Mental Health Crisis in U.S. Spurs New Recommendations for Anxiety Screenings

A mental health crisis in the United States has led a panel of experts to recommend that primary care physicians start screening their adult patients for anxiety disorders.

The recommendation is long overdue, says Christine Marrero, D.O., a family medicine physician with Baptist Health Primary Care who believes the nation is facing an epidemic of mental illness, with anxiety and depression at the very top of the list.

Christine Marrero, D.O., a family medicine physician with Baptist Health Primary Care

“I’m seeing anxiety and depression on a daily basis in my practice,” Dr. Marrero reports. “The most common complaint I hear from patients is that they feel fatigued or they’re having trouble sleeping, which are often associated with underlying depression or anxiety.”

The recommendation from the U.S. Preventive Services Task Force, published earlier this month in JAMA, the American Medical Association’s journal, stems from concerns about “aburgeoning mental health crisis, with growing concerns about depression, anxiety and suicide,” according to a report in the Washington Post.

The new guidelines state that “asymptomatic adults ages 19 through 64, including those who are pregnant and postpartum, should be screened for anxiety disorders, using questionnaires and other screening tools.”

The same independent panel of doctors and other experts – appointed by the Department of Health and Human Services – also issued a recommendation last October that children ages 8 to 18 be screened for anxiety.

Anxiety takes different forms

“Some degree of anxiety in life is normal,” Dr. Marrero says. “However, if it is impacting your sleep, your health and your overall well-being, you should talk to a health care provider.” Primary care physicians are in a unique position to help identify if a patient is suffering from anxiety, she says, and to recommend first-line approaches for treatments.

Anxiety can take different forms and isn’t always apparent, according to Dr. Marrero. “However, if a patient reports that they’re easily irritable, can’t stop worrying, has trouble relaxing or feels restless, or has a sense of impending doom, like something bad is about to happen, that’s when I know I’m not just treating something physical.”

Dr. Marrero explains to these patients that they are not at all “crazy” and that there are many, many others like them who also suffer from anxiety. “I tell them that I see this every day – as much as I do high blood pressure and cholesterol – and that there is nothing wrong with seeking help,” she says.

Most people only see their doctor when they’re not feeling well physically, or for their annual physicals and vaccinations. So how does a primary care physician get a patient to talk about how they’re feeling emotionally?

“I first try to make some conversation, asking them what they do for work, if they have a family, that sort of stuff – just to get a sense of where they are,” Dr. Marrero says. “I also ask how everything is going in general and if there is anything else they were maybe feeling reluctant to share for whatever reason. With a little bit of gentle prodding, something usually bubbles up.”

Several factors driving anxiety

What’s behind the nation’s anxiety epidemic? Dr. Marrero says a global pandemic spanning more than two years certainly contributed to our collective anxiety levels, but she points to other factors, too, including the rising cost of living.

“Some of our patients report having to work extra jobs or that they have extra demands placed on them at work while they’re struggling every day to pay for basic necessities such as food, medication and housing,” Dr. Marrero says. “That can create a tremendous amount of anxiety, on top of all of the other daily stresses that life brings.”

But the leading cause of our nation’s anxiety epidemic may be right in the palms of our hands, Dr. Marrero believes. She says a number of her patients identify social media as being a trigger for their anxiety.

“Virtually every teen has a smart phone and lives their life on social media,” Dr. Marrero says. “They’re constantly comparing themselves to what other people post and comparing their timelines with those of others. She says social media is “not at all beneficial to becoming a confident, well-adjusted and emotionally balanced adult.”

Emphasizing the link between one’s emotions and one’s health, Dr. Marrero says it can be “very difficult” to take care of your physical health if your emotional health is not looked after first. “For some people, it can be hard to do the things that are necessary, such as going to the doctor for a physical,” she says. “They may have paralyzing anxiety that the doctor is going to find something wrong.”

Dr. Marrero believes it is important to raise awareness of mental health and work to remove the stigma behind it, which prevents many people from seeking help.

“The panel’s recommendations are an important step towards increasing awareness and diagnosis of anxiety and directing patients towards resources for treatment,” Dr. Marrero says. “People often don’t realize that their symptoms may not necessarily be physical in nature but in fact due to underlying anxiety.”