USPSTF Issues Final Recommendations for Anxiety, Depression Screening in Youth

The US Preventive Services Task Force (USPSTF) published final recommendations on screening for anxiety, depression, and suicide risk in children and adolescents in JAMA.

For the first time, the USPSTF recommended screening for anxiety in children aged ≥8 years who do not have a diagnosed anxiety disorder and are not showing signs or symptoms of anxiety (B grade). The task force also recommended screening for major depressive disorder (MDD) in adolescents aged 12-18 years who are not showing signs or symptoms of MDD (B grade). The B grade recommendation means there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial, according to the USPSTF.

The task force also concluded that current evidence was insufficient to assess the balance of benefits and harms of screening for MDD in children aged ≤11 years or for screening for suicide risk in children and adolescents. Both were I-grade recommendations.

“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,” said USPSTF member Martha Kubik, PhD, RN, in a press release. “Fortunately, screening older children for anxiety and depression can identify these conditions so children and teens can receive the care that they need.”

These recommendations replaced the 2014 USPSTF recommendation statement on screening for suicide risk in adolescents and the 2016 recommendation statement on screening for MDD in children and adolescents.

The final recommendations are consistent with the 2022 draft recommendation statements on these topics, which were posted for public comment on the task force’s website from April 12, 2022, to May 9, 2022.

“The Task Force cares deeply about the mental health of all children and adolescents. Unfortunately, there are key evidence gaps related to screening for anxiety and depression in younger children and screening for suicide risk in all youth,” said task force member Lori Pbert, PhD, in the release. “We are calling for more research in these critical areas so we can provide healthcare professionals with evidence-based ways to keep their young patients healthy.”

The USPSTF emphasized that screening is only the first step in helping children and adolescents with anxiety and depression. Children who screen positive need further evaluation to determine if they have anxiety or depression. After diagnosis, the task force stated that children and adolescents should participate in shared decision-making with their parents and health care professional to identify the treatment or combination of treatments that are best for them, and then be monitored regularly to ensure that the chosen treatment is effective.