Addressing Anxiety, Depression: Making Strides But Still More Work to Be Done

Mental health issues continue to increase in prevalence among various age groups, even pediatric patients. Issues such as anxiety and depression can present various challenges in day-to-day living and reduce productivity for those affected and their loved ones. Moreover, stress can exacerbate these issues as well.  

The National Alliance on Mental Illness¹ indicates that in the United States an estimated 8.4% of the adult population—approximately 21 million individuals—experiences a major depressive episode each year. Additionally, 19.1% of adults, or 48 million individuals, have anxiety disorders. Many experts have indicated that the social isolation, fears, concerns, and challenges brought on during the COVID-19 pandemic augmented the number of individuals experiencing mental health issues such as depression and anxiety disorders. The Mental Health America organizational website² also indicates the pandemic had a profound impact on mental health. Throughout the pandemic, there was increased incidence of anxiety, depression, loneliness, and other mental health concerns, even among health care providers.

Unfortunately, many individuals experiencing depression and anxiety often do not discuss these issues and struggle daily. Moreover, some individuals remain untreated, citing a lack of or reduced access to mental health care and concerns about the stigma surrounding mental health issues. It is important for health care providers and the loved ones of those affected by mental health issues to remind individuals they are not alone and to encourage them to seek medical care from a mental health professional. In many cases, with prompt clinical intervention and patient adherence to therapies—including pharmacological therapies, psychotherapy, cognitive behavioral therapy, and support groups—individuals can improve their mental health and overall health-related quality of life.

The issue of mental health has been brought to the forefront and progress has been made. However, there is still a need to expand awareness about the value of routine screenings for mental health issues and prompt initiation of therapy tailored to patient needs. There is also a need to implement effective patient education measures to eradicate stigmas associated with mental illness which, in turn, may encourage affected individuals to seek assistance.

Below is a summary of news and clinical data from various publications.

Recent Findings From US Department of Health and Human Services

Various publications indicate that mental health issues continue to rise among younger individuals. According to a US Department of Health and Human Services (HHS) study published in JAMA Pediatrics,^3,4 between 2016 and 2020, the number of people aged 3 to 17 years who were diagnosed with anxiety and depression increased by 29% and 27%, respectively. The trends were exacerbated by issues related to the pandemic.

New US Preventive Services Task Force Recommendation for Screenings

In October 2022, the US Preventive Services Task Force (USPSTF) published updated screening recommendations in JAMA Network.⁵ The USPSTF recommended for the first time that all children aged 8 to 18 years should be screened for anxiety, even if there are no symptoms. Screening for anxiety received what is known as a "B" recommendation, meaning the USPSTF concluded with "moderate certainty" that the benefits of screening outweigh the harms. However, the USPSTF also concluded current evidence is insufficient to evaluate the balance of benefits and harms of screening for anxiety in children aged 7 years or younger.

Additionally, the USPSTF recommends screening for major depressive disorder in those aged 12 to 18 years ("B" recommendation) but stated there is insufficient evidence to weigh the balance of benefits and harms of screening for depression in children aged 11 and younger.⁶

The USPSTF also issued comparable draft guidelines in September 2022, recommending screening for anxiety in adults aged 64 years and younger; however, those are still subject to revision prior to being finalized.⁷

Survey on Stress in America

In a recent survey conducted by the American Psychological Association (APA),⁸ researchers found more than 25% of adults in the United States reported being so stressed that they cannot function.

Survey participants also stated that stress has impacted their health, with 76% of adults experiencing at least one of the following symptoms in the last month as a result of stress: headache (38%), fatigue (35%), feeling nervous or anxious (34%), and feeling depressed or sad (33%). An estimated 72% of adults experienced additional symptoms in the last month, including feeling overwhelmed (33%), experiencing changes in sleeping habits (32%), and/or worrying constantly (30%).

In the press release, Arthur C Evans Jr, PhD, the APA’s chief executive officer, said, “With so many people suffering health effects from these unrelenting external stressors, it’s important that all health care providers understand the research and offer their patients evidence-based techniques to reduce the effects of extreme stress and build their resilience.”

