The U.S. Preventive Services Task Force released new guidelines in June urging that adults ages 19 to 64 be routinely screened for anxiety, even if they show no signs of the disorder. This is in addition to the agency’s guidance from last year recommending children ages 8 to 18 be regularly screened.
The task force has been given credit for bringing even more awareness to the possible links between anxiety and other diseases. But not everyone agrees with what the agency is advising.
Nationwide Children’s Hospital clinical psychologist John Ackerman, Ph.D., told me that the guidance confusingly “recommends screening for anxiety starting at 8 and depression starting at 12 — but, then, does not suggest there is sufficient evidence to screen for suicide risk, specifically.” Ackerman is suicide prevention clinical manager at Nationwide’s Center for Suicide Prevention and Research.
Epidemiologist Jeff Bridge, Ph.D., director of the Center, went further. He was the lead author of a response published in Pediatrics saying that task force members “are to be commended for their painstaking work in synthesizing and translating a tremendous amount of information into concrete recommendations … [W]e will discuss our rationale for disagreeing with the [U.S. Preventive Services Task Force’s] conclusion that there are insufficient data either for or against screening for suicidal risk in adolescents.”
The need for mental health screening
Co-authored with the director of the University of Pittsburgh’s Child and Adolescent Bipolar Spectrum Services and its endowed chair in suicide studies, both of whom are psychiatrists, “The Case for Universal Screening for Suicidal Risk in Adolescents” counters the task force. It argues that there are several well-founded, well-established reasons for a much wider swath of youth to be screened at school by a primary care physician and in a specialized mental/behavioral health setting.
Together, said Nationwide researcher Ackerman, those three levels of screening “lay the foundation for a behavioral health well visit.”
He continued: “Suicide is either the second or third leading cause of death [for youth], depending on how you create age or demographic splits.” In light of that, what the task force is proposing isn’t precautious or preventive enough, Ackerman said.
Several research studies have long concluded that anxiety and depression often co-exist. Depression is among the risk factors for suicidal thoughts and attempts (though the vast majority of people with depression do not attempt suicide).
A growing problem
An analysis of federal data released by KFF in March concluded that half of all 18- through 24-year-olds reported experiencing symptoms of anxiety and depression symptoms in 2023, compared to a third of adults overall.
“After no significant change between 2001 and 2007, the suicide rate among young people ages 10‒24 increased 62% from 2007 through 2021, from 6.8 deaths to 11.0 per 100,000,” reads the report.
“Anxiety and depression have effective treatments,” Nationwide’s Ackerman told me. “And caregivers and youth should be provided with accurate prevention …,” especially amid the swell of mental illness that youth have been reporting.
In making its particular case for routine anxiety screenings of those ages 19 through 64, the task force was, in its own way, confronting that reality. But, as those Nationwide and University of Pittsburgh researchers ask, is there more to do to safeguard the mental health of young people, including as it relates to their suicidal ideation?
That’s the broad question reporters should be asking. Additionally:
- What are the preventive task force’s hopes and aims regarding this new guidance?
- What, if any outcomes, is the task force projecting will result from this guidance?
- As a persistent shortage of psychiatrists puts primary care physicians, licensed clinical social workers and even school nurses at the core of mental health delivery for young people, how does that shape services to vulnerable youth?
“There are many implications, of course, including the need for more training [for clinicians], integrated behavioral health support and resources for families,” Ackerman said. “It should not stop us from … [taking] steps early to address symptoms and build a set of strategies.”
- “Implementing Suicide Risk Screening in Pediatric Primary Care Setting: From Research to Practice,” a March 2022 study in Pediatrics
- “Familial Pathways to Early-Onset Suicide Attempts,” a 2015 study in JAMA
- “Hiding in Plain Sight: Youth Mental Illness,” a 2022 Ken Burns-produced documentary
- “The Case for Universal Screening for Suicidal Risk in Adolescents,” a May 2023 op-ed in Pediatrics
- “Anxiety Disorders in Adults: Screening,” June 2023 U.S. Preventive Task Force final recommendation statement
- “Anxiety in Children and Adolescents: Screening,” October 2022 U.S. Preventive Task Force final recommendation statement