Anxiety disorders are the most common mental illness, which affects up to 40% of women and 20% of men during their lifespan. Women and teen girls are particularly at high risk for developing anxiety disorders because of various hormonal issues such as effects of oestrogen and progesterone, biological issues such as differences in their brain chemistry and psychosocial contributors such as childhood sexual abuse. Wouldn’t early detection of anxiety disorders among women and girls lead to improved outcomes?
Women’s Preventive Service Initiative (WPSI) Guidelines
In a recent clinical guideline, the Women’s Preventive Service Initiative (WPSI) recommends that all women and adolescent girls ages 13 and older should be screened for anxiety disorders, including pregnant and postpartum women.
The WPSI is a national coalition of 21 health professional organizations and patient representatives in the United States that analyzes and disseminates evidence-based guidelines for women’s preventive health care services.
A systematic review was performed by using moderate to the high accuracy of screening tools to provide the recommendations. But no study has been conducted to evaluate the effectiveness or harms of screening on these women.
Why are the recommendations changing now?
The US Preventive Services Task Force (USPSTF) has previously recommended routine screening for depression in adolescents and adults, but there were no recommendations for the screening of anxiety disorders. Based on studies exhibiting the accuracy of screening instruments, as well as evidence of the benefits of treatment of anxiety disorders with cognitive behavioural therapy and medications, the WPSI’s made the recommendations.
Are anxiety disorders on the rise?
In recent years, according to the media, anxiety disorders have seen a rise due to various causes. The Covid-19 pandemic, use of social media, to prove one of being worthy, career issues, stress at school or work and personal lives have brought an increase in anxiety disorders.
Researchers do not have robust epidemiologic data which suggests that there has been an increase in anxiety disorders. But we do know that more and more individuals are seeking treatment for anxiety and that more individuals are willing to speak about their anxiety. Also, the prevalence of anxiety in different countries and cultures are more likely due to differences in how the data were collected, rather distinct cultural differences.
Challenges of Screening
The screen tools for anxiety have limitations in diverse populations. There has been decreased accuracy among non-western populations because they are not represented in the studies used to build screening tools. Among people living in the United States, anxieties are based on various factors such as ethnic, racial, and cultural contexts.
Among immigrants in the US, anxiety screening tools do not reflect the correct source of anxiety and psychological distress which may occur due to the effects of migration, legal status, and experiences of discrimination.
If the screening tools for anxiety have not been validated to represent these populations, then it may lead to errors in diagnosis and inappropriate treatment.
But, among the populations where anxiety screening tools even have been validated, universal anxiety screenings for women and adolescent girls have posed the following concerns:
- There are grave consequences for an improper diagnosis.
- People may suffer from medication side effects or over-prescription of medications.
- Based on a false diagnosis, inappropriate treatment of people may occur
- Some people having mild anxiety may not even benefit from the treatment, and it will lead to a waste of resources
- People with known anxiety disorders may not get treatment or may receive less than adequate treatment
Anxiety disorders are particularly common among women, but it goes unrecognized and untreated. Keeping this in mind, the new WPSI guidelines have recommended screening all adolescent girls and women for anxiety disorders. Universal screening for anxiety among women and teen girls may help to identify those suffering from anxiety disorders, resulting in earlier diagnosis and treatment. However, future research should be conducted to analyze the effectiveness of such screening and to assess potential harms.