USPSTF 2023 Update on Depression, Suicide, and Anxiety Screening Recommendations

SUMMARY:

The USPSTF has issued updated recommendations on screening for the most common mental health conditions, with guidance focusing on anxiety, depression, and suicide risk. Effective treatments (e.g., psychotherapy and pharmacotherapy) exist, and delays in diagnosis and treatment can lead to increased healthcare costs and poor health outcomes. Doctors screening for these psychiatric diseases should be prepared to offer treatment or referral to a specialist when screening is positive.

Screening

Anxiety

The USPSTF recommends screening all adults ages ≤ 64 for anxiety disorders
- This includes pregnant and postpartum persons
- This notably excludes older adults, ages ≥ 65, as the data within this age group is insufficient to determine balance of benefits and harms
The lifetime prevalence of anxiety disorders in adults is roughly 26% for men and 40% for women, highlighting the importance of universal screening
Anxiety disorders include
- Generalized anxiety disorder | Social anxiety disorder | Panic disorder | Separation anxiety disorder | Phobias | Selective mutism | Anxiety not otherwise specified
Anxiety disorders tend to peak in incidence in early adulthood, and decline with age
Several anxiety screening tools exist such as the GAD-7 Screening tool
For more information on the diagnosis and treatment of anxiety disorders, see “Related Topics” below

Depression

The USPSTF recommends screening all adults for depression
- This includes pregnant and postpartum patients
- This DOES include older adults (e.g., ages ≥ 65)
The 12 month and lifetime prevalences of major depressive disorder are roughly 10% and 20%, respectively
Screening is not meant for patients already diagnosed with a mental health disorder or showing recognized signs or symptoms of depression
Severe depression screening tools exist, such as the Patient Health Questionnaire – 9 and Patient Health Questionnaire – 2
- To view these questionnaires, see below
Patients at risk of developing depression should be screened at regular intervals, based on the doctors best clinical judgment
- Risk factors include: Family history of depression | Prior episodes of depression | Other mental health conditions | History of trauma or adverse life events | History of disease or illness
For more information on the diagnosis and treatment of depressive disorders, see “Related Topics” below

Suicide Risk

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in the adult population
Suicidal behavior includes
- Suicidal ideation, (e.g., Thinking about or planning suicide)
- Suicide attempts (e.g., Nonfatal, self-directed, and possibly injurious behavior that is intended to result in death but does not)
- Suicide completion
Suicide is the 10^th leading cause of death in the US
Many people attempt suicide more than once, and 7% of people who have attempted suicide will go on to eventually die from suicide
The PHQ-9 screening test (see above) includes a question assessing suicidal thoughts, so many patients will continue to receive suicide risk screening if that questionnaire is utilized

KEY POINTS:

The USPSTF recommends universal screening of anxiety and depression in adults, though older adults are excluded from anxiety screening after the age of 64
Current evidence is insufficient to determine harms and benefits of suicide risk screening
Evidence is limited on timing of screening intervals, and repeat screening should be based on the patient’s history and risk factors