When Does Anxiety Become a Problem?

The primary care setting is being seen more and more as a place to detect conditions that traditionally are not part of general practice. This enables early interventions with an indisputably positive cost-benefit ratio in terms of health and money.

That is the opinion of the US Preventative Services Task Force (USPSTF), which makes recommendations on the efficacy of specific preventative care services for patients without signs or symptoms of a condition, with the aim of improving health and eventually promoting early treatment.

With this goal in mind, the group recently recommended screening for anxiety disorders in primary care settings in adults ages 18 to 64, including pregnant and postpartum women, who do not have symptoms of this condition.
Anxiety disorders include:

• Generalized anxiety disorder
• Social anxiety disorder
• Panic disorder
• Separation anxiety disorder
• Phobias
• Selective mutism
• Unspecified anxiety

Initial screening tests for the degree of anxiety or possibility of an anxiety disorder are simple: the patient answers a series of questions about how they feel emotionally and what worries them.

What happens if a patient screens positive? Further evaluation is necessary to determine the need for referral or treatment, says the group. Though most positive anxiety screening results will reflect anxiety stemming from a mental disorder that requires further psychological evaluation, some anxiety symptoms will be caused by a physical health condition, such as a thyroid condition, excessive caffeine, or stimulant intake.

Doctors screening for anxiety in the primary care setting should be prepared to rule out these possible causes of anxiety before referring to a mental health professional.

According to data collected in the United States between 2001 and 2002, the lifelong prevalence of anxiety disorders in adults was 26.4% in men and 40.4% in women.

Generalized anxiety disorder has an estimated prevalence of 8.5% to 10.5% during pregnancy and 4.4% to 10.8% during the postpartum period.

Anxiety disorders generally start in childhood and early adulthood, and symptoms seem to decrease with age. Some community epidemiological studies indicate that rates of anxiety disorders are lower in adults ages 65 to 79, but these data need to be updated.

Anxiety disorders especially affect Latino adults: one third of Hispanics with children in low-income families have frequent symptoms of anxiety and depression. There continue to be high barriers to treatment access.

In Latin America, the prevalence of anxiety and depression is 32%, with substantial differences from country to country.

The USPSTF acknowledges that clinical decisions involve more considerations than just evidence. And it believes that doctors should understand this evidence while also adapting their decisions to each specific patient and situation.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.