Screening all adults for depression could help prevent a mental health epidemic

In a climate where mental illness is a leading cause of death, illness and disability worldwide, it is clear that a new approach is needed. The pandemic has only made things worse, with mental health problems on the rise in many countries, with little sign of improvement.

The US Preventative Services Task Force, a panel of medical experts, has recommended that doctors screen all adults under the age of 65 for depression and possibly other mental health problems. They came to this conclusion after reviewing scientific evidence on the pros and cons of screening and existing treatments.

As a researcher of public health and well-being, I think the UK and other countries should do the same.

Mental health problems already cost the UK economy nearly £120 billion a year, 90 percent of which is spent on people under the age of 70.

Covid-19 has only worsened the mental health of many people. Early in the pandemic, our research found that people were experiencing new mental challenges due to the fear of the virus or the sense of isolation caused by lockdowns.

Globally, since the start of the pandemic, we have seen a 25 percent increase in the prevalence of anxiety and depression. Especially young adults, but also young people between the ages of 30 and 59 were most affected.

The pandemic is still not over, with some predictions of record rates of Covid-19 in the near future. When it finally ends, the mental health effects of both the pandemic itself and the measures needed to contain it will continue.

In addition, the cost of living crisis – which will only increase in the coming months, both globally and in the UK – is already hurting people’s mental health. Financial stress continues to mount, particularly among those already most vulnerable to mental health problems, including those living on lower incomes, those from ethnic minorities of black and Asian minorities, and those with pre-existing mental health disorders.

There is no mental health vaccine; there are no quick fixes to the emotional and psychological burden caused by the pandemic and the cost of living crisis is mounting. We live in a perfect storm for a mental health epidemic.

The recommendation to screen for psychological problems in primary care is therefore a huge step forward in recognizing the importance of identifying psychological problems as soon as possible. Detecting emotional and mental health problems early is more effective than trying to treat them later when they are more severe.

But if we want to be really serious about preventing mental illness, we need to go further and look at how we can identify emerging mental health problems in adolescents as well. Too little progress has been made in recognizing and supporting the mental health of young people since I argued this nearly a decade ago in the British Medical Journal. Research suggests that about three-quarters of adult mental health disorders begin in adolescence or young adulthood, so the earlier the problems are identified, the better.

We need to better embed the recognition and support of mental health into our daily lives. Too many illnesses, especially ‘internalizing’ illnesses such as depression and anxiety, are often more difficult to detect compared to other conditions.

Some good initiatives for children and adolescents have started to gain popularity over the past decade, for example the ‘whole school approach’ to mental well-being in Wales, or the growth of children’s mental health charities such as Place2Be. A school-wide approach involves collaboration between teachers, parents, students and the wider school community and aims to promote a culture of emotional and social well-being, mental health education and specialized well-being intervention or referral where appropriate.

However, there is a danger that such progress will be held back or negated if the cuts in public health funding that we have seen over the past decade continue and if the threats to curtail physical health policies , such as those associated with obesity, are also applied to mental health policy.

There are some potential concerns. One concern is whether mental health screenings may be stigmatizing. To this I would like to say that, first, we should note that universal screening can help identify early, “preclinical” mental health problems before they become a full-fledged clinical diagnosis, and second, that we need to work harder to de-stigmatize mental illness. as a society. Early identification may also address concerns about whether more people will be prescribed drugs such as antidepressants, and possibly at a younger age, leading to “overmedicalization.” Again, embedding mental health education and support in organizations, workplaces and schools can help relieve clinical services and the need for pharmaceutical intervention.

While there are concerns about whether current resources can meet demand, this is no reason to throw the baby out with the bathwater. We need to increase resources to meet real demand, not artificially reduce demand to meet supply by failing to identify early mental health problems where we can.

The US Task Force’s recommendations are currently open for comment. Time will tell if they are implemented and if so, if they are effective. However, they represent progress on the path to true “equality of esteem” – recognizing that mental health is just as important as physical health.

If governments and their science advisory groups don’t urgently prioritize support for mental health issues, the aftermath of this perfect storm will be felt for years to come.

dr. Simon Williams is a psychology professor at Swansea University and an adjunct assistant professor at Northwestern University in Chicago, with research expertise in public health and wellness


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