Screening for Anxiety, Depression, and Suicide Risk in Children and Adolescents

A 13-year-old patient with a history of eczema presents for a well-child examination. His height, weight, and development are appropriate for his age. His eczema is well controlled. He enjoys science class. His physical examination is unremarkable.

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation statements, which of the following conditions should this patient be screened for?

• A. Only anxiety.
• B. Only depression.
• C. Anxiety and depression.
• D. The patient should not be screened for anxiety or depression.

2. Which one of the following is the USPSTF recommendation regarding screening for suicide risk in children and adolescents?

• A. A recommendation: There is high certainty that the net benefit of screening is substantial.
• B. B recommendation: There is high certainty that the net benefit of screening is moderate or there is moderate certainty that the net benefit is moderate to substantial.
• C. C recommendation: There is at least moderate certainty that the net benefit of screening is small. Screening should be selectively offered or provided to individual patients based on professional judgment and patient preferences.
• D. D recommendation: The USPSTF recommends against screening. There is moderate or high certainty that screening has no net benefit or that the harms outweigh the benefits.
• E. I statement: Current evidence is insufficient to assess the balance of benefits and harms of screening.

3. Screening and further discussion reveals that the patient has symptoms consistent with generalized anxiety disorder. Which of the following are appropriate treatment options?

• A. Collaborative care.
• B. Pharmacotherapy with duloxetine.
• C. Pharmacotherapy with sertraline.
• D. Psychotherapy.

1. The correct answer is C. Because the patient is 13 years of age, the USPSTF recommends screening for anxiety and major depressive disorder (B recommendation).^1,2 The USPSTF recommends screening for major depressive disorder in adolescents 12 to 18 years of age.¹ However, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for major depressive disorder in children 11 years or younger (I statement).¹ The USPSTF recommends screening for anxiety in children and adolescents 8 to 18 years of age.² The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger (I statement).²
2. The correct answer is E. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in children and adolescents.^1,3 In the absence of evidence, health care professionals should use their judgement based on individual patient circumstances when determining whether to screen for suicide risk in youth without recognized signs or symptoms.
3. The correct answers are A, B, and D. Treatment for anxiety disorders can include psychotherapy, pharmacotherapy, a combination of both, or collaborative care.² Several psychotherapy approaches are used to treat anxiety; cognitive behavior therapy is the most common.⁴ Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is the only medication approved by the U.S. Food and Drug Administration for treatment of generalized anxiety disorder in children 7 years or older. Other medications such as sertraline have been reported as being prescribed off-label for treatment of anxiety in youth. Collaborative care is a team approach in which the primary care clinician works with a behavioral health care manager and psychiatrist to ensure patients receive optimal care.

The views expressed in this work are those of the authors and do not reflect the official policy or position of Emory University or the U.S. government.