The AAP is urging clinicians to screen all adolescents for suicide risk despite a national panel’s findings that more research is needed to weigh the benefits and harms.
Suicide is the second-leading cause of death for adolescents and young adults ages 10-24 years, and clinicians play a crucial role in supporting those who are at risk.
“Youth may keep suicidal thoughts to themselves and will not bring up the topic unless directly asked,” said May Lau, M.D., M.P.H., FSAHM, FAAP, a member of the AAP Section on Adolescent Health Executive Committee and a lead author of the Blueprint for Youth Suicide Prevention. “By screening all youth for suicide, we can identify those that are at risk and connect them with the services they need.”
Her comments come in response to draft recommendations on screening youths for suicide, major depressive disorder and anxiety that were released today by the U.S. Preventive Services Task Force (USPSTF), a panel of national experts.
The group is calling for screening asymptomatic adolescents ages 12-18 years for major depressive disorder and youths ages 8-18 years for anxiety, saying there would be a moderate benefit to each. On suicide risk, the USPSTF concluded there is insufficient evidence to weigh the benefits and harms of screening asymptomatic children and adolescents.
“The challenge is that, for children and adolescents without signs or symptoms, we do not have the evidence to tell us whether or not it’s beneficial to screen younger children for depression and anxiety and all youth for suicide risk,” task force member Lori Pbert, Ph.D., said in a news release. “More research on these important conditions is critical.”
The group noted the recommendations apply to asymptomatic youths. Children and adolescents showing signs or symptoms of depression, anxiety or suicide risk should be connected to resources.
The USPSTF draft recommendations are open for comment through May 9.
The AAP agrees depression screening should start at 12 years without specifying the severity. It also supports anxiety screening and is developing more tools to help pediatricians incorporate this screening into their practice. However, in the Blueprint for Youth Suicide Prevention, the AAP and its partners recommend screening all youths ages 12 years and older for suicide risk and screening those 8-11 years when clinically indicated.
“Universal screening is an important way to help all patients feel less alone with suicidal thoughts. Otherwise, they may pass through healthcare settings undetected,” according to the blueprint, which also says universal screening helps promote equity.
Recent studies published by the Centers for Disease Control and Prevention (CDC) show 21% of teens experienced a major depressive episode before the pandemic, and 9% of children and adolescents experienced anxiety problems. The pandemic has exacerbated these issues. About 44% of teens surveyed during the pandemic said they felt persistently sad or hopeless during the past 12 months, and 20% seriously considered attempting suicide.
The AAP has been sounding the alarm on these issues. Late last year, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency in children’s mental health, and the U.S. surgeon general issued an advisory calling for action to protect the mental health of youths.
- Blueprint for Youth Suicide Prevention
- AAP suicide prevention resources
- AAP statement of endorsement Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management
- Bright Futures health promotion and prevention initiative
- AAP clinical report Promoting Optimal Development: Screening for Behavioral and Emotional Problems
- AAP mental health initiatives
- AAP interim guidance on children’s emotional and behavioral health during the pandemic
- Information for parents from HealthyChildren.org on mental health during the pandemic
- COVID-19 parental resources toolkit on mental health from the CDC
- S. surgeon general advisory “Protecting Youth Mental Health”
- Information from the American Medical Association on integrating behavioral health care into a clinical practice