Johanna Taylor Katroscik, PharmD
The US Preventive Services Task Force (USPSTF) now recommends that children and adolescents should be screened for anxiety. The task force detailed this recommendation for children and adolescents between the ages of 8 and 18 years in an October 11, 2022, JAMA article. Data to support their recommendation came from a systematic review of evidence looking at whether screening children and adolescents for anxiety would benefit or harm this patient population.
The task force reviewed 10 studies (n = 3,260) to evaluate the accuracy of different tests used. These studies were considered to be of fair quality and looked at 12 different screening tools that are used to assess for anxiety disorders. The anxiety disorders that were screened for included generalized anxiety disorder, panic disorder, and social anxiety disorder. The review did not focus on other types of anxiety disorders, such as obsessive-compulsive disorder or post-traumatic stress disorder.
Additionally, the task force noted that the accuracy of the tools varied widely between studies when looking at different types of anxiety disorders.
Risk versus benefit in early screening
USPSTF believes that early screening for anxiety does have a moderate benefit to patients who are 8 to 18 years. Although there were no trials that directly assessed screening children or adolescents for anxiety disorders, the task force did look at trials that assessed treatment of these disorders. In doing so, they hoped to make a connection between the accuracy of the screening and the benefit of treatment.
Treatments in these studies included both cognitive behavioral therapy as well as pharmacotherapy. In the studies that were reviewed, pharmacotherapy showed a reduction of anxiety symptoms while cognitive behavioral therapy was associated with an improvement in overall outcomes. The potential risks of early screening were also not directly assessed. Rather, outcomes were reviewed by making connections between inaccurate screening or diagnosis that may have led to harm from treatment received. USPSTF did not find any statistically significant risks associated with screening children or adolescents for anxiety.
The reality of clinical practice
While USPSTF does recommend anxiety screening for children and adolescents, they have not made recommendations on which screening tools to use or how to implement screening into practice.
USPSTF recognizes there are gaps in available data. Some of the areas they believe need more research include looking at direct benefit or harm caused by screening, the accuracy of the screening tools that are used, and the ability to screen in different settings (including primary care).
USPSTF also notes that “Anxiety screening tools alone are not sufficient to diagnose anxiety. If the screening test is positive for anxiety, a confirmatory diagnostic assessment and follow-up is required.” Although they don’t go too deeply into this, it brings up a more important issue on how to triage a patient who has been screened for anxiety and will need follow-up care—a point that will be particularly important if screenings are conducted outside of primary care or other settings. ■