TOPLINE

Adding anxiety and suicide risk screening to depression screening in pediatric primary care identified one additional adolescent with moderate or severe mental and behavioral health symptoms for every 13 patients screened.

METHODOLOGY

• Researchers conducted a retrospective study at three academic primary care practices between March and October 2025.
• A total of 2776 adolescents completed three mental and behavioral health screeners at well child visits: the Patient Health Questionnaire-9 (PHQ-9) for symptoms of depression, the Ask Suicide Questionnaire (ASQ) for suicide risk, and the Generalized Anxiety Disorder-7 (GAD-7) for symptoms of anxiety.
• Participants had a mean age of 14.2 years, 50.2% were female, and 74% self-identified as Black.
• Patients with significant mental and behavioral health concerns were identified based on a PHQ-9 score ≥ 10 or a positive response to a question on thoughts of self-harm or death indicating moderate or severe depressive symptoms, a GAD-7 score ≥ 10 indicating moderate or severe anxiety symptoms, or responses to ASQ indicating a nonacute positive or imminent risk.
• Researchers calculated the number needed to screen to identify one additional individual with moderate or severe mental and behavioral health symptoms by comparing the rates from PHQ-9 alone and PHQ-9 combined with ASQ or GAD-7.

TAKEAWAY

• Overall, 15.0% of adolescents met the criteria for at least one positive screen: 7.0% screened positive for moderate or severe depression, 6.6% for suicide risk, and 8.0% for moderate or severe anxiety.
• Among patients who screened positive on at least one instrument, 47% screened positive on PHQ-9 alone.
• Combining ASQ with PHQ-9 identified 109 additional unique patients, and combining GAD-7 with PHQ-9 identified 125 additional patients; combining both with PHQ-9 identified 220 additional patients compared with PHQ-9 alone.
• When both GAD-7 and ASQ were included with PHQ-9, the number needed to screen was 13 (one unique adolescent screening positive for every 13 patients screened).

IN PRACTICE

"[The study] results underscore the complementary value of multidomain screening and support the integration of anxiety and suicide assessments into primary care," the authors wrote.

SOURCE

The study was led by Mary Carol Burkhardt, MD, MHA, of the Department of Pediatrics at the University of Cincinnati College of Medicine in Cincinnati. It was published online on August 17, 2026, as a brief report in The Journal of Pediatrics.

LIMITATIONS

The study included a small group of participants from one healthcare system that mainly served a publicly insured population, which made it hard to apply the results to a larger population. The number needed to screen values reflected extra positive screening results, not confirmed diagnoses of mental and behavioral health, and some of these could have been false positives. The screenings were obtained electronically; hence, it was possible that a parent or caregiver completed them, which might not have represented the adolescent's symptoms.

DISCLOSURES

The research received no specific grant from any funding agency. One author reported having common stock holdings in Pfizer, Merck, Abbott Laboratories, Viatris, and Johnson & Johnson from February 2022 to April 2023.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.