Ought to we display all adolescent women and girls for nervousness? – . Well being Weblog

Anxiety disorders are the most common mental illness, affecting up to 40% of women and 20% of men in their lifetime. Women and adolescent girls are exposed to a particularly high risk of developing anxiety disorders due to different brain chemistry, psychosocial factors such as sexual abuse in childhood and the hormonal effects of estrogen and progesterone. Could early detection lead to improved outcomes given that anxiety disorders are so common in women and girls?

The recommendations of the US experts

In a recently published clinical guideline, the WPSI (Women's Preventive Service Initiative) recommends screening all women and adolescent girls aged 13 and over for anxiety disorders, including pregnant and postpartum women. The WPSI is a national coalition of 21 health organizations and patient advocates that researches and disseminates evidence-based recommendations for women's health care. Their universal screening recommendations are based on a systematic review that shows moderate to high accuracy of the screening tools but clearly recognizes that no studies have assessed the effectiveness or harm of the screening. While these new guidelines recommend a wider network for screening, I, as practicing psychiatrists, shouldn't recommend further screening until the potential harm has been assessed.

Why are the recommendations changing?

Although the US Preventive Services Task Force (USPSTF) recommends routine screening for depression in adolescents and adults, no recommendations have been made for screening for anxiety disorders. The WPSI's recommendations are based on studies showing the accuracy of screening tools, as well as confirming the benefits of treating anxiety disorders with cognitive behavioral therapy and medication.

Are Anxiety Disorders On The Rise?

According to the media, anxiety disorders appear to have increased in recent years, due to various causes: the COVID-19 pandemic, higher performance stress in school or at work, social media use, etc. However, we don't have robust epidemiology data to suggest suggest that the prevalence rate for anxiety disorders has actually increased due to the inaccuracy of data collected prior to the introduction of psychiatric classification systems.

Studies conducted over time with the same population and methodology as the National Comorbidity Survey and data from the European Union have shown no increase in anxiety disorders. However, we know that more people are seeking treatment for anxiety and that more people are willing to talk about their anxiety. We also know that prevalence rates in different countries and cultures are due to differences in the way data are collected rather than cultural differences.

Screening Risks

As with all other medical screening tools, anxiety screening tools have limitations in different populations. Non-Western populations are not represented in the studies used to build screening tools, resulting in decreased accuracy in populations where their use has not been validated. People who live in the United States experience symptoms of anxiety differently depending on their ethnic, racial, and cultural context. For example, anxiety can appear as a physical or mental complaint. In the case of immigrants in particular, the effects of migration, legal status and experiences of discrimination can lead to psychological stress and anxiety, which are not exactly reflected in the tools for anxiety assessment. The risks of screening anxiety in populations where the screening tools have not been validated include diagnostic errors and inappropriate treatment (or lack of treatment).

Even among populations where anxiety screening tools have been validated, universal anxiety screening for women and adolescent girls raises the following concerns:

  • Redirecting resources away from treating people with known anxiety disorders who are already receiving inadequate treatment
  • the high cost of identifying people with mild anxiety who may not benefit from treatment
  • Inappropriate treatment of people due to an incorrect diagnosis as a result of a positive anxiety screen
  • Overprescription of drugs, with an increased number of people suffering from drug side effects
  • Consequences of a wrong diagnosis.

Both the Canadian Health Care Task Force and the UK National Screening Committee are not in favor of questionnaire-based screening for mental illness due to concerns about potential harm and resource use.

The takeaway message

The new WPSI guidelines recommend screening all adolescent girls and women for anxiety disorders. Anxiety disorders are particularly common in women, but they are often not recognized and under-treated. Universal screening for anxiety in this population can help identify those who have anxiety disorders, leading to earlier evaluation and treatment. However, future research is needed to assess the effectiveness of such a screening and assess possible harm.

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