Under a new recommendation from the Women’s Preventive Services Initiative (WPSI), all adolescent and adult women age 13 and older should be screened for anxiety. The new recommendation, which includes women who are pregnant or postpartum, was published June 9 in the Annals of Internal Medicine along with a systematic review of the effectiveness of screening, accuracy of screening instruments and the benefits and harms of treatments in adolescent and adult women.

Recommendations from WPSI are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders; because of the new recommendation, screening for anxiety in women in the primary care settings will now be covered without cost-sharing. This is the first such recommendation for universal screening for anxiety.

“The new recommendation has the potential to dramatically expand access to treatment for anxiety for our patients,” said Kimberly D. Gregory, MD, MPH, chair of the WPSI Advisory Panel. “Ensuring that screening will be available without cost-sharing means more equitable care for women who are living with anxiety today. This is especially important at a time when anxiety is high as a result of the ongoing COVID-19 pandemic—and, as data show, disproportionately impacting women.”

The WPSI recommendation stipulates that when screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and to determine appropriate treatment and follow-up. Although the recommendation does not identify optimal screening intervals, it does recommend screening for women who have not been previously screened; screening may be conducted in conjunction with screening for depression.

Overall, the recommendation for screening for anxiety was based on the determination that the balance of benefits and harms would likely be favorable based on the high prevalence of anxiety in women; the substantial impact of anxiety on health, function, and quality of life; and evidence on the accuracy of screening instruments in primary care settings and the effectiveness and harms of treatment.

“WPSI developed this recommendation based on the substantial evidence that points to the benefits of screening for anxiety in routine clinical practice. The current crises that pose barriers to patients coming to the office—the COVID-19 epidemic and the current social unrest in response to continued racism and injustice—make this even more important,” said David Chelmow, MD, chair of the WPSI Interdisciplinary Steering Committee. “Since screening for anxiety can be done by telehealth, clinicians should feel comfortable immediately incorporating it into their practice as they see patients remotely.”

For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author of the review, Heidi D. Nelson, MD, MPH, please contact Tracy Brawley at brawley@ohsu.edu. To request an interview with someone from WPSI, please contact Kate Connors at kconnors@acog.org.