Anxiety screening

Adults 19 to 64, including pregnant and postpartum people: USPSTF (2023) grades screening B and applies it "regardless of risk factors." It covers adults who do not have a diagnosed mental health disorder and are not showing recognized signs or symptoms of anxiety disorders. USPSTF still lists the factors that raise risk: family history of mental health conditions, other mental health conditions, a history of stressful life events, smoking or alcohol use, and being widowed or divorced. It adds that women and Black individuals are also at risk, and its full statement gives the cause: "Black persons and individuals of non-Hispanic ethnicity are at increased risk of anxiety disorders due to social, rather than biological, factors." Anxiety and depressive disorders often overlap.

Anyone in well-woman, prepregnancy, prenatal or postpartum care: ACOG's 2023 guideline adds a second recommendation, in one sentence: it recommends that "everyone receiving well-woman, prepregnancy, prenatal, and postpartum care be screened for depression and anxiety", using validated, standardized questionnaires. The guideline itself is about pregnancy: its stated target population is people who are pregnant or postpartum and have a mental health condition, and every other recommendation in it is perinatal. Its reach into nonpregnant women rests on that one sentence, which names well-woman and prepregnancy care explicitly, not on a general adult anxiety guideline. It sets no age limit and no interval.

Men: ACOG defines its population by the care received, so its recommendation does not reach men, or anyone outside those four kinds of care. For a man, this page rests on USPSTF alone: screening from 19 to 64, and the I statement below from 65.

Adults 65 and older: USPSTF (2023) issues an I statement: "The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults." An I statement is not a recommendation against screening. USPSTF leaves the decision to the clinician, based on the individual patient's circumstances, and names one harm specific to this age group: some screening instruments not designed for older adults may more often misidentify them as having anxiety disorders. A woman 65 or older in well-woman care is inside ACOG's recommendation, which has no upper age, and inside USPSTF's I statement at the same time.

You answer a short questionnaire yourself, and the care team scores it. ACOG's 2023 guideline says the EPDS and PHQ-9 come in multiple languages, are filled in by the patient, are quick to complete and can be scored by the care team. It adds that patients accept screening done on the web, on a tablet or by text message. The GAD-7 has seven items and is self-administered; the EPDS anxiety subscale is three of the EPDS items (items 3, 4 and 5).

The cutoff depends on the instrument and on whose table you read. ACOG's table of perinatal instruments lists, for anxiety: the GAD-7, positive at 5 or more, with a sensitivity of 73% and a specificity of 67%; the EPDS anxiety subscale, positive at 5 or more, with too little data to estimate accuracy but a correlation with the GAD-7; and the 20-item STAI, positive at 40 or more, with a sensitivity of 81% and a specificity of 78%. USPSTF (2023) reports the GAD-7 at 10 or more and the GAD-2 at 3 or more. ACOG also gives severity bands for the GAD-7: a score of 5 to 9 often represents mild symptoms, 10 to 14 moderate, and 15 or higher is consistent with severe symptoms.

A screen helps only if something happens after it. USPSTF (2023): "Adequate systems and clinical staff are needed to ensure that patients are screened with valid and reliable screening tools." ACOG's third recommendation (2023) is that screening run alongside systems that get patients to assessment and diagnosis on time, to effective treatment, and to monitoring and follow-up matched to severity. ACOG also reports that a positive screen makes it more likely that the obstetric clinician recommends or provides treatment, more so once every patient is screened.

A positive screen leads to a diagnostic assessment, not straight to treatment. USPSTF (2023): "If a screening test result is positive for an anxiety disorder, a confirmatory diagnostic assessment is needed." ACOG's 2023 guideline says the diagnosis comes from evaluating the patient, through conversation or an interview, while weighing other conditions that could explain the symptoms.

ACOG also asks clinicians to check for other conditions that can produce the same symptoms. Its guideline names thyroid dysfunction, severe anemia and substance use disorder, to be assessed from the symptoms and, when clinically indicated, with lab work. The tests it lists as examples are thyroid-stimulating hormone, hemoglobin or hematocrit, folate, B12, and iron. Before any medication for anxiety or depression, ACOG (2023) recommends screening for bipolar disorder, if not previously done.

If the diagnosis is confirmed, USPSTF (2023) lists the treatments: psychotherapy, for example cognitive behavioral, interpersonal, family, and acceptance and commitment therapy, and pharmacotherapy, for example antidepressants, antihistamines, beta-blockers, anticonvulsant medications and benzodiazepines. ACOG's 2023 guideline puts psychotherapy first, calling it "first-line treatment for depression and anxiety regardless of symptom severity", and recommends referral to behavioral health services. In pregnancy and while breastfeeding, USPSTF encourages clinicians to consider the unique balance of benefits and harms in the perinatal period, and ACOG notes that perinatal depression and anxiety are treated in much the same way. ACOG covers treatment in a separate guideline, No. 5 (June 2023), which is outside this page.

Why the follow-up matters, in USPSTF's figures: only 11% of US adults with an anxiety disorder started treatment within the first year of onset, and the median time to starting treatment was 23 years. The harms USPSTF lists for screening are false-positive results that lead to unnecessary referrals, the potential for overdiagnosis and unnecessary treatment, labeling, and stigma.