Contrary to new recommendations from the US Preventive Services Task Force, health professionals in Canada are warning against routine anxiety testing for adults.
The American Health Advisory Board earlier this week released a draft recommendation that US primary care physicians should regularly screen all adults under the age of 65 for anxiety using standardized questionnaires such as the Generalized Anxiety Disorder (GAD) scale.
The panel argues that anxiety disorders are common in the US — they occur in 26.4 percent of men and 40.4 percent of women — but that they often go unrecognized in primary care, leading to years of delays in treatment . Misdiagnosis rates are higher in black and Hispanic/Hispanic patients than in white patients, the draft recommendation said.
“The USPSTF concludes with moderate confidence that screening for anxiety in adults, including pregnant and postpartum individuals, has a moderate net benefit,” the document said. “(There is) sufficient evidence that psychological interventions to treat anxiety are associated with a moderate benefit for reduced anxiety symptoms in adults, including pregnant and postpartum individuals.”
However, doctors and psychiatrists from three major mental health research organizations in Canada warn that the risks of implementing a routine anxiety screening program here would likely outweigh the benefits.
dr Eddy Lang is a member of the Canadian Task Force on Preventive Health Care and the Department of Emergency Medicine at the University of Calgary Cumming School of Medicine.
dr David Gratzer is a Physician and Attending Psychiatrist at the Center for Addiction and Mental Health.
dr Keith Dobson is Principal Investigator for the Mental Health Commission of Canada’s Opening Minds program and Faculty Professor Emeritus in Clinical Psychology at the University of Calgary.
All three told CTVNews.ca they had concerns about the evidence supporting the draft recommendation, the outcomes of patients being automatically screened for anxiety, and how a similar program would be implemented in Canada.
Here are some of the concerns they shared.
Lang said the Canadian Task Force on Preventive Health Care is aware of its US counterparts’ draft recommendations but is not convinced that universal screening would actually lead to better outcomes for patients.
“The evidence presented in these draft recommendations is indeed questionable,” he told CTVNews.ca in a phone interview on Thursday. “It shows that you can recognize more fear, but it doesn’t show that patients are better off at the end of the day because they are identified or labeled as having an anxiety disorder.”
Lang said the observational evidence supporting the recommendations only shows that screening results in higher diagnosis rates, but doesn’t measure whether patients are less likely to be hospitalized, less likely to miss work, or other indicators of well-being. To draw these conclusions, the US researchers would have to conduct a randomized study.
He said the Canada Task Force is also concerned that standardized screening could lead to over- and misdiagnosis.
“These polls that are being proposed are far from perfect. They have very high false positive rates and also false negatives,” he said. “You could be labeled with a condition that would have never harmed you and that you shouldn’t have known about.”
“The spectrum of anxiety problems is wide, so screening can identify many people who are unlikely to need care,” he told CTVNews.ca in a phone interview on Wednesday. “There are many people who deal with anxiety on a daily basis who don’t need an intervention.”
Finally, Lang said false positives can have a significant impact on patients, especially when doctors are prescribing potentially addictive drugs like benzodiazepines or drugs with moderate or severe side effects.
Lang, Dobson, and Gratzer also worry about how a mental health care system already struggling to care for patients with overt symptoms of anxiety might handle a new influx of anxiety disorder diagnoses.
“The potential danger with a screening program like this is that you’re putting extra strain on an already overburdened system and taking away the opportunity to help those who are really in need,” Lang said.
“There are already longer delays in referrals to mental health specialists, and it’s not going to get any better as we start a universal screening program and send more patients, many with false positives, to mental health professionals who are already dealing with longer wait times and waiting times.” are struggling lists for patients who need their help.”
Lang said a universal anxiety screening program would also increase the workload of primary care physicians in Canada, many of whom are already overburdened.
“We know that doctors are closing offices, retiring and leaving for other work. Saying now that you need to screen your patients for anxiety is only going to put more strain on GPs,” he said.
Dobson believes a routine anxiety screening program could be beneficial in a less fragmented healthcare system than Canada’s. For it to work here, the provinces and federal government would need to work together to implement the program consistently across the country.
“For screening to be done well, it needs to be done nationally, it needs to be readily available and there needs to be a clear link to appropriate services for people who test positive,” he said.
“One important issue may be that national screenings could identify people who would benefit from services, but health care is provided by the province, so finding services could remain a challenge. The standards and mental health services are also unfortunately different in this country.”
Gratzer agrees that federal and provincial governments need to close these mental health care gaps before they can take steps to create a mass anxiety screening program.
“Ultimately, we don’t necessarily need screening. We need better care,” he told CTVNews.ca in a phone interview on Thursday. “If we had really well-funded point-of-use cognitive behavioral therapy in Canada like they do in the UK, it would be different.”
Canada spends about nine cents on every health care dollar funding for mental health care, Gratzer said, compared to 15 cents on every health care dollar in the United Kingdom.
“We need to think about funding for health care and mental health care,” he said.
“Many people fall through the cracks in our system. They should get care, they would benefit from care, and yet they cannot get the care they need.”