High Anxiety

According to Medscape.com “with anxiety reportedly on the rise globally, the US Preventive Services Task Force (USPSTF) has posted for public comment new draft recommendations for screening for anxiety.”

For the first time the USPSTF is recommending screening adults younger than 65 for anxiety.  The recommendation applies to “adults 19-64 years who do not have a diagnosed mental health disorder or are not showing recognised signs or symptoms of anxiety.”

Why would they do this? They say, “To address the critical need for supporting the mental health of adults in primary care, the Task Force reviewed the evidence on screening for anxiety”. Task Force member Lori Pbert added that “The good news is that screening adults younger than 65 for anxiety can help identify these conditions early so people can be connected to care.”

Medscape cite a research study that looked at 64 published articles with 170,000 participants. The conclusions should be alarming; for anxiety the pooled prevalence Worldwide was 25%. North America had a higher prevalence rate at 43%, compared with 22.1% in Europe, 20.5% in Latin America and 15% in the Asia Pacific region.

How much higher can rates go? What could the USPSTF screening recommendation lead to? If Europe and the UK ever match the rates in the US, the NHS and the benefit system would surely be overwhelmed.

As far as anxiety is concerned, the first thing we have to do to feel anxious is focus on something that could go wrong. So, what could go wrong?

The COVID pandemic changed the public discussion of mental health. Since then, every commentator on the BBC and other media outlets reminds us of the things we could worry about and alerts us to how these things might affect our mental health. The pandemic rumbles on. Now we have war, a cost-of-living crisis, mortgage rates, the NHS teetering on the brink, staff and worker morale low and according to the National Grid we face the prospect of blackouts this winter. There is no shortage of issues.

This relentless negative messaging insidiously shapes our consciousness. Anxiety is always about focus. This messaging keeps us focused on problems and what might be wrong with us. It is hard to overstate how this negatively affects our quality of life and expectations.

Does the USPSTF recommendation matter? Will it put the prevalence rates in North America up to 50% or perhaps even 60%? Will there come a time when anyone without a diagnosis of one mental condition or another will feel they are missing out?

Many of us believe we are not influenced by advertising. Yet the advertising industry spends what would be a fortune in the Third World encouraging us to buy their products. Whether we admit it or not being exposed to constant messages changes our minds. Perhaps, we should see what the USPSTF is doing is more like advertising than promoting our mental health; it will change our minds. More and more of us will come to regard our ordinary and often useful apprehension as anxiety that we suffer from.

If we continue to believe that our psychological distress should be labelled as mental health conditions that we suffer from we will believe that the solution is to be ‘connected to care’. We will expect, and even demand, the services or products of the mental health services.; their advertising will have worked for them but not necessarily for us.

Incidentally and unbelievably: Is the USPSTF screening recommendation really prevention as they claim? At best it could be considered as early intervention. At worst………The full report of the USPSTF is simply massive. Buried in its many pages is the following statement. ”But the direct evidence for screening for anxiety was extremely limited and did not suggest a benefit. Further the evidence on the diagnostic accuracy of screening tools had minimal replication for anxiety disorders other than generalised anxiety disorder.” As we know advertising can be misleading; but the detail is much less important than the headlines.