Conference Coverage

Universal adolescent anxiety screening is feasible in primary care



A pediatric primary care practice saw anxiety diagnoses in teens increase by nearly four percentage points a year after implementing universal anxiety screening, according to a new study.

Teenage girl looking worried AndreaObzerova/iStock/Getty Images Plus

The findings suggest that implementing a universal anxiety screening for teen patients is feasible and improves detection of patients with anxiety.

“Our providers were able to act on these positive screens and are able to catch a really serious entry-level condition that may have otherwise been missed,” presenter Sarah Malik, MD, a resident at Penn State Children’s Hospital, told attendees at the Pediatric Academic Societies annual meeting. “Hopefully, this will make a really meaningful difference in these kids’ lives, which is, of course, what we all want.”

An estimated 32% of U.S. teens have anxiety, according to the National Institute of Mental Health, and “8.3% of adolescents with anxiety have severe impairment defined by DSM­4 criteria,” according to the study’s background information. Yet neither the American Academy of Pediatrics nor the U.S. Preventive Services Task Force has issued recommendations regarding screening for anxiety in teens.

“For this reason, we developed a study in which we implemented and measured the effect of a universal anxiety screening program in the pediatric primary care setting,” Dr Malik said.

The screening intervention took place in a single Penn State Health Children’s Hospital primary care practice in Hershey, Pa., that typically received 37,000 visits a year from 12,500 patients. The practice has 19 attending physicians, 4 nurse practitioners, and 21 residents.

Providers asked patients aged 11-18 years to fill out a nine-question Generalized Anxiety Disorder subscale of the Screen for Child Anxiety Related Disorders (SCARED) during their well-child visits from April 2017 to March 2018. Two-thirds of the patients had private insurance, 80% were white and 8% were black; 10% were Hispanic.

Providers had access to the screening results after nurses transcribed them into electronic medical records. The researchers used EMRs to determine how many patients completed a SCARED at their well-child visit and how many screened positive for anxiety, defined as a score of at least 9/18.

Then the providers compared the prevalence of anxiety 1 year after implementing the routine screening with the prevalence of teens with an ICD-10 anxiety diagnosis within the 36 months before the screening was implemented. The practice’s prevalence of adolescent anxiety was 13.3% 1 year after implementing universal anxiety screening, compared with 9.6% in the previous 3 years (P less than .0001).

Among 2,276 well-child visits for adolescents during the study period, 80% completed a SCARED. Of those who completed the screening, 17% screened positive. The physicians identified 70% of those patients with positive screens (214/306) as having anxiety, and 82% of those patients (n = 176) were diagnosed with anxiety.

About half of those diagnosed with anxiety (n = 93) received one or more interventions: 77 received referrals for counseling, 15 received psychiatric referrals, and 20 were prescribed new anxiety medication.

“We did find that a universal screening program for anxiety is very useful to implement in the primary care setting, and it’s also really effective at identifying adolescents with anxiety symptoms,” Dr. Malik said.

The study’s generalizability is limited by its implementation at a single academic center with integrated behavioral health, and the use of the SCARED, a portion of the GAD scale, is not considered a standard of care.

The researchers used no external funding, and they had no disclosures.

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