USPSTF Recommendations on Depression and Anxiety Screening
The United States Preventive Services Task Force (USPSTF) recommends that all adults under age 65 get routinely screened for anxiety and all adults get screened for depression. The recommendation is based on data showing that while the benefits of screening for anxiety are questionable, the benefits of treatment are clear; the data around depression show that both screening and treatment are beneficial. Treatment for depression is underutilized, as the CDC reports that “depression is often underdiagnosed and untreated; nearly 60% of women with depressive symptoms do not receive a clinical diagnosis, and 50% of women with a diagnosis do not receive any treatment.” Further, there is a gender gap in depression and anxiety, with women having almost twice the rates of men.
The Task Force specifically recommended that both older adults and pregnant/postpartum women be screened for depression. This is important, as more than 10% of people who have just given birth exhibit signs of postpartum depression. Ten years ago, it was shown that follow-up treatment was key to ensuring that screening was a useful intervention. With the expansion of Medicaid to one-year postpartum in many states and the increase call for mental health parity, we hope that families get the treatment they need.
Importantly, the recommendations do not include adolescents, which is where we see the biggest gender gap in diagnosis. In fact, the largest difference in diagnosing major depressive disorder is in young teens; this could indicate a large need for teen girls, or a huge unmet need for teen boys. Either way, screening for depression would be useful. Overall, approximately 4% of children in the US have depression.
Similarly, anxiety is both more often diagnosed in women and often first diagnosed in early years. One metanalysis showed phobias being diagnosed around age nine and generalized anxiety disorders being diagnosed around age 26. Overall, approximately 9% of children in the US have anxiety.
Lastly, the need for antidepressants and antianxiety medications appears to be growing as we face increasing instability in the US. Early during the COVID public health emergency, there was a shortage of Zoloft, a drug commonly used for both conditions. School shootings, climate change, a decline in gender equality - all of these affect mental health, particularly for teens and young adults. Screening and treatment for mental health conditions should not be limited to adults, but should be available to all who need it.