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Why doctors will ask you about anxiety

28 September 2022
Why doctors will ask you about anxiety

Think back to your last few annual check-ups. What questions did your doctor ask? Which blood tests did they order? Did they recommend any new vaccinations or cancer screenings? The answer may differ each year since your primary care provider will tailor your visit based on your age, sex, and baseline health.
If you are under the age of 65, your future check-up may soon include questions about anxiety symptoms. This scenario is based on a draft recommendation proposed by members of the U.S. Preventive Services Task Force (USPSTF).
USPSTF is an independent panel of primary care experts that assesses the effectiveness of medical interventions to develop recommendations for health providers in the United States. Their evidence-based guidelines are why doctors check blood pressure in adults, recommend syphilis tests in pregnant women, and order colonoscopies for patients over 50. The guidance set forth by USPSTF has likely saved thousands, if not millions, of lives, by preventing illnesses or catching diseases early in their course.
Now, among their recommendations, the USPSTF may recommend adding screening for anxiety disorders as part of a routine annual visit. One of the reasons for this inclusion is that anxiety in the United States has risen from 36.5 percent to 41.5 percent from August 2020 to February 2021, according to the Centers for Disease Control and Prevention.
Anxiety is a normal and adaptive response to the possible presence of danger; it allows our evolutionary ancestors to survive hostile environments filled with predators and other physical hazards. But in our modern world, our anxiety mechanisms can become maladaptive, as people who struggle with anxiety disorders experience overwhelming and persistent worries.
Unfortunately, science is still far from fully understanding anxiety. Still, researchers believe these disorders are based on biological and environmental factors. For some, anxiety may run in their family; for others, their anxiety may be primarily situational.
Considering the existential threats faced by our society, I am not surprised by the increased prevalence of anxiety disorders. For one, the world has collectively undergone a major traumatic event; the World Health Organization reported that the global prevalence of anxiety and depression increased by 25 percent in the first year of the pandemic. At the time of writing, 6.5 million people have died of COVID-19, with over one million deaths from the United States alone. The pandemic and its sequelae will reverberate through our psyche for years-perhaps generations-to come.
We also have other good reasons for being so anxious. Americans have faced increasing political polarization, rising crime rates across the country, and a looming economic recession. And those are just some of the newer problems. We must still contend with long-standing issues, such as climate change, nuclear proliferation, and the widening socioeconomic gap between the rich and the poor, to name a few. At this point, none of these issues seems likely to improve any time soon.
While the problems are here to stay, asking more questions about anxiety disorders will lead-appropriately-to an increased number of diagnoses. Incorporating anxiety screening in doctor's visits will encourage more patients to access therapy and pharmacological tools to improve their mental health. Still, while these screenings will help individuals better cope with reality, they won't address the broader, systemic issues that pushed us into this dismal situation in the first place. In short, we may be able to change ourselves, but we remain powerless to tackle the most pressing issues of our time.
So in all, I applaud the effort and the recommendations made by USPSTF. If implemented, the proposal will help more Americans improve the quality of their lives. However, to fully address Americans' mental health, we can't be content with just re-framing our well-founded worries through therapy or modulating our brain chemistry. We need to implement lasting societal change, which will require work and resources far beyond that of well-meaning healthcare providers.

(Yoo Jung Kim, M.D., is a physician at a major academic hospital in Chicago. She is the co-author of What Every Science Student Should Know).
Yoo Jung Kim

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