Maintenance

Should a clinic screen for both anxiety and depression?

Last updated

Short answer

There is a strong case for it. Anxiety disorders are common in primary care, often ride along with depression, and are frequently missed. In one large study, about one in five patients had an anxiety disorder, and many were going untreated. Screening for anxiety alongside depression catches people a depression screen alone would overlook.

The research
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Annals of Internal Medicine, volume 146, issue 5, pages 317 to 325.
Sample 965 primary care patients completed a short anxiety questionnaire and then a structured telephone interview with a mental health professional, which served as the yardstick.
Published 2007
Journal Annals of Internal Medicine
Kurt Kroenke, Robert Spitzer, Janet Williams, Patrick Monahan, and Bernd Löwe set out to measure how common anxiety disorders are in ordinary primary care and how often they are caught. Across 15 United States clinics, patients completed a brief self-report of anxiety and then sat for a separate telephone interview with a mental health professional that served as the yardstick. About one in five patients, 19.5%, had at least one of the four most common anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, or post-traumatic stress disorder, and some had more than one. These disorders traveled with high rates of depression, more physical symptoms, and greater difficulty with work and daily life, and the impairment grew with each additional anxiety disorder a person carried. The gap in care was wide: roughly 41% of patients who had an anxiety disorder were getting no treatment for it at the time. The authors showed that a short questionnaire a patient can finish in a couple of minutes picks up most of these cases, and they argued it belongs in routine care as a first step, not as a diagnosis on its own.
Read the paper

What does this mean for your clinic?

Most clinics already screen for depression. The question this study raises is whether stopping there leaves too much on the table. Its answer is that anxiety is about as common, about as impairing, and much less likely to be caught, so a depression screen alone misses a large and treatable group of your patients.

The overlap is the practical point. Anxiety and depression are not tidy, separate boxes. In this study the two traveled together often, and a patient who screens negative for depression can still be carrying a serious anxiety disorder that is shaping their sleep, their physical symptoms, and how often they land in your office. If your intake asks only about mood, that person reads as fine. Adding a brief anxiety measure, like the companion questionnaire this same research group built, turns a blind spot into a number your team can act on.

The treatment gap is the part worth sitting with. Roughly 41% of patients who had an anxiety disorder were getting no care for it. That is not mostly a treatment failure. It is a detection failure, people whose problem was never named in the room. A two-minute form does not fix that by itself, but it is a cheap, reliable way to surface the cases that would otherwise stay quiet.

Be honest about the limits. This was a sample of selected United States primary care clinics around 2005, so your own population may read differently, and the study measured detection and burden, not whether routine double screening improves outcomes down the line. A screen is also only a prompt: it flags a likely problem for a clinician to confirm, it does not diagnose and it does not decide a plan. What the evidence supports is plain and low-cost: looking for anxiety, not just depression, finds people you are otherwise missing.

The takeaway

Terms in this page
Between-session support Mental readiness

This is the work Asendar™ was built for: collecting the same validated anxiety and depression scores between visits and keeping both in front of your team, so a patient who is sliding on one measure while looking steady on the other shows up while there is still time to act.

Start a 15-day free trial for your clinic

Track CoCM minutes, catch patients at risk of missing the code, export a billing packet. No card to start, $199/mo per clinician after the trial.

People also ask

Can one questionnaire measure both anxiety and depression?

Yes. Kurt Kroenke and colleagues (2016) combined a short depression scale and the GAD-7 anxiety scale into a single 16-item measure, the PHQ-ADS, and tested it in 896 patients across three trials. It held together well and tracked change over three months, so a clinic can gauge both conditions with one brief form. The authors describe it as a promising first validation that still needs testing in other groups.

How often do anxiety and depression show up together?

Often. In the primary care study by Kroenke and colleagues (2007), anxiety disorders carried high rates of comorbid depression along with more physical symptoms and greater functional impairment, and the burden rose with each additional anxiety disorder a person had. Screening for one condition without the other leaves a common, treatable problem in the dark.

Does adding an anxiety screen actually catch more cases?

It can. Kroenke and colleagues (2007) found that about 41% of patients with an anxiety disorder were getting no treatment at the time, and that a brief self-report finished in a couple of minutes flagged most of these cases. The screen is a prompt for a clinician to look closer, not a diagnosis, but you cannot act on a problem no one has named.

Explore more in the Maintenance pillar