Should US adults under 65 get routine anxiety screening for depression and other mental illnesses? The answer is yes according to new recommendations from psychologists and physicians. It’s been a long time since the United States Preventive Services Task Force (USPSTF) recommended screening for mental health conditions in primary care settings. While this is just a proposal, the panel has made it open to public comments until October 17.

The recommendations are based on a study conducted prior to the COVID-19 outbreak, which evaluated the potential benefit and risks of mental health screenings. Mental health experts say the coronavirus outbreak has increased anxiety and depression among people who are not used to living under lockdown conditions. Evidence suggests that benefits, including effective treatments, outweigh any risks, which include inaccurate screening tests that may lead to unnecessary follow-ups.

Dr. Les Kertay, Axiom Medical’s Senior Vice President for Mental and Behavioral Health, shares his thoughts on this. “While this is all over newsfeeds, mostly with accolades for ‘finally’ recommending universal screening for anxiety, it may be heresy for a behavioral health specialist to say this. Still, I’m not much of a fan,” says Dr. Kertay.

He further shares his opinion on universal screening.

“What was the impact of universal screening with the 1-10 pain scale?” asked Dr. Kertay. “Not to put too fine a point on it, the impact was the opioid epidemic.” What has been the impact of near-universal screening for depressive symptoms – you know, answering those two questions about how much of the last two weeks you’ve been feeling sad, down, or hopeless and/or having less interest and pleasure in things – at virtually every medical appointment? Yes, we’ve been able to identify people who will benefit from mental health care and may have saved a few lives, but we’ve also gotten a considerable number of antidepressant medications, side effects and all, prescribed solely based on screening that isn’t diagnostic, without good follow up care. In both cases, there have been some good things, but with unintended consequences that are anything but benign.

So should we talk to patients about their worries and how they cope with them? Absolutely. But universal symptom screening without a plan in place for how we will follow up for true diagnostic workup, and how we will treat the host of new ‘anxiety disorders’ that will be recorded is a prescription for poor outcomes. Paradoxically, we also risk worsening mental health stigma by pathologizing a common response to modern life.

“Feeling anxious isn’t the same as having an anxiety disorder. The actual Panel recommendation makes this point, but it doesn’t answer the question of what we’re going to do about it. It also doesn’t account for our current system of quick visits with prescriptions instead of high-quality conversations to help patients cope and build resilience. In my opinion, universal screening for anxiety will only worsen until we are ready to change how we respond to the results.”