Depression in Younger Patients

A study recently published in The American Journal of Preventative Medicine⁹ revealed that from 2015 to 2019, there were extensive increases in depression without equal increases in treatment. The study also showed that in 2020, past 12-month depression was prevalent in approximately 1 in 10 Americans and almost 1 in 5 adolescents and young adults. Across nearly all gender, racial/ethnic, income, and education groups, depression augmented most swiftly among adolescents and young adults, but incidence of pursuing care remained consistently low.

The authors concluded that decisive action, involving a multifaceted public health campaign that incorporates evidence-based prevention and intervention to deal with this ongoing mental health crisis, is of extreme importance.⁹  

Depression and Dementia

Another study published in Biological Psychiatry¹⁰ examined connections between courses of depression, the application of depression treatment, and the risk of incident dementia. Researchers discovered that depression elevated the risk of dementia by an astonishing 51% compared to participants without depression.

However, the degree of risk was contingent upon the course of depression. Those with increasing and chronically high- or low-course depression were more susceptible to dementia, while those with diminishing course faced no greater risk than participants without depression. Researchers said the evidence suggests that prompt initiation of treatment for depression could potentially lessen the risk of dementia in certain groups of patients.

Conclusion

Recognizing and addressing mental health issues such as depression and anxiety continue to be of paramount importance. To expand awareness, many well-known individuals from various walks of life are sharing their stories about mental health issues and the significance of seeking help in public awareness campaigns. Hopefully, employing the recent USPSTF recommendations will enable health care providers to identify more patients struggling with depression and anxiety issues, so they can urge patients to obtain appropriate therapy.

The first crucial step to improving mental health is to encourage affected individuals to seek assistance from a mental health care provider who can guide them on their path to healing. The next step is to remind patients they are not alone and help them find the support they need.

The National Institute of Mental Health and the National Alliance on Mental Illness provide more resources.

References:

1. Mental health by the numbers. National Alliance on Mental Illness. Updated June 2022. Accessed October 28, 2022. https://www.nami.org/mhstats
2. The mental health of healthcare workers in COVID-19. Mental Health America. Accessed October 28, 2022. https://mhanational.org/mental-health-healthcare-workers-covid-19
3. US Department of Health & Human Services. New HHS study in JAMA Pediatrics shows significant increases in children diagnosed with mental health conditions from 2016 to 2020. News release. March 14, 2022. Accessed October 28, 2022. https://www.hhs.gov/about/news/2022/03/14/new-hhs-study-jama-pediatrics-shows-significant-increases-children-diagnosed-mental-health-conditions-2016-2020.html
4. Lebrun-Harris LA, Ghandour RM, Kogan MD, Warren MD. Five-year trends in US children’s health and well-being, 2016-2020. JAMA Pediatr. 2022;176(7):e220056. doi:10.1001/jamapediatrics.2022.0056
5. US Preventive Services Task Force. Screening for anxiety in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2022;328(14):1438–1444. doi:10.1001/jama.2022.16936
6. Depression and suicide risk in children and adolescents: screening. US Preventive Services Task Force. October 11, 2022. Accessed October 28, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents
7. Screening for anxiety in adults. US Preventive Services Task Force. September 20, 2022. Accessed October 28, 2022. https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening
8. American Psychological Association. More than a quarter of US adults say they’re so stressed they can’t function. News release. October 19, 2022. Accessed October 28, 2022. https://www.apa.org/news/press/releases/2022/10/multiple-stressors-no-function
9. Goodwin R, Dierker LC, Wu M, Galea S, Hoven CW, Weinberger AH. Trends in US depression prevalence from 2015 to 2020: the widening treatment gap. Am J Prev Med. 2022;63(5):726-733. doi:10.1016/j.amepre.2022.05.014
10. Yang L, Deng Y, Leng Y, et al. Depression, depression treatments, and risk of incident dementia: a prospective cohort study of 354,313 participants. Biol Psychiatry. Published online September 3, 2022. doi:10.1016/j.biopsych.2022.08.026