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Anxiety disorders are often underdiagnosed and underdiagnosed in primary care: a study cited by the Task Force found that the median time to initiation of treatment for anxiety was staggering. 23 years.
While the task force’s initial discussion on anxiety testing predates the coronavirus pandemic, the new guidelines come at an especially important time, said task force member Lori Pibert, a clinical psychologist and professor at the Massachusetts Institute of Technology Chan Medical School in Worcester, Mass.
“Covid has taken a toll on Americans’ mental health,” Pibert said. “This is a priority topic of public health importance, but obviously there has been a greater focus on mental health in this country over the last few years.
In April, the task force issued similar recommendations for starting anxiety Screening of children and adolescentsAges 8 to 18. The proposal released Tuesday focuses on young and middle-aged adults, including those who are pregnant and postpartum, citing research that suggests screening and treatment can improve symptoms of depression in those under 65.
But the guidelines, surprisingly, stop short of recommending stress testing for people age 65 and older.
One reason: Many common signs of aging, such as sleep problems, pain and fatigue, can be symptoms of stress. The task force said there is insufficient evidence to determine the accuracy of screening tools for older adults, which may not be sensitive enough to detect signs of stress and conditions of aging.
The task force recommended that clinicians use their judgment in discussions with elderly patients. The task force He also reiterated earlier advice that adults of all ages should be screened regularly for depression.
The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, is highly influential, and while its recommendations are not binding, the panel’s recommendations often change the way doctors practice medicine in the United States.
Some doctors have asked how the recommendations play out in the real world, where Mental health providers In the past, they say they have not been able to meet the needs of the patient, and patients complain of waiting months for an appointment with a therapist.
“Screening is great, but it’s confusing if there’s no plan to provide additional funding for clinics, given the critical shortages in manpower,” said Eugene Beresin, M.D., MD, a psychiatrist at Massachusetts General Hospital. Clay center for healthy minds of young people.
The World Health Organization reported that the global prevalence of anxiety and depression increased by 25 percent in the first year of the epidemic. reported earlier this year. In the year By the end of 2021, the World Health Organization said, “The situation has improved somewhat, but today far too many people do not have access to the care and support they need for pre-existing and newly developed mental health conditions.”
Anxiety, in its terrifying and gut-wrenching, physical symptoms of palpitations, sweaty palms, generalized anxiety disorder, social anxiety disorder, panic disorder, and more, can be diagnosed.
These together The most common mental illnesses They are afflicting 40 million adults in the United States every year, according to the American Anxiety and Depression Association. Treatment may include psychotherapy, especially cognitive behavioral therapy; Antidepressants or antidepressants; As well as various sedation, consciousness and unconsciousness treatments, doctors said.
The panel reached this conclusion despite considering the benefits of screening patients for suicidal risk. Although suicide is the leading cause of death in adults, “there is insufficient evidence that screening people without signs or symptoms ultimately helps prevent suicide.”
Still, the panel urged providers to use their own clinical judgment to decide whether each patient should be evaluated for suicidality.
For primary care physicians, already under stress “Crisis” With burnout, epidemic-driven stress, and their own mental health challenges, adding another screening test to a long list of clinical tasks can feel daunting.
“If primary care providers are asked to diagnose one more thing, we’re going to break even without additional resources,” said one nurse practitioner in Northern California, who spoke on condition of anonymity because she was not authorized to speak from her clinic. About it.
Eliminating current requirements such as routine screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, she said everything should be completed in a 15-minute appointment. Treating complex, chronic patients.
“It’s only wrong if people test positive for depression or anxiety, and we don’t have the mental health support to help them,” the expert said.
But Mahmuda Qureshi, MD, an internal medicine physician at Massachusetts General Hospital, said extra support can help patients suffering from depression or anxiety.
“After 2020, it’s the rare patient who doesn’t feel anxious,” says Qureshi, who now routinely asks patients, “How’s your anxiety?” She said she would ask. “We’ve found that when it comes to mental health, if we don’t ask, we often don’t know.”
The task force acknowledges the challenge of delivering mental health care to all those in need, stating that “less than half of individuals with mental illness receive mental health services.”
The panel also noted that “racism and structural policies” disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services compared to other groups, and that misdiagnosis of mental health conditions occurs more frequently in black and Hispanic populations. Patients.
Pebert said the latest guidance is just one step in addressing patients’ urgent mental health needs. “Our hope is that this set of recommendations will raise awareness of the need to develop high-quality mental health services across the country,” she said, adding that “by highlighting gaps in the evidence, funders will support much-needed research in these areas.”
The recommendations are open Public opinion Until October 17, after which the task force will consider them for final approval.
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