98 - More Screens for Teens? The Incremetal Value of Screening for Depression, Anxiety, and Suicidality in Pediatric Primary Care

Publication Number: 2093.98

Landon B. Krantz, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; William Brinkman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Gehring, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Mary Burkhardt, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Mental behavioral health (MBH) disorders such as depression, anxiety, and suicidality are increasing among adolescents. The American Academy of Pediatrics now recommends universal screening for these conditions. However, depression screening has higher adoption in primary care, likely due to its earlier implementation and uncertainty around the added value of also screening for anxiety and suicide.

Objective: To determine:

1. The prevalence of moderate/severe symptoms on the Patient Health Questionnaire-9 (PHQ9), Generalized Anxiety Disorder-7 (GAD7), and Ask Suicide-Screening Questions (ASQ).

2. The incremental value of GAD7 and ASQ in identifying significant MBH concerns

Design/Methods: We conducted a retrospective study at three primary care practices from 3/2025-10/2025 serving a predominantly Black, non-Hispanic, publicly insured population. Universal screening with the PHQ9, GAD7, and ASQ occurs at annual well visits for youth ≥ 12 years old. We first determined the percentage of patients with significant MBH concerns based on the following criteria: PHQ9 score of ≥ 10 or endorsing question #9 indicating moderate/severe depressive symptoms or risk of self-harm, respectively; GAD7 score ≥ 10 indicating moderate/severe anxiety symptoms; ASQ responses indicating potential or imminent risk. Using the PHQ9 alone as a control, we calculated the number needed to screen (NNS) with GAD7 and ASQ to detect additional patients with significant MBH concerns.

Results: In total, 2,770 adolescents completed all 3 screeners (Table 1) with 414 (14.9%) meeting criteria for ≥1 significant MBH concern, including 195 (7.0%) based on the PHQ9, 222 (8.0%) based on the GAD7, and 182 (6.6%) based on the ASQ. The PHQ9 alone detected only 47.1% of significant MBH concerns. We detected an additional 124 patients (NNS=22 patients) adding the GAD7 and 108 additional patients (NNS=26) adding the ASQ. When adding both the GAD7 and the ASQ, 219 additional patients were detected compared to the PHQ9 alone (NNS=13 patients) (Figure 1).

Conclusion(s): Universal screening for MBH conditions is critical to identify high-risk adolescents in primary care. While many patients exhibit overlapping symptoms of depression and anxiety, reliance on a single screening tool may fail to detect significant MBH concerns. By adding anxiety and suicide screeners to depression screening, we detected an additional moderate/severe MBH concern every 13 adolescents.

Demographics of Adolescents ≥ 12 years completing a PHQ9, ASQ, and GAD7
a Other race includes: Multiracial, Asian, Middle Eastern, Native Hawaiian/Pacific Islander, American Indian/Alaska Native

Waterfall Detection of Moderate/Severe Mental Health Symptoms
a NNS = Number Needed to Screen. This indicates the number of patients needed to be screened to detect an additional significant mental behavioral health concern when compared to depression screening alone.