{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T09:34:39Z","timestamp":1793266479174,"version":"4.5.0"},"reference-count":94,"publisher":"American Medical Association (AMA)","issue":"24","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,6,27]]},"abstract":"<jats:sec id=\"ab-jus230007-1\"><jats:title>Importance<\/jats:title><jats:p>Anxiety is commonly seen in primary care and associated with substantial burden.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-2\"><jats:title>Objective<\/jats:title><jats:p>To review the benefits and harms of screening and treatment for anxiety and the accuracy of instruments to detect anxiety among primary care patients.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-3\"><jats:title>Data Sources<\/jats:title><jats:p>MEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-4\"><jats:title>Study Selection<\/jats:title><jats:p>English-language original studies and systematic reviews of screening or treatment compared with control conditions and test accuracy studies of a priori\u2013selected screening instruments were included. Two investigators independently reviewed abstracts and full-text articles for inclusion. Two investigators independently rated study quality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-5\"><jats:title>Data Extraction and Synthesis<\/jats:title><jats:p>One investigator abstracted data; a second checked accuracy. Meta-analysis results were included from existing systematic reviews where available; meta-analyses were conducted on original research when evidence was sufficient.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-6\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Anxiety and depression outcomes; global quality of life and functioning; sensitivity and specificity of screening tools.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-7\"><jats:title>Results<\/jats:title><jats:p>Of the 59 publications included, 40 were original studies (N\u2009=\u2009275\u202f489) and 19 were systematic reviews (including \u2248483 studies [N\u224881\u202f507]). Two screening studies found no benefit for screening for anxiety. Among test accuracy studies, only the Generalized Anxiety Disorder (GAD) GAD-2 and GAD-7 screening instruments were evaluated by more than 1 study. Both screening instruments had adequate accuracy for detecting generalized anxiety disorder (eg, across 3 studies the GAD-7 at a cutoff of 10 had a pooled sensitivity of 0.79 [95% CI, 0.69 to 0.94] and specificity of 0.89 [95% CI, 0.83 to 0.94]). Evidence was limited for other instruments and other anxiety disorders. A large body of evidence supported the benefit of treatment for anxiety. For example, psychological interventions were associated with a small pooled standardized mean difference of \u22120.41 in anxiety symptom severity in primary care patients with anxiety (95% CI, \u22120.58 to \u22120.23]; 10 RCTs [n\u2009=\u20092075]; <jats:italic>I<jats:sup>2<\/jats:sup><\/jats:italic>\u2009=\u200940.2%); larger effects were found in general adult populations.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jus230007-8\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Evidence was insufficient to draw conclusions about the benefits or harms of anxiety screening programs. 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