Anxiety and Depression Screening
Primary care routinely screens for anxiety and depression because both are common, often go unspoken, and respond well to treatment when caught. The 2023 USPSTF recommendation gives a Grade B recommendation to screen all adults for depression, and adults 64 and younger for anxiety.
Symptoms
The GAD-7 screens for excessive worry, restlessness, and physical tension; the PHQ-9 screens for low mood, loss of interest, sleep and appetite changes, and thoughts of self-harm.
Causes and risk
Family history, chronic stress, major life changes, chronic illness, and social isolation all raise risk; anxiety and depression frequently occur together.
How it is evaluated
A positive screen (elevated GAD-7 or PHQ-9 score) requires a follow-up clinical conversation to confirm a diagnosis -- screening tools flag possibility, they don't diagnose on their own. Item 9 of the PHQ-9, which asks about self-harm, triggers an immediate safety conversation regardless of the total score.
Treatment
First-line treatment combines cognitive behavioral therapy with SSRIs or SNRIs when medication is appropriate, per current JAMA Internal Medicine and AAFP guidance; benzodiazepines are generally discouraged given dependence risk. Evidence for USPSTF screening in adults 65 and older for anxiety, or for standalone suicide-risk screening, remains insufficient to make a blanket recommendation.
When to seek care
Thoughts of suicide or self-harm, especially with a plan, need immediate attention -- call or text 988 (Suicide & Crisis Lifeline), go to the nearest emergency department, or call 911.