US Preventive Services Task Force calls for anxiety screenings for kids

Mental health problems among children may become a raging fire the industry isn't prepared for, experts warn.

The U.S. Preventive Services Task Force, which comprises volunteer primary care experts who review scientific evidence in making recommendations for screenings by healthcare providers, for the first time said all children aged 8 to 18 years old should be screened for anxiety.

The task force’s updated recommendation was published in JAMA Network on Tuesday.

Also Tuesday, the United Health Foundation, the philanthropic arm of insurer UnitedHealth Group, released America’s Health Rankings "Health of Women and Children" report, which included some alarming findings about the state of mental health of children aged 3 to 17 years old.

The release of the report accompanied an announcement of UnitedHealth Group’s $3 million donation to Active Minds, a not-for-profit organization that promotes mental health awareness for young adults. The report found that:

  • Anxiety increased 23% among children ages 3 to 17 between 2017 and 2018 and between 2020 and 2021. In 2020 to 2021, anxiety affected roughly 5.6 million children ages 3 to 17—an increase of more than 1 million children since 2017 to 2018.
  • Depression increased 27% among children ages 3 to 17 between 2017 and 2018 and between 2020 and 2021. In 2020 to 2021, depression affected roughly 2.5 million children ages 3 to 17, an increase of more than a half a million than in 2017-18.
  • The teen suicide rate increased 29% at the national level between 2012 and 2014 and between 2018 and 2020 among 15- to 19-year-olds.

“We look forward to helping youth gain skills to help counter the alarming increases we are seeing in youth mental health,” Rhonda Randall, chief medical officer of UnitedHealthcare's employer and individual division, said in a press release.

The $3 million will fund a pilot program in 50 school districts in Florida, North Carolina and Minnesota officials hope will address the mental health needs of kids in middle schools.

Alison Malmon, executive director and founder of Active Minds, said in the press release that “many mental health disorders can start by age 14, so it’s critical that we provide promotion, prevention, and early intervention strategies to equip younger adolescents with the necessary tools and coping skills to proactively manage and care for their mental health.”

Randall noted one of the goals of the program will be expanding “evidence-based solutions to help our young people thrive.”

Evidence prodded the task force to expand anxiety screening for children between 8 and 18 but to hold back on recommending that children under 7 also be screened.

“The USPSTF concludes with moderate certainty that screening for anxiety in children and adolescents aged 8 to 18 years has a moderate net benefit,” the recommendation said. “The USPSTF concludes that the evidence is insufficient on screening for anxiety in children 7 years or younger.”

The task force assigns letter grades A, B, C, D or I for certain preventive services. A recommendation made with “moderate certainty”—the updated one about adolescents issued yesterday—receives a B rating.

The task force found no evidence that would point to how often children should be screened for anxiety but did say that “repeated screening may be most productive in adolescents with risk factors for anxiety.” Those risk factors include conflict with parents, attachment difficulties, overprotective parents, mistreatment and separation from parents. Poverty and low socioeconomic status are also risk factors.

The task force did not recommend screening for depression among children aged 11 or younger who are not at risk. A task force recommendation drafted in 2016 and upheld by the panel calls for universal screening for depression for adolescents 12 to 18 years old. 

An editorial in JAMA Network accompanying the release of the recommendation argues that “the absence of a recommendation for suicide screening among adolescents in primary care settings does not call suicide screening into question but rather universal screening apart from screening for other risk factors such as depression. … Given the salience of depression as a risk factor for suicidal behavior and the value of depression screening … screening for suicide under the umbrella of depression screening could accomplish both screening tasks at the same time.”

However, the editorial does say such screening would place an added burden on the healthcare system. It states that “even if all adolescents who have or are at risk for suicidal behavior and depression could be identified, providing follow-up and evidence-based interventions for these adolescents promises to be a lofty goal, especially given constraints in training and the overall workforce and limited access to mental health professionals.”

The task force recommendation also notes real-world constraints in screening, saying that it “does not consider the costs of providing a service … [and] recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation."