New screening recommendations spotlight America’s silent mental health epidemic: Anxiety

Published: Dec. 28, 2022 at 3:21 PM HST|Updated: Jan. 31, 2023 at 1:09 PM HST
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HONOLULU (HawaiiNewsNow) - Since the COVID-19 pandemic began, many Americans have not only been facing a brutal virus but they’ve also been dealing with something deeper — an invisible mental health epidemic.

Two years ago, it was as if the world came to a sudden stop and everything changed in the blink of an eye.

While some were able to adapt quickly, others needed more time and more help. And in many instances, they didn’t get either. An already-stressed mental health system cracked under the new strains of the pandemic and many conditions went untreated.

Now there’s an effort to change that ― by bolstering screening and connecting people with services.

Researchers believe roughly half of Americans grapple with some form of anxiety. About 1 in 5 US adults have a diagnosed anxiety disorder and just under 10% of children experience anxiety issues each year.

Despite how prevalent it is, anxiety isn’t very well understood or talked about.

The good news: That’s slowly changing — starting with a recommendation that most kids and adults now be screened for anxiety.

To shine a spotlight on anxiety, we turned to the professionals who screen for it and the people who struggle with it.

‘Good anxiety and bad anxiety’
Meet Monica. She’s a busy student and she first realized she might have an untreated anxiety...
Meet Monica. She’s a busy student and she first realized she might have an untreated anxiety disorder during an Intro to Psychology class.(Megan Ramones)

“There’s good anxiety and there’s bad anxiety,” said Monica, who is diagnosed with depression and generalized anxiety. “You get anxiety that helps you stay motivated, and then there’s anxiety like kind of feels like it’s you know, pointless.”

Monica is a busy student at Grand Canyon University. She asked that we keep her name private.

She first realized she might have an untreated anxiety disorder during an Intro to Psychology class.

“When I started to make friends and talk about things, I say, you know how I feel about something that, you know, it was very nonchalant for them, but for me it was always something more,” Monica said.

Learning about mental health kept her asking questions. And that knowledge eventually gave her the courage to seek help.

Monica was diagnosed with generalized anxiety and major depressive disorder earlier this year.

“It’s like one thing to be nervous, but anxiety is like ten times for that,” Monica described.

“It’s like your body starts to feel like you can’t breathe. I had shortness of breath and it’s everything starts to get kind of hazy... And, you know, it’s worrisome because you’re in your head.”

Monica was diagnosed with major depressive disorder, which is recurrent and in partial...
Monica was diagnosed with major depressive disorder, which is recurrent and in partial remission. She was also diagnosed with generalized anxiety disorder.(HNN)
Anxiety is common — and commonly misunderstood

We’ve all had anxiety: First dates, final exams, job interviews, public speaking, the pandemic lockdowns. All of these situations brought some kind of stress.

Dr. Bart Pillen, Hawaii Pacific Health chief of Behavioral Health, said it’s normal for humans to have some level of anxiety.

“What we know is that when we’re faced with a challenge, for example, moderate levels of anxiety can be really motivating and help us perform better,” said Pillen, a psychologist of 40 years who’s worked with a wide range of patients.

He added that when anxiety impacts your relationships, your work or other aspects of your life, it might be time to pay closer attention — and get help.

“It’s the type of anxiety that won’t go away so easily and it keeps coming up,” Pillen explained. “Even if you try to ignore it or try to keep busy.”

You’re not alone

“About 1 in 4 men and … about 1 in 2 women, actually have anxiety,” said Dr. Gbenga Ogedegbe, director at the Institute for Excellence in Health Equity and a professor of Medicine at NYU Grossman School of Medicine.

He said the abundance of anxiety in the United States prompted the U.S. Preventative Service Task Force to recommend broad screening for anxiety.

On Sept. 20, the task force came out with a draft recommendation: Adults 64 years and younger should get screened for anxiety even if there are no signs or symptoms of anxiety.

Less than a month later, the body recommended kids ages 8 to 18 should also get screened for anxiety.

It was a significant shift ― and a recognition that more screening is key to catching problems early.

Symptoms of anxiety disorder
Symptoms of anxiety disorder(HNN)
What’s going on?

At this point, you’re probably asking: What does anxiety actually look like?

The symptoms vary but here are some things to look for:

  • Feelings of restlessness
  • Tense muscles
  • Increased heart rate
  • Spike in blood pressure
  • Difficulty breathing

“Your body has a reaction where you get stress hormones, you know, flowing through you, that cortisol and adrenaline,” Pillen explained.

“Also your brain starts to go into high gear and usually not about happy things. You probably will start to think, oh my gosh, what’s going on?”

Pillen added that when your mind starts to race with unhappy thoughts, they expand or magnify the physical distress, too.

Generalized anxiety disorder
Generalized anxiety disorder(HNN)
What to know about anxiety disorders

Anxiety disorders come in many different forms, including:

  • Generalized Anxiety Disorder: Otherwise known as heightened anxiety. If you’re going through a period of stress, you can have adjustment issues where your anxiety is a little bit more prominent than the next person.
  • Panic Disorder: You regularly have sudden attacks of panic or fear that last up to 20 minutes or longer.
  • Post-Traumatic Stress Disorder: You have flashbacks, nightmares or fear triggered by a traumatic event that’s difficult to recover from. Many veterans, children and assault survivors have this disorder.
  • Obsessive Compulsive Disorder (OCD): A person has uncontrollable, reoccurring thoughts (“obsessions”) and/or behaviors (“compulsions”) that he or she feels the urge to repeat over and over.
  • Phobia Disorder: An uncontrollable, irrational, and lasting fear of a certain object, situation, or activity. There are many types of phobias but they are usually divided into two categories: Simple and complex.

There’s also social anxiety, separation anxiety and agoraphobia (fear of being in situations where escape might be difficult).

And experts say anxiety plays a role in depression.

Finding support

When Monica first noticed her anxiety in 2018, she remembers how empowering it was to acknowledge it — and tell others what she was dealing with.

“And for me and took a lot to even talk about it with, you know, my parents and then to be able to tell them aloud, it made me stronger,” Monica recalled.

About a year ago, she started seeing a therapist.

“And as time went on, I was like, you know, I can’t keep living like this anymore,” Monica said. “I can’t live like that, you know, you can’t really grow.”

Monica said there’s only so much you can do for yourself, which led her to reach out for help.

“So I decided that I wanted to see a therapist just for so I can see if one my findings were true. Like I said, you can’t really self-diagnose yourself. So I wanted to make sure what I was thinking was valid.”

She said she was referred to a therapist by her doctor following a screening.

“I’m not too sure if other doctors do that, but I’m very fortunate that she does that,” Monica said.

That screening was exactly what experts are hoping happens more often.

Overcoming anxiety
Overcoming anxiety(HNN)
Anxiety screening

“In our primary care settings where we screen people for anxiety, we also have psychologists or licensed clinical social workers available for short term psychotherapy to kind of find out, well, what is this about?” Pillen explained.

He said if you can clearly identify anxiety and follow up with an action plan, you’re less likely to feel helpless.

“When you hold back and you avoid it tends to get bigger,” Pillen added.

“But when you start talking about it with somebody who’s not going to be judgmental, and they can talk about what you can do about it, that’s great. That’s one big benefit of screening on a regular basis.”

Ogedegbe said the hope is that screening those who don’t have symptoms or signs of anxiety, will raise awareness for why it is important to diagnose and treat people with anxiety.

Being able to differentiate between anxiety disorders and isolated anxiety has been blurred by the COVID-19 pandemic.

Anxiety screening would offer some kind of clarity to both the doctor and the patient.

“Is this anxiety really related to the pandemic?” Ogedegbe said.

“Is this situational or is this much more endogenous, which is related to having (an) anxiety disorder? So I think that’s a question that will come up once folks are screened positive for anxiety.”

An important note: Screening positive for anxiety doesn’t necessarily mean you are diagnosed with a disorder.

It’s just the start of a process — and getting help, experts say.

Treatment for anxiety looks different for everybody because anxiety disorders have different...
Treatment for anxiety looks different for everybody because anxiety disorders have different symptoms: Talk therapy, medication, relaxation techniques, finding healthy ways to cope.(HNN)
The power of being proactive

Treatment for anxiety looks different for everybody because anxiety disorders have different symptoms.

Common types of treatment used include:

  • Talk therapies: Psychotherapy and cognitive behavioral therapy
  • Medications: Anti-anxiety medications and anti-depressants
  • Finding healthy ways to cope: Stress and relaxation techniques, journaling, calling a friend

Mental health experts say having a plan — like calling a friend— in the face of anxiety can also be beneficial.

“So like, if I can predict, well, you may have a panic attack or anxiety at 2:00 today, would you just worry about it or would we have a plan about it?” Pillen said.

He said creating a behavioral plan and cognitive approaches enables you to be ready.

We asked Pillen what his biggest piece of advice is for those concerned about their anxiety.

His answer? “Be proactive.”

“Don’t actually wait for the anxiety to hit you,” Pillen said.

He introduced the idea of practicing fire drills at school. The purpose of it is so that in case there’s a real emergency, you’d be able to manage it calmly.

“The same is true for anxiety… that when you have anxiety, you’ll say, I’m ready for you, okay? I’m not helpless. I can manage this as well,” Pillen said.

He also says a good social support is important to have, especially a professional voice who can give a positive perspective and support.

“I think the most common, you know, mistake people think is that they’re all alone and that they have to wait until it’s really bad.”

Pillen said the “best insurance policy” is to know how to respond.

“And if you really are overwhelmed and it’s affecting you, then please reach out to us.”

Surround yourself with positivity

Today, Monica is working toward her master’s degree.

“I will say that with what I’ve gone through, what I still continue to go through, even to this day, it has shaped me a lot,” Monica said. “And in a sense I’m very thankful for it because not a lot of people can survive it.”

She’s found ways to cope, including by surrounding herself with her family and investing time into hobbies. And she’s thankful for the people in her life who have helped her along the way by simply being present.

“Surround yourself with people that you care about and that love you, and you’ll be OK,” Monica said.

Monica standing in her neighborhood park.
Monica standing in her neighborhood park.(HNN)

Here’s what the experts say:

Anxiety is just one of the many mental health issues children, adolescents, and adults face in today’s society. Look for key changes in behavior. It might not just be a typical teenage angst or a “bad day,” but something clinical.

And parents: Don’t be afraid to start an open conversation.

Experts say the best way to approach discussions is with compassion and not blame.

Remember, asking for help is strength — never weakness.

For more information on local mental health resources and support groups, visit Hawaii’s National Alliance for Mental Illness here.

For details on Hawaii Pacific Health’s mental health services, click here.

If in crisis, don’t hesitate to reach out to: