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.
At the same time, the task force has concluded there is not enough evidence to recommend for or against screening for anxiety and depression in younger children, or for or against screening for suicide risk in youth.
The recommendation statements on screening for anxiety (graded “B” and “I”) and depression and suicide risk (graded “B,” “I” and “I”), published Oct. 11, apply to children and adolescents who do not have a diagnosed anxiety disorder or mental health condition, and are not showing recognized signs or symptoms of anxiety, depression or suicide risk. The recommendation on depression and suicide risk focuses on screening for major depressive disorder, and does not address screening for other disorders, such as minor depression or dysthymia.
The combined recommendation on screening for depression and suicide risk replaces separate recommendations the task force issued in 2014 and 2016, while the recommendation on screening for anxiety is new to this patient population.
“The task force reviewed the evidence on screening for anxiety, depression, and suicide risk to provide primary care professionals with guidance on how they can help support the mental health of children and adolescents,” task force member Martha Kubik, Ph.D., R.N., said in a bulletin. “Fortunately, screening older children for anxiety and depression can identify these conditions so children and teens can receive the care that they need.”
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.
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.”
The task force called for studies to close research gaps in several areas, including