Kimberly D Gregory1, David Chelmow2, Heidi D Nelson3, Maureen Sayres Van Niel4, Jeanne A Conry5, Francisco Garcia6, Susan M Kendig7, Nancy O'Reilly5, Amir Qaseem8, Diana Ramos9, Alina Salganicoff10, Sarah Son5, Julie K Wood11, Christopher Zahn5. 1. Cedars-Sinai Medical Center, Los Angeles, California (K.D.G.). 2. Virginia Commonwealth University School of Medicine, Richmond, Virginia (D.C.). 3. Oregon Health & Science University, Portland, Oregon (H.D.N.). 4. Cambridge, Massachusetts (M.S.V.). 5. American College of Obstetricians and Gynecologists, Washington, DC (J.A.C., N.O., S.S., C.Z.). 6. Pima County Health Department, Tucson, Arizona (F.G.). 7. National Association of Nurse Practitioners in Women's Health, Washington, DC (S.M.K.). 8. American College of Physicians, Philadelphia, Pennsylvania (A.Q.). 9. California Department of Public Health, Sacramento, California (D.R.). 10. Kaiser Family Foundation, Menlo Park, California (A.S.). 11. American Academy of Family Physicians, Leawood, Kansas (J.K.W.).
Abstract
DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors. RECOMMENDATION: The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.
DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors. RECOMMENDATION: The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.
Entities:
Keywords:
Adolescents; Anxiety; Anxiety disorders; Forecasting; Health services administration and management; Quality of life; Questionnaires; Reuptake inhibitors; Serotonin; Systematic reviews
Authors: Danielle J O'Laughlin; Brittany Strelow; Nicole Fellows; Elizabeth Kelsey; Sonya Peters; Joy Stevens; Johanna Tweedy Journal: J Prim Care Community Health Date: 2021 Jan-Dec