Anxiety, Depression Screening Recommended for Some Youth

USPSTF Finds Evidence Lacking to Screen for Suicide Risk

November 3, 2022, 3:51 p.m. Michael Devitt — For the first time, the U.S. Preventive Services Task Force is recommending that health care professionals screen children and adolescents ages 8 to 18 years for anxiety, while also recommending screening children 12 to 18 years for major depressive disorder.

Findings

While the task force found no studies that directly evaluated the benefits or harms of screening for anxiety disorders, two screening instruments — Screen for Anxiety Related Emotional Disorders and the Social Phobia Inventory — were found to be reasonably accurate for detecting anxiety. In addition, the task force suggested that repeated screening may be beneficial in adolescents with risk factors for anxiety.

Of the treatments evaluated for anxiety, cognitive behavioral therapy was associated with improvements in anxiety outcomes, including treatment response, increased remission and loss of either primary anxiety diagnosis. Pharmacotherapy was also associated with favorable treatment response rates and increased symptom improvement, and both CBT and pharmacotherapy were associated with statistically significant functioning improvements on the Children’s Global Assessment Scale.

As for depression and suicide risk, indirect evidence suggested that some screening instruments, such as the Beck Depression Inventory and the Paediatric Index of Emotional Distress-Depression Subscale, were reasonably accurate in detecting depression. For depression, pharmacotherapy demonstrated statistically significant benefits for improved symptoms, as well as benefits for loss of diagnosis and functional status. Evidence on psychotherapy also suggested some benefits for symptom improvement and clinical response, but the results were inconsistent across all measures for other outcomes, and evidence on harms was limited. For suicide risk, evidence suggested that psychotherapy could produce statistically significant improvements in suicidal ideation, but no statistically significant differences on any other measures.

Family Physician Perspective

Corey Lyon, D.O., an associate professor in the Department of Family Medicine at the University of Colorado School of Medicine, Denver, associate program director at the University of Colorado Family Medicine Residency program, and incoming chair of the Academy’s Commission on Health of the Public and Science, explained how the recommendations could guide family physicians in the care of young patients.

“This helps reinforce what I feel many of us know and have been seeing in our clinics,” Lyon said. “Our adolescent patients are presenting more and more with anxiety and depression symptoms. Recommending to screen this population to assure we are identifying patients early and providing treatment and resources as early as possible will only help improve our patient care.”

Lyon also commented on the screening instruments he regularly uses.

“We screen our adolescents with the PHQ-9A on a routine basis,” said Lyon. “When we feel an adolescent patient may have some anxiety symptoms, we utilize the GAD-7. Both of these screening tools are brief and effective tools for identifying patients that may need additional workup and treatments.”

Research Needs

The task force called for studies to close research gaps in several areas, including

• the benefits and harms of screening children and adolescents for anxiety or suicide risk in primary care settings compared with no screening or usual care,
• the feasibility of using screening tools in primary care;
• the accuracy of screening tools in children and adolescents and the effectiveness of anxiety treatment in younger children;
• the benefits and harms of screening for and treating major depressive disorder in children 11 years or younger; and
• the effects of collaborative care and integrated behavioral health in children and adolescents.