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April 14, 2022

Youth mental health crisis: USPSTF recommends anxiety screenings for children

Daily Briefing

    As a youth mental health crisis grows in the United States, the U.S. Preventive Services Task Force (USPSTF) released new draft guidance recommending all children ages 8 to 18 be screened for anxiety.

    Radio Advisory episode: Seattle Children's approach to behavioral health

    A growing youth mental health crisis

    According to CDC data, the percentage of high school students reporting persistent feelings of sadness or hopelessness increased from 27.1% in 2004 to 44.2% in 2021. This increase has also been recorded in teenagers across sex, racial and ethnic groups, and more.


    "Rising teenage sadness isn't a new trend, but rather the acceleration and broadening of a trend that clearly started before the pandemic," said Laurence Steinberg, a psychologist at Temple University. However, he added, "We shouldn't ignore the pandemic, either. The fact that Covid seems to have made teen mental health worse offers clues about what's really driving the rise in sadness."

    USPSTF recommends screening children for anxiety

    To address the growing mental health crisis among children and adolescents, USPSTF on Tuesday released draft guidance recommending all children ages 8 to 18 be screened for anxiety—one of the most common mental health disorders in childhood.

    According to the task force, untreated anxiety can lead to negative physical effects in the short term, such as headaches and stomachaches, as well as poor academic performance and developmental delays in the long term. In addition, a report from the Child Mind Institute found that childhood anxiety disorders have been linked to an increased risk for depression, anxiety, behavior problems, and substance use disorders later in life.

    Martha Kubik, a member of the USPSTF and a professor in the school of nursing at George Mason University, said children should ideally be screened at their annual well child checkups, but clinicians should also screen them during other visits, if possible, even if they are not notified of any signs or symptoms.

    "It's critical to be able to intervene before a life is disrupted," she said.

    Stephen Whiteside, a child psychologist and director of the Pediatric Anxiety Disorders Clinic at the Mayo Clinic, said screening more children for anxiety is "really important" since "[m]ost kids in need of mental health care don't get it."

    Overall, as more children and adolescents in need of help are identified, it could "start to put pressure on many of the decision makers and people who hold the purse strings," said Carol Weitzman, the co-director of the Autism Spectrum Center at Boston Children's Hospital and a spokesperson for the American Academy of Pediatrics. "We need to shine the light brightly on the mental health needs of children, youth and adolescents in this country, and we need to be advocating for better access to mental health care.

    What's driving this increase?

    Writing for The Atlantic, Derek Thompson outlines four factors that may be driving the current youth mental health crisis, including:

    1. Social media use: For instance, research has found that roughly a third of teenage girls using Instagram said the app made them feel worse, while other research from Cambridge University found that social media was strongly associated with worse mental health for girls ages 11 to 13 and boys ages 14 to 15.

    2. Decreased social interaction: Decreased social interaction, particularly during the pandemic, has likely influenced adolescents' feelings of loneliness and sadness, Thompson writes. For example, a CDC report found that teenagers who did not feel close to people at school or were not virtually connected to people during the pandemic reported higher rates of poor mental health and persistent feelings of sadness and hopelessness.

    3. An increasingly stressful world: Fears about the pandemic, climate change, and other worldwide issues have all likely exacerbated adolescents' feelings of stress, which has then negatively impacted their mental health, Thompson writes. "I think of it as a pile-on effect," Steinberg said. "Every day, it feels like there’s something else. It creates a very gloomy narrative about the world."

    4. Ineffective parenting strategies: Over the years, according to experts, there has been a rise in "accommodative" parenting in which parents remove anything that may cause their children fear or discomfort—while at the same time, children are engaging in fewer activities that provide them a sense of competence, such as driving or completing household chores. As a result, when children do not learn to release negative emotions in face of inevitable stressors or discomforts, they are more likely to experience anxiety as they grow older. (Thompson, The Atlantic, 4/11; Hughes, New York Times, 4/6; Caron, New York Times, 4/12; Prieb, The Hill, 4/12)


    Advisory Board's take

    Screening can work—if we’re approaching it equitably

    Early intervention with mental health conditions can make a huge difference in outcomes and quality of life. The UPSTF draft guidance moves the industry in the right direction by attempting to further integrate mental health with physical health care—encouraging clinicians to screen children for mental health conditions early and often.

    While we are excited about the new screening guidance, there is a risk it could exacerbate existing inequities if it's inconsistently applied or reaches only a subset of children. For example, children who don't have a primary care physician or regularly interact with the health care system may be at risk of falling between the cracks of screening.

    We've long known that some children face higher rates of mental health conditions and inequitable access to care. In fact, socioeconomically disadvantaged children and adolescents are two to three times more likely to develop mental health problems. And psychiatric and behavioral problems among Black and Hispanic children and young adults are more likely to result in school punishment or even incarceration than mental health care. These findings have unfortunately remained consistent for many years, and the Covid-19 pandemic seems to have exacerbated the issue.

    How partnerships with schools can aid in equitable mental health screening

    If we have learned anything about the pursuit of health equity, it is that there is a real power in community partnerships. One way for health systems to reach children who might otherwise slip through the cracks is to partner with schools to provide onsite mental health screening and support. For example, we spoke with one health system in the western United States that has embedded mental health clinicians in over 20 local schools, as well as training school staff on how to support students' mental health. We also heard from a health system on the East coast that they run wellness centers where students can receive care at school. In some communities, it may be challenging to engage parents in conversations about behavioral health. This organization worked to engage students in discussions surrounding behavioral health and encouraged them to bring information back to their parents.

    Receiving care directly at school removes a layer of stigma often associated with mental health care; and importantly, it improves accessibility. To advance behavioral health equity, it's crucial to partner with schools where the need is greatest. This means partnering with schools that serve low-income students, regions with high populations of students of color, and systems where budget cuts may limit a school's ability to invest in mental health services for students.

    Students can benefit through early intervention and easier access to holistic services. And here's the thing: health care organizations will see the payoff into the future, with reduced costly behavioral health and physical challenges.

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