Young people ages 8 to 18 should all receive an annual screening for anxiety, according to a new recommendation by the U.S. Preventive Services Task Force, a volunteer panel of experts who make public health recommendations.
The goal is to identify mental health conditions earlier and direct youth to treatment that can help a problem from becoming worse.
The screening is important because it can be difficult for parents and caregivers to identify anxiety in children and teens. Young people may express worries verbally, but their anxiety can instead present itself as irritability or frustration. Anxiety can result in physical symptoms such as trouble sleeping, fatigue, headaches, or stomachaches. Research shows that half of young people with mental health disorders never receive a diagnosis or treatment.
Current data show that youth mental health has been on a downward spiral since the COVID-19 pandemic. Before the pandemic, nearly 8 percent of U.S. youth were diagnosed with anxiety. Recent surveys show that number has risen as young people coped with social distancing and then re-entry into social situations. In a 2021 survey, more than 30% of U.S. high school students reported that their mental health was not good most or all of the time. (This includes anxiety, but also other issues like depression and suicidal thoughts.)
The new recommendation will most likely result in anxiety screenings becoming a regular part of annual check-ups. A variety of questionnaires can help medical providers identify young people who need further assessment and treatment. Such an assessment would help determine whether a young person is having a tough period or experiencing an on-going mental health issue that affects their daily life.
For young people who are diagnosed with an anxiety disorder, the standard treatments are therapy, prescription medications, or a combination of the two. The most common, evidence-based treatment is cognitive behavioral therapy which can be delivered either in-person or online. There is one prescription medication, a serotonin–norepinephrine reuptake inhibitor, approved by the U.S. Food and Drug Administration for treatment of generalized anxiety disorder in children ages 7 and up. In addition, many medical providers prescribe off-label medications (those that have been approved by the FDA for other purposes) to treat children in this age group with anxiety disorders.
“This is a time of intense change and uncertainty,” said Janis Whitlock, emerita research scientist at the BCTR whose work focuses on adolescent mental health. “Everybody is feeling it, but our young people are especially impacted. Noticing heightened anxiety early and responding in supportive ways is imperative.”
Should we screen all youth for suicide?
The task force is also considering the evidence on screening young people for suicide, but did not find enough data to support a screening recommendation for all youth.
There is ample evidence that suicide is on the rise among U.S. teens. In a 2021 survey, almost 20% of teens said they had considered suicide, and 9% said they attempted suicide. More young people are also showing up in emergency rooms for suicide attempts. Compared to 2019, emergency room visits for suicide attempts in 2021 increased by 51% for adolescent girls; attempts increased by 4% for boys.
The task force did recommend that children and teens at high risk for suicide receive screening, and reiterated a previous recommendation for screening major depressive disorder during primary care visits for youth ages 12 to 18 years.
“We need to keep a close eye on teen mental health trends,” Whitlock said. “Teens need adult attention and support now more than ever.”
The take-home message: To address the mental health crisis facing American youth, the U.S. Preventive Services Task Force recommended all youth ages 8 and up receive screening for anxiety. This is an important step to getting young people the treatment they need to cope with the challenges presented by modern society and the COVID-19 pandemic.
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