The new anxiety screening protocol in the US
The Star Chamber uses pseudoscience to gaslight the population, drive up prescription revenues
The U.S. Preventative Services Task Force recently recommended that doctors do an anxiety screening for children and adolescents. What does this mean in a practical sense? If you’re seeing your doctor for a sprained ankle or sore throat, you’ll also be screened for an “anxiety disorder.” What could possibly go wrong.
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Notice that, for ages 8-18, the Task Force grades their advice at a “B.” For children under 8, the evidence does not support the practice. The problem with all of this is that this screening has no basis in science.
The data source for this is a single meta-analysis that examined PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021 and references, experts, and surveillance through June 1, 2022. It looked for English-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.
Here’s what they found:
RESULTS: Twenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, −0.58 [95% CI, −0.83 to −0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, −2.25 [95% CI, −4.09 to −0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children’s Depression Rating Scale–Revised mean difference, −3.76 [95% CI, −5.95 to −1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children’s Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, −2.35 [95% CI, −4.06 to −0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different.
CONCLUSION AND RELEVANCE: Indirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
In other words, there’s no direct evidence that their plan works, no evidence of a benefit, but also no evidence of a harm created from presenting these surveys … so, it’s now a recommended “evidence-based” evaluation.
This is what happens when an arbitrary criteria is generated in a plebiscite, not a research-based methodology. The outcome was pre-determined. The results and recommendation were presented with the authority of the state. They hope that you won’t go and read the foundation for their conclusion. Thankfully, I did.
This is pseudo-science. It’s an attempt to imitate the quantitative nature of physical medical diagnosis. By their own documentation, the included mental health assessments use fuzzy descriptors that masquerade as metrics.
But wait, there’s more.
“Many instruments that screen for anxiety were initially developed for epidemiologic studies for surveillance or to evaluate response to treatment. Not all of the screening instruments are feasible for use in primary care settings because of length.1,3 Currently, only 2 screening instruments are widely used in clinical practice for detecting anxiety: SCARED and Social Phobia Inventory.
Anxiety screening tools alone are not sufficient to diagnose anxiety. If the screening test is positive for anxiety, a confirmatory diagnostic assessment and follow-up is required.”
Imagine that. You’re writhing in pain from your broken bone. Do you want to answer a lengthy questionnaire about how you’re feeling? SCARED versions have between 38 and 71 questions. The Social Phobia Inventory is shorter, at 17 questions, but … still … you’re their to have your bone fixed.
It’s important to consider that according to the DSM, to be diagnosed with “Anxiety Disorder,” you must have “excessive” anxiety and worry occurring “more days than not” for “at least 6 months.”
“Excessive”? According to what or who? For an autistic person, when does your generalized anxiety become “excessive?” Is it more than you think you should feel or more than someone else thinks you should feel? Where's the threshold and how do you measure it? What about the non-verbal? None of the included “evidence” features a specific sample of autistic and/or non-verbal populations.
Then there’s the duration of “symptoms.” “Six months?” So, if I’m anxious for 179 days, I don’t have a “mental illness.” But suddenly, if it lasts one more day, on the 180th day I have one? “On more days than not?” Does this sound like science to you?
To the star chamber, he anxiety must be about “events or activities (such as work or school performance).” In other words, if your anxiety interferes with capitalism, it must be treated so that you remain optimally engaged in commerce. But, doesn’t this criteria omit most of the reasons people get anxious, including being anxious for no conscious reason? Does your normal autistic anxiety fit their definition?
But wait … there’s even more: you must also have 3 of the following 6 “symptoms:”
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
There are obviously 100s of reasons for these 6 nonsensical “symptoms." Can you think of a few?
I guarantee that this will lead to an epidemic of “anxiety disorder” and millions of psychotropic medication prescriptions … which is, I think, the point.
It’s important to note that anxiety is NOT an “illness.” In most cases, it’s a meaningful and purposeful process of profound change and growth trying to come forth. Of course, this usually can’t be solved through mere talking or thinking. Like all forms of mental distress, it must be processed viscerally. Taking meds, when they’re not necessary, helps no one but the big pharma companies.
So, be on the look out for these new “assessments” the next time you see your doctor.