Most pediatric offices that screen teenagers for mental health ask about depression. A study of 2,776 adolescents suggests that stopping there leaves a measurable number of struggling teenagers unidentified.
Researchers at three academic primary care practices had adolescents complete three questionnaires at well-child visits rather than one: the PHQ-9 for depressive symptoms, the GAD-7 for anxiety symptoms, and the Ask Suicide-Screening Questions for suicide risk. Adding the two extra tools yielded one additional adolescent with a positive result for moderate or severe symptoms per 13 teenagers screened.
For a parent, that number translates into something concrete. In a classroom of 26 students, adding two brief questionnaires to a routine checkup would flag roughly two additional teenagers whose depression screen alone would not have raised a concern.
The study was led by Mary Carol Burkhardt of the Department of Pediatrics at the University of Cincinnati College of Medicine and published as a brief report in The Journal of Pediatrics, reported by Medscape. Participants had a mean age of 14.2 years, about half were female, and 74 percent self-identified as Black. The screenings were collected between March and October 2025.
One Extra Positive Result for Every Thirteen Teenagers
The number needed to screen is a plain measure: how many people you have to test to find one additional case you would otherwise have missed. Here it was 13 when both the anxiety and suicide questionnaires were added alongside the depression screen.
Teenagers were counted as having significant concerns based on standard cutoffs for moderate to severe symptoms on the depression and anxiety questionnaires, or a positive response on the suicide screen.
The authors concluded that the results "underscore the complementary value of multidomain screening" and support integrating anxiety and suicide assessments into primary care.
Distress in Teenagers Does Not Always Look Like Sadness
The clinical logic behind the finding is not complicated. A teenager whose primary experience is persistent worry, physical tension, avoidance of school or social situations, or difficulty sleeping may not endorse the low mood and loss of interest that a depression questionnaire is built to detect.
Anxiety and depression frequently occur together, but they are separate conditions with separate treatments, and a tool designed for one is not a reliable detector of the other. Thoughts of self-harm are a third dimension again, and they do not always accompany a high depression score.
MedicalDaily has previously reported that teen depression often presents differently from adult depression, with irritability rather than visible sadness as the most common mood presentation. The same principle applies here in a different form: what a questionnaire asks about determines what it can find.
Federal guidance has already moved partway in this direction. The US Preventive Services Task Force recommends screening for major depressive disorder in adolescents 12 to 18 and screening for anxiety in children and adolescents 8 to 18. On screening specifically for suicide risk in children and adolescents, the task force has concluded that current evidence is insufficient to weigh benefits against harms. This study adds to that evidence base rather than settling it.
A Positive Screen Is Not a Diagnosis
This point deserves emphasis because the study's own authors make it. The number needed to screen reflected additional positive screening results, not confirmed mental or behavioral health diagnoses, and some of those results could have been false positives.
Screening questionnaires are designed to be sensitive, which means they are built to catch more than they confirm. A positive result is a signal to have a longer conversation, not a conclusion. Follow-up evaluation by a clinician is what distinguishes a teenager who needs treatment from one who had a difficult few weeks. The evidence review behind that recommendation makes the same distinction between identifying symptoms and confirming a diagnosis.
That distinction also matters for capacity. Identifying more adolescents is only useful if there is somewhere for them to go, and shortages of child and adolescent mental health clinicians remain a real constraint in most parts of the country. Screening more broadly without follow-up capacity moves the bottleneck rather than removing it.
Limits of a Single Health System Study
The study has real constraints, and the authors list them plainly. It was retrospective. It drew on a relatively small group across three practices within one health system serving a mostly publicly insured population, which limits the generalizability of the results. The demographic profile, with 74 percent of participants self-identifying as Black, differs from the national adolescent population.
One further limitation is worth understanding. The screenings were completed electronically, so it is possible that a parent or caregiver filled out some of them, which would not reflect the adolescent's own reported symptoms.
For families, none of this requires action beyond a question at the next appointment. Parents can ask which mental health screenings a practice uses and whether anxiety and suicide risk are included alongside depression. Adolescent mental health screening is generally covered as preventive care, so asking usually does not add cost.
Warning signs that warrant a conversation with a pediatrician include marked changes in sleep or appetite, withdrawal from friends and activities, falling grades, persistent expressions of hopelessness, and any talk about death or self-harm. Nobody should wait for an annual visit if those are present.
This is a sensitive subject, and anyone in the United States who is struggling or worried about a young person can reach the 988 Suicide and Crisis Lifeline by call or text. If you or a teenager you care for is in immediate danger, call emergency services.
What happens next is a question for larger studies. A brief report from three practices is a starting point, not a basis for changing national recommendations, and confirmation across more diverse settings would be needed before guidance shifts. MedicalDaily will report follow-up research and any change to task force recommendations.
Key Questions Answered
What did the study find? Adding anxiety and suicide risk questionnaires to a depression screen identified one additional adolescent with moderate or severe symptoms for every 13 teenagers screened at well-child visits.
Which questionnaires were used? The PHQ-9 for depressive symptoms, the GAD-7 for anxiety symptoms, and the Ask Suicide-Screening Questions for suicide risk.
Does a positive screen mean a teenager has a diagnosis? No. The authors note the results reflect additional positive screens rather than confirmed diagnoses, and some may be false positives. A clinician evaluation is what establishes a diagnosis.
What are the study's main limitations? It was retrospective, drawn from three practices within one health system serving a mostly publicly insured population, and the electronic format means a caregiver may have completed some screens on behalf of the adolescent.
What does federal guidance currently recommend? Screening for depression in adolescents 12 to 18 and for anxiety in children and adolescents 8 to 18. On suicide risk screening specifically, the task force has found the evidence insufficient to weigh benefits and harms.
What can a parent do with this? Ask the pediatric practice which screenings it uses and whether anxiety and suicide risk are included. Screening is generally covered as preventive care.
Which signs should not wait for an annual visit? Marked changes in sleep or appetite, withdrawal from friends and activities, falling grades, persistent hopelessness, or any talk about death or self-harm.
