Screening may identify depression in children to reduce suicide risk

According to the Centers for Disease Control and Prevention (CDC), rates of suicide attempts and deaths among children have increased in the U.S. over the past decade, and suicide is now the eighth leading cause of death in children age 5–11.

Despite these rates, very little research has been conducted on the risk factors for suicide in this age group but understanding the factors that put a child at risk for suicide is a critical step toward preventing such outcomes and protecting youth.

The U.S. Preventive Services Task Force recently posted draft recommendations on screening for anxiety, depression, and suicide risk in children and adolescents.

The task force advocates screening children 12 and older for depression and, for the first time, is recommending screening children ages 8 and older for anxiety. 

There is not enough evidence to recommend for or against screening for anxiety and depression in younger children or suicide risk in all youth, but children and teens who are not showing symptoms of these conditions may benefit.

Too many children and teens in the United States experience mental health conditions, including anxiety, depression, and suicidal thoughts or behaviors.

Research suggests young children who attempt suicide are six times more likely than their peers to attempt suicide again in adolescence.

There are several forms of anxiety, including generalized anxiety disorder and social anxiety, but all forms are characterized by excessive fear or worry.

Depression, or major depressive disorder, is a condition that negatively affects how people feel, think, and act.

Suicide is when people harm themselves with the intention to end their lives.

“To address the critical need for supporting the mental health of children and adolescents in primary care, the task force looked at the evidence on screening for anxiety, depression, and suicide risk,” says task force member Martha Kubik, Ph.D., R.N. “Fortunately, we found that screening older children for anxiety and depression is effective in identifying these conditions so children and teens can be connected to the support they need.”

For older children and teens, screening and follow-up care can reduce symptoms of depression and can improve, and potentially resolve, anxiety.

However, there is very limited evidence on the benefits and harms of screening children younger than 8 for anxiety and younger than 12 for depression.

While suicide is tragically a leading cause of death for older children and teens, there continues to be limited evidence about screening for suicide risk in those without signs or symptoms across all ages. This is an area where more research is critical.

“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. More research on these important conditions is critical,” says task force member Lori Pbert, Ph.D. “In the meantime, healthcare professionals should use their clinical judgment based on individual patient circumstances when deciding whether or not to screen.”

The task force recognizes that screening is only the first step in helping children and teens with depression and anxiety. Youth who screen positive need further evaluation to determine if they have depression or anxiety.

After diagnosis, youth should participate in shared decision-making with their parents or guardians and their healthcare professionals to identify the treatment or combination of treatments that are right for them, and then be monitored on an ongoing basis to ensure that the chosen treatment is effective.

It is also important to emphasize that these draft recommendations are for youth who are not showing signs or symptoms of anxiety, depression, or suicide. Anyone expressing concerns about or showing signs of these conditions should be connected to care.

The draft recommendation statements and draft evidence review have been posted for public comment on the task force website at www.uspreventiveservicestaskforce.org.

Comments may be submitted at www.uspreventiveservicestaskforce.org/tfcomment.htm until May 9, 2022.

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

When researchers looked at the characteristics of children who had died by suicide, they found most child suicide deaths occurred in the family home (95.5%) and, more specifically, in the child’s bedroom (65.6%).

The most common way children died by suicide was by hanging (78.4%), although a significant number of children died by suicide using a firearm (18.7%).

When researchers investigated deaths by firearm, they found that more than half of these deaths involved a handgun (52%), and in all cases in which the details of gun access were known, the firearm used was not stored safely (for example, a gun and ammunition stored in an unlocked nightstand or a loaded gun stored in a common living area).

In more than half of cases (58.4%), a parent was home at the time of the child’s death.

Mental health concerns were identified in a third (31.4%) of the suicide deaths examined, with the most common diagnoses being attention-deficit/hyperactivity disorder (ADHD) or depression.

Trauma, including suspected or confirmed cases of abuse, neglect, and domestic violence, was seen in more than a quarter (27.1%) of children who died by suicide. Of children who were reported to have experienced trauma, almost half (40.6%) had experienced multiple traumatic events.

Family-related problems, such as divorce, custody disputes, parental substance use, or a family history of suicide or mental health concerns, were seen in more than a third (39.8%) of children who died by suicide.

School problems, such as expulsion, changing schools, or suspension, were also reported for almost a third (32%) of children who died by suicide.

Suicidal thoughts or actions, even in very young children, are a sign of extreme distress and should not be ignored. If you or someone you know needs immediate help, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Crisis Text Line by texting “home” to 741 741.

Dr. Kubik is a professor with the School of Nursing, College of Health and Human Services at George Mason University. She is a nurse scientist, active researcher, and past standing member on the National Institutes of Health’s Community-Level Health Promotion Study Section. Dr. Kubik is an advanced practice nurse and fellow of the American Academy of Nursing.

Dr. Pbert is a professor in the Department of Population and Quantitative Health Sciences, associate chief of the Division of Preventive and Behavioral Medicine, and founder and director of the Center for Tobacco Treatment Research and Training at the UMass Medical School.