Contrary to new recommendations from the US Preventive Services Task Force, medical professionals in Canada are warning against routine anxiety testing for adults.
The U.S. Health Guidelines Committee released a draft recommendation earlier this week that U.S. primary care physicians should routinely screen all adults under age 65 for anxiety using standardized questionnaires like the Generalized Anxiety Disorder (GAD) scale.
The panel argues that anxiety disorders are very common in the United States – occurring in 26.4% of men and 40.4% of women – but are often unrecognized in primary care settings, resulting in processing delays of several years. Rates of misdiagnosis are higher in black and Hispanic/Latino patients than in white patients, the draft recommendation notes.
“The USPSTF concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum women, has a moderate net benefit,” the paper states. “(There is) sufficient evidence that psychological interventions to treat anxiety are associated with a moderate magnitude of benefit for reducing anxiety symptoms in adults, including pregnant and postpartum women.”
However, doctors and psychiatrists at three major mental health research institutions in Canada warn that the risks of implementing a systematic 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 Head of the Department of Emergency Medicine at the Cumming School of Medicine at the University of Calgary.
Dr. David Gratzer is a physician and attending psychiatrist at the Center for Addiction and Mental Health.
Dr. Keith Dobson is Principal Investigator of the Mental Health Commission of Canada’s Opening Minds Program and Emeritus Professor of Clinical Psychology at the University of Calgary.
All three told CTVNews.ca they were concerned about the evidence supporting the proposed recommendation, the results of patients automatically screened for anxiety, and how a similar program would be delivered in Canada.
Here are some of the concerns they shared.
OVERDIAGNOSIS, DIAGNOSIS ERROR
Lang said the Canadian Task Force on Preventive Health Care is aware of draft recommendations from their U.S. counterparts, but isn’t convinced that universal screening would actually lead to better patient outcomes.
“The evidence cited in these draft recommendations is actually questionable,” he told CTVNews.ca in a phone interview Thursday. “It shows that you can detect more anxiety, but it doesn’t show that patients will be better off at the end of the day because they are identified or labeled as someone with an anxiety disorder.”
Lang said the observational evidence supporting the recommendations only demonstrates that screening leads to a higher rate of diagnosis, but does not measure whether patients are less likely to be hospitalized, less likely to absent from work or other indicators of well-being. In order to draw these conclusions, he said, US researchers would need to conduct a randomized study.
He said the Canadian task force was also concerned that standardized screening could lead to overdiagnosis and misdiagnosis.
“These polls that are proposed are far from perfect. They have very high false positive and false negative rates as well,” he said. “You could be tagged with a condition that would never have harmed you and that you better not know about.”
Dobson agrees.
“The range of anxiety issues is wide, so screening can identify many people who probably don’t need care,” he told CTVNews.ca in a phone interview Wednesday. “There are many people who deal with anxiety on a daily basis and do not need intervention.”
Finally, Lang said false positives can have major implications for patients, especially when doctors prescribe potentially addictive drugs like benzodiazepines or drugs with moderate or severe side effects.
INADEQUATE RESOURCES
Lang, Dobson and Gratzer also worry about how a mental health care system that is already struggling to serve patients with obvious symptoms of anxiety could accommodate a new influx of anxiety disorder diagnoses.
“The danger with a screening program like this, potentially, is that you add a burden to an already strained system and take away the ability to help those who really need it,” Lang said.
“There are already prolonged delays in being referred to mental health specialists and this is not going to improve if we launch a universal screening program and send more patients, many with false positives, to psychologists. who are already facing extended wait times and waiting lists for patients who need their help.
Lang said a universal anxiety screening program would also add to the workload of primary care physicians in Canada, many of whom are already overstretched.
“We know that doctors are closing offices, retiring, leaving for other types of work. Saying now that you have to screen your patients for anxiety will only increase the workload for family physicians,” he said.
Dobson thinks that a systematic screening program for anxiety could be beneficial in a healthcare system that is less fragmented than Canada’s. For it to work here, he said provinces and the federal government would have to work together to deliver the program consistently across the country.
“For testing 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 the appropriate services for people who test positive,” he said. he declares.
“A significant issue may be that national screening could identify people who would benefit from services, but health care is delivered provincially, so finding services could remain a challenge. In addition, mental health standards and services unfortunately vary across the country. »
Gratzer agrees that federal and provincial governments need to address these gaps in mental health care before they can take steps to create a mass screening program for anxiety.
“At the end of the day, we don’t necessarily need screening. We need better care,” he told CTVNews.ca in a phone interview Thursday. “If we had really well-funded point-of-use cognitive behavioral therapy in Canada, like they’re doing in the UK, that would be different.”
Canada spends about nine cents of every health care dollar on funding mental health care, Gratzer said, compared to 15 cents of every health care dollar in the UK.
“We need to think about funding health care and funding mental health care,” he said.
“A lot of people fall through the cracks of our system. They should get care, they would get care, and yet they can’t get the care they need.