In new draft guidelines, the U.S. Preventive Services Task Force (USPSTF) for the first time recommends that healthcare providers screen children for anxiety, regardless of whether they are showing signs and symptoms.
USPSTF is recommending anxiety screening for children ages 8 and older (B grade) and reaffirmed their recommendations to screen for major depression in adolescents ages 12 and up (B grade), citing a “moderate net benefit” for these age groups.
“Too many children and teens in the United States experience mental health conditions, including anxiety, depression, and suicidal thoughts or behaviors,” the Task Force wrote in a press release. “For older children and teens, screening and follow-up care can reduce symptoms of depression and can improve, and potentially resolve, anxiety.”
While the recommendations apply in the absence of signs or symptoms of these conditions, the group noted that “anyone expressing concerns or showing symptoms should be connected to care.”
The group is not recommending screening for anxiety and depression in younger children due to a lack of evidence (I statement).
In addition, despite the Task Force acknowledging in its statement that “suicide is tragically a leading cause of death for older children and teens,” they could not recommend for or against screening for suicide risk in children of any age, again due to insufficient evidence (I statement).
“More research on these important conditions is critical,” said USPSTF member Lori Pbert, PhD, of the University of Massachusetts Medical School in Worcester, in a statement. “In the meantime, healthcare professionals should use their clinical judgment based on individual patient circumstances when deciding whether or not to screen.”
While screening for major depressive disorder is recommended in all adolescents, risk factors include a personal or family history of depression, childhood abuse or neglect, exposure to traumatic events, bullying (either as perpetrators or as victims), adverse life events, early exposure to stress, maltreatment, and an insecure parental relationship, the USPSTF noted.
Some of the risk factors for childhood anxiety disorders include attachment difficulties, parental conflict or early separation, overprotection, and maltreatment. LGBTQ youth are at significantly increased risk for anxiety, they said.
The group cited several resources for screening, including the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), and the Patient Health Questionnaire (PHQ-9), which is the most commonly used screening instrument in clinical practice, and includes a question on suicidal ideation. Of the numerous screening tools for anxiety, only the Screen for Child Anxiety Related Disorders (SCARED) and the Social Phobia Inventory are widely used in clinical practice.
The optimal screening interval is not known, the Task Force noted, but repeated screening may be helpful for adolescents at higher risk for depression.
Screening is only the first step in helping children and teens with depression and anxiety, the group said. Diagnosis of both conditions cannot be based on screening results alone — confirmatory diagnostic evaluation and follow-up are required.
Following diagnosis, “youth should participate in shared decision making with their parents or guardians and their healthcare professionals to identify the treatment or combination of treatments that are right for them,” they wrote. Patients should be monitored “to ensure that the chosen treatment is effective,” they added.
In addition, the Community Preventive Services Task Force recommends targeted school-based cognitive behavioral therapy programs to reduce depression and anxiety symptoms.
Public comment on the new USPSTF draft recommendations will be accepted through May 9.
Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.