxiety, which applies to women and girls over age 13.All women and girls over 13 years old should be screened for anxiety, according to the Women’s Preventive Services Initiative (WPSI), a federal panel tasked with developing recommendations for the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services.The recommendation was published June 9 in the Annals of Internal Medicine. This is the first recommendation related to universal screening for anxiety that WPSI has issued.The recommendation that all women and girls over 13 receive anxiety screenings will draw attention to a condition that is often underdiagnosed and undertreated, says APA CEO and Medical Director Saul Levin, M.D., M.P.A.“Anxiety disorders are some of the most prevalent and consequential mental health problems among women in the United States,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in a news release. “This groundbreaking recommendation will be a critical step in the advancement of the diagnosis and treatment of these conditions, which have previously been underdiagnosed and undertreated.”Maureen Sayres Van Niel, M.D., the APA Assembly’s representative to the Caucus of Women Psychiatrists and chair of the Assembly Committee of Representatives of Minority/Underrepresented Groups, was a member of the WPSI Steering Committee and an author of the clinical guidelines published in the Annals of Internal Medicine. She was the first mental health practitioner to be appointed to the panel in 2016 (see Psychiatric News).“This recommendation was a direct result of a collaboration between APA and other major medical associations throughout the country to develop an integrated plan to screen women for mental health problems as well as physical problems during their yearly well-woman visits,” Van Niel said. “The recommendation was approved for services without a copay to allow women of all socioeconomic groups to have equal access to this screening.”The Affordable Care Act requires that some preventive services must be covered without cost sharing, including copays, deductibles, and coinsurance. WPSI, which is led by the American College of Obstetricians and Gynecologists (ACOG), is responsible for recommending which women’s preventive services should be covered.The new recommendation applies to all adolescent and adult women 13 years or older, including pregnant and postpartum women. WPSI does not stipulate at what intervals screenings should occur and notes that clinicians should use their judgment when determining screening frequency.“Given the high prevalence of anxiety disorders, lack of recognition in clinical practice, and multiple problems associated with untreated anxiety, clinicians should consider screening women who have not been recently screened,” the recommendation states.Given recent events, it is especially important that women are screened for anxiety disorders now, Van Niel said. “This is a time when we are all experiencing national trauma. Anxiety levels, especially in women, have been shown to have increased due to the COVID-19 pandemic,” she said. “Additionally, the severe anxiety caused by structural racism is very significant, and it is especially evident right now.”She continued, “The U.S. Preventive Services Task Force recommends yearly screening for depression in all adults and adolescents and adding this universal screening for anxiety in women can be performed easily at the same time. The screening of men for anxiety disorders should also be addressed.”WPSI’s recommendation is especially important because the incidence of anxiety and depressive disorders in women is twice that of men, Van Niel pointed out. This increased incidence may be due to ongoing stresses women face, including carrying more of the household and childrearing responsibilities, experiencing a higher incidence of childhood and adult sexual abuse, and continued financial inequities due to a lack of paid leave and lower pay for equal work, she explained.“It is possible that, by correcting these social inequities, we can reduce the incidence of anxiety disorders in women,” she said.In an editorial accompanying the guidelines’ publication in the Annals of Internal Medicine, Kim G. Smolderen, Ph.D., and Matthew M. Burg, Ph.D., of the Yale University School of Medicine, emphasized the need to understand why so many women across age groups are struggling with anxiety. “Tools like the WPSI screening recommendations directed toward vulnerable groups are great first steps, but only one of the many elements needed to address mental health crises,” the authors wrote. ■“Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative” is posted here.“Screening for Anxiety in Adolescent and Adult Women” is posted here.“Awareness for Anxiety in Women: A Great Start” is posted here. ISSUES NewArchived

Annals for Educators - 7 July 2020.

Annals for Educators - 7 July 2020.

Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative.

The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors. The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.

Using the Edinburgh postnatal depression scale to screen for anxiety disorders: Conceptual and methodological considerations

BackgroundPerinatal anxiety symptoms and disorders are prevalent and disabling but have not to date been a focus for specific clinical and public health attention. The EPDS is widely used to detect probable depression, and many studies have also found that three items from this scale load on an anxiety factor, in both the antenatal and postnatal periods. In addition, studies have found clinically significant correlations between the EPDS and various anxiety-specific measures in the perinatal period. The aim of this paper is to examine studies which address the capacity of the EPDS to detect anxiety disorders, to assess whether the EPDS performs differently in women with depressive or anxiety disorders and to consider the implications for future research and clinical practice. MethodsThe English-language perinatal mental health literature was searched. Six studies with data pertaining to the capacity of the EPDS to detect perinatal anxiety disorders in women were identified. These studies provide information on i) comparison of total EPDS score by diagnoses of anxiety and depression and ii) comparison of the anxiety subscale score (EPDS-3A) by diagnoses of anxiety and depression. ResultsThere is evidence from both sets of information that the EPDS is useful for screening for anxiety in women and emerging evidence that Total EPDS and EPDS-3A can distinguish depression from anxiety reliably. LimitationsThe findings are based on a small number of studies, conducted in a variety of clinical and community settings in different languages and countries, and with variable sample sizes, some of which lack power to ensure reliable conclusions. ConclusionsThe EPDS appears to detect perinatal anxiety disorders, but further research is required to establish the clinical and public health value of the EPDS for this purpose, and whether it has more robust psychometric properties or is more feasible and acceptable than existing anxiety-specific measures.