Anxiety screening
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Anxiety Screening: Insights from Recent Research
Importance of Anxiety Screening in Primary Care
Anxiety disorders are prevalent yet often underdiagnosed in routine healthcare settings, particularly among adolescent girls and adult women. Effective screening can lead to early diagnosis and treatment, improving overall health outcomes1 4. The Women's Preventive Services Initiative (WPSI) recommends screening for anxiety in women and adolescent girls aged 13 years or older, including pregnant and postpartum women, to enhance detection and treatment4.
Accuracy of Screening Instruments
Generalized Anxiety Disorder Scale (GAD-7)
The GAD-7 is a widely used tool for screening generalized anxiety disorder. Studies have shown it to have moderate to high accuracy, with sensitivity ranging from 70% to 97% and specificity from 50% to 89% in adults1. In low- to middle-income countries (LMICs), the GAD-7 has also been validated, showing a pooled sensitivity of 76% and specificity of 64%5.
Screen for Child Anxiety Related Emotional Disorders (SCARED)
The SCARED instrument is commonly used to evaluate anxiety symptoms in children and adolescents. It has demonstrated excellent internal consistency and moderate to large test-retest reliabilities. The parent and child versions of SCARED have shown robust psychometric properties across various countries, making it a reliable tool for screening childhood anxiety disorders3 6 9.
Edinburgh Postnatal Depression Scale (EPDS)
For pregnant and postpartum women, the EPDS has been adapted to screen for anxiety, showing a sensitivity of 74% and specificity of 64%1. This tool helps in identifying anxiety symptoms during a critical period, ensuring timely intervention.
Effectiveness of Treatments for Screen-Detected Anxiety
Cognitive Behavioral Therapy (CBT)
CBT has been found to be effective in improving anxiety symptoms across various populations. A systematic review of 246 randomized controlled trials (RCTs) involving 17,209 participants confirmed the efficacy of CBT in reducing anxiety symptoms1 4. In pediatric primary care, individual CBT has also been effective for adolescents with social phobia identified through screening2.
Pharmacologic Treatments
Antianxiety medications, including selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs), have been shown to improve anxiety symptoms. A review of 126 RCTs involving 8,225 participants supported the effectiveness of these medications in treating anxiety disorders1 4.
Limitations and Gaps in Current Research
Despite the availability of effective screening tools and treatments, there are significant gaps in the evidence related to the overall effectiveness and harms of anxiety screening in primary care settings. No studies have directly evaluated the long-term harms of treatment, and there is a lack of treatment trials specifically for pregnant or postpartum women1 4. Additionally, many screening tools have been validated in inadequately designed studies, particularly in LMICs, limiting their generalizability5.
Conclusion
Screening for anxiety in primary care settings is crucial for early detection and treatment, particularly among high-risk groups such as adolescent girls, adult women, and children. While tools like the GAD-7 and SCARED have shown high accuracy and reliability, more research is needed to evaluate the long-term benefits and potential harms of screening. Effective treatments, including CBT and pharmacologic options, are available and can significantly improve anxiety symptoms when identified early.
Sources and full results
Most relevant research papers on this topic
Screening for Anxiety in Adolescent and Adult Women
Screening for anxiety in adolescent and adult women is insufficiently evidenced, but most screening instruments are moderately to highly accurate, and behavioral therapies and antianxiety medications effectively improve anxiety symptoms.
Systematic Review
Rigorous JournalScreening for Anxiety in Pediatric Primary Care: A Systematic Review
Anxiety screening in primary care for children and adolescents shows limited sensitivity and specificity, but individual cognitive behavioral therapy is effective for those identified through screening.
Systematic ReviewScreening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders.
The SCARED instrument has robust psychometric properties and performs consistently well in community and clinical settings across various countries, making it a valuable tool for diagnosing and monitoring childhood anxiety.
Meta-AnalysisRigorous JournalScreening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative
Screening for anxiety in women aged 13 and older is recommended to improve detection, achieve earlier diagnosis, and enhance health, function, and well-being.
Systematic ReviewRigorous JournalA systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries
Locally validated screening tools for anxiety and PTSD in low- to middle-income countries need further evaluation in well-designed studies to improve detection and management of these common disorders.
Systematic Review
Very Rigorous JournalThe Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics.
The SCARED is a reliable and valid screening instrument for children with anxiety disorders, showing good internal consistency, test-retest reliability, and discriminative validity.
Observational Study
Highly CitedScreening for anxiety disorders
The Anxiety Screening Questionnaire (ASQ) is an effective, easy-to-administer screening tool for generalized anxiety syndromes, with high sensitivity and specificity for threshold and subthreshold generalised anxiety disorder.
Observational StudyHighly CitedScreening for anxiety disorders in children
Screening for anxiety disorders in primary school children is useful for discriminating between those with and without disorders and predicting specific disorders like separation anxiety, social phobia, and specific phobia.
Observational StudyRigorous JournalHighly CitedA meta-analysis of the cross-cultural psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED).
The SCARED is a robust screening instrument for DSM-IV-TR anxiety disorders in children and adolescents from various countries, with females scoring higher than males and age moderating score differences.
Meta-AnalysisRigorous JournalHighly CitedA Brief Online and Offline (Paper-and-Pencil) Screening Tool for Generalized Anxiety Disorder: The Final Phase in the Development and Validation of the Mental Health Screening Tool for Anxiety Disorders (MHS: A)
The Mental Health Screening Tool for Anxiety Disorders (MHS: A) is a clinically useful screening tool for generalized anxiety disorder in Korea, with better diagnostic accuracy than the GAD-7 and BAI.
Observational Study