Should You Be Screened for Anxiety?

[Originally published: May 21, 2020. Updated: Sep 22, 2022.]

Long before the coronavirus pandemic mixed fear and uncertainty into daily life, Americans felt stressed out. 

They worried about the country’s rising health care costs, struggled to pay them, and wondered if they could even access care in the future. One-quarter of U.S. adults reported discrimination—based on race and gender—as a significant source of stress. And on an individual level, work and money ranked as the top two major stressors, all according to a 2019 study. 

Wherever constant stress lives, so too does its more agitated and debilitating cousin: anxiety. About 31% of Americans will experience an anxiety disorder at some point in their lives, with adult and teen women experiencing one far more often than men, according to the U.S. National Institute of Mental Health. 

The problem has worsened during the pandemic, with the percentage of adults reporting recent symptoms of anxiety or a depressive disorder increasing from 36.4% to 41.5% between August and February of 2021.

Now, Americans have been reporting even more heightened anxiety about inflation, loss of income, and gun violence, according to a national poll from the American Psychiatric Association in June 2022.

Given all these factors, the U.S. Preventive Services Task Force (USPSTF) recently released a draft recommendation saying doctors should screen all adults under age 65 for anxiety. The USPSTF is a group of independent medical experts that makes recommendations to guide doctors. The draft recommendation is not final, and the public can make comments on it through Oct. 17. The group says the intention is to help prevent mental health problems from going undetected and untreated for years. It made a similar recommendation for children and teenagers earlier this year.

What’s more, anxiety often goes hand-in-hand with depression. Nearly half of people diagnosed with depression also have an anxiety disorder, according to the Anxiety and Depression Association of America. At any one time, “about 7% of the U.S. population meets criteria for a major depressive disorder,” says Rachel Katz, MD, a psychiatrist at Yale Psychiatric Hospital. 

As if those statistics weren’t worrying enough, the pandemic has upended daily life in numerous ways over the past few years—causing sickness, death, job loss, and disrupting schedules for children and adults.  

“With these concerns, the experience right now is, ‘I don’t have a lot of control over what is happening around me,’” says Carolyn M. Mazure, PhD, a Yale Medicine psychologist and director of Women’s Health Research at Yale. 

Feeling a lack of control over a situation can lead to stress, anxiety, and even depression. Recognizing the differences between the them can lead to the right treatment. 

Stress is a physical response to a situation. When the brain receives a threatening signal, a flood of chemicals overwhelms the rational, more evolved part of the brain, called the prefrontal cortex. Neurotransmitters, including dopamine and norepinephrine, activate the amygdala, a more primitive part of the brain that evolved to prepare the body’s “fight or flight” response in the face of, say, a lion. 

Another biological process that arises is a combination of nerve and hormonal signals that causes your adrenal glands to release the hormones adrenaline and cortisol. Your heart beats faster and your breathing becomes shallower as your body gears up to react to a situation; this makes it difficult to reflect with the calmer emotion, measured logic, and impulse check that the prefrontal cortex offers. Millions of years ago, this intricate process saved our lives. Today, in the face of daily stressors, it threatens our collective mental health.  

This a uniquely modern problem. “In contemporary society, individuals are stressed for long periods of time,” Mazure says. “In this situation, stress no longer serves its initial biological function of alerting us; its function becomes corrupted when it is chronic or prolonged and you cannot turn it off.” 

Constant exposure to stress can cause physical problems such as headaches, constipation, diarrhea, chest pain, insomnia, and grinding teeth. Left unchecked, stress can increase a person’s risk of high blood pressure, heart disease, diabetes, and obesity. “It’s also thought to play a role in autoimmune disease,” Mazure adds. Stress has also been linked to a weakened immune system, causing people to be more susceptible to catching colds and other infections.  

Mazure offers tips for interrupting and reducing our stress that can be applied to everyday life.

1. Prioritize exercise and a balanced diet. “By now this advice might seem worn out. But those two things are important—they really are,” Mazure says. Altering your routine to include walking, running, biking, aerobics or yoga classes, and trying to bring more fruits, vegetables, and whole grains into a daily diet are not small changes or easy ones, but they can reduce stress and improve the way you feel, she says.
   
2. Establish a routine. Studies have shown that the predictability of routine can help fight the out-of-control feelings that stress can cause. “We need to build a personal structure or routine that is rewarding and that brings us a sense of control,” Mazure says.
3. Do things that have personal meaning for you. “One of the central aspects of resilience is feeling that you have purpose in life,” Mazure says. “To ensure this, remind yourself what is important, remember your values, and value your relationships.”

Persistent stress that feels unmanageable can lead to anxiety and depression. 

Anxiety shares the same physical and biological elements as stress. Two differences are that stress-induced neurotransmitters and hormones stay ramped up and our minds get stuck in repetitive worry, or panic-driven thought loops. 

“Think of anxiety as a normal reaction to a situation where people feel pressured and, to some degree, fearful because there’s an unknown factor or a perceived danger,” says Michelle Alejandra Silva, PsyD, assistant professor of psychiatry at Yale School of Medicine and director of the Connecticut Latino Behavioral Health System. “But it becomes clinically concerning when the feeling persists even when the threat is not there, and when it begins to interfere with day-to-day functioning and relationships.” 

Anxiety can also be described as feeling that one’s internal resolve and strength is outmatched by an external stressor, Silva explains. 

Any single cause or the combined weight of numerous factors can lead to an anxiety disorder. Anxiety triggers can be obvious, like losing a job or house, or more difficult to pin down, such as traumatic events from one’s past.

“Understanding context is key,” Silva says. “I try to do a thorough assessment of patients’ current environment and circumstances to understand their feelings and experiences within their reality. For instance, many of my clients are dealing with poverty or immigration-related stressors.” 

Silva recommends several tips to help with anxiety. 

1. Engage in an activity that requires mindfulness. Repetitive anxious thoughts might fixate on something that happened in the past or latch onto worrying about an unknown future. “Anything that helps us stay in the present, like journaling, coloring, or practicing meditation, can help interrupt anxiety,” Silva says.
2. Practice self-compassion. “We all experience anxiety to some degree—it’s a very normal feeling,” Silva says. She emphasizes the importance of accepting your uncomfortable feelings rather than judging yourself for whatever you are experiencing. 
   
3. Seek professional help. “There’s still a significant stigma when it comes to mental health services,” Silva says. However, she emphasizes that programs and health care providers can help with a variety of treatments, including individual or group therapy and possibly medication.

If anxiety is particularly severe or prolonged, it can become intertwined with depression, a disorder that can look very different from one person to another, but that tends to share a common theme: an inability to enjoy life.