The USPSTF recommends screening adolescents aged 12 to 18 for major depressive disorder and children and adolescents aged 8 to 18 for anxiety. Both are grade B recommendations from 2022. For suicide risk screening, the USPSTF found the evidence insufficient to weigh benefits and harms. The AAP's Bright Futures schedule includes depression and suicide risk screening at each annual visit from 12 through 21.
What the recommendations cover
The USPSTF depression and anxiety statements apply to young people without a diagnosed disorder or recognized symptoms. The evidence was insufficient to assess depression screening at 11 or younger and anxiety screening at 7 or younger. The USPSTF found no evidence on the best screening interval. It suggests that repeated screening may be most productive in adolescents with risk factors, and that opportunistic screening may suit adolescents who rarely visit.
Screening needs a system behind it. The depression statement says adequate systems and clinical staff are needed so that adolescents who screen positive are appropriately diagnosed and treated. The anxiety statement says a positive screen requires a confirmatory diagnostic assessment and follow-up.
The Bright Futures/AAP periodicity schedule marks depression and suicide risk screening at every annual visit from 12 through 21. Its footnote asks clinicians to make every effort to preserve the adolescent's confidentiality. The GLAD-PC guideline, Part I, also recommends annual universal depression screening for youth 12 and older at health maintenance visits.
Choosing screening tools
The USPSTF calls the PHQ-9 the most commonly used depression screening instrument in clinical practice, although its evidence review found no accuracy studies that used it. Adolescent data come from other studies. In a 2010 study of 442 youth aged 13 to 17, the unmodified PHQ-9 was compared with a structured diagnostic interview. A score of 11 or more had 89.5% sensitivity and 77.5% specificity for major depression.
That cut point comes from one adolescent study. It is not a severity band: the bands come from adult validation and place 10 to 14 in the moderate range. The PHQ-9 page on this site covers the adult English form and does not establish adolescent use.
The PHQ-A is the full Patient Health Questionnaire modified for adolescents. Its 2002 validation in 403 adolescent primary care patients covered anxiety, eating, mood, and substance use disorders. The USPSTF reports one study in which the PHQ-A had 0.73 sensitivity and 0.94 specificity for major depression.
For a two-step approach, the PHQ-2 covers the first two PHQ-9 items. In a 2010 study of youth aged 13 to 17, a score of 3 or more had 74% sensitivity and 75% specificity for interview-confirmed major depression. A positive result calls for the full PHQ-9 or a clinical interview.
For anxiety, the USPSTF statement names two instruments widely used in practice, the Screen for Child Anxiety Related Disorders (SCARED) and the Social Phobia Inventory. It also lists the PHQ-A, which covers generalized anxiety and panic disorder, among broader instruments. It does not mention the GAD-7, which was developed and validated in adult primary care patients. If you use the GAD-7 or GAD-2 with adolescents, document that choice and treat a positive result as a prompt for diagnostic assessment.
A positive screen is not a diagnosis. GLAD-PC recommends systematic assessment with reliable depression scales, interviews with the adolescent and caregiver, and DSM-5 criteria.
Workflow and confidentiality
Have adolescents complete questionnaires privately. NIMH's suicide screening toolkit, for example, recommends screening youth without a parent or guardian present when possible. Pre-visit completion, by portal link or on a clinic tablet, lets staff check scores and safety items before the clinician enters.
Explain confidentiality at the start of the visit, before the questionnaire. Tell the adolescent which answers stay private and when a safety concern means others must be told. A parent or guardian may be reading too, so give both the same plain explanation.
Who can see an adolescent's results depends on state law and the circumstances of the visit. The HHS Privacy Rule summary explains that parents are usually the personal representatives of minor children. In some cases, the rule defers to state and other law. Know your state's rules on minor consent and parental access before setting a default.
Responding to positive screens
A positive screen starts an assessment. It does not confirm a disorder, and it does not by itself decide treatment.
The GLAD-PC guideline, Part II, recommends active monitoring for mildly depressed youth and evidence-based medication and psychotherapeutic approaches for moderate or severe depression. It also recommends consultation and co-management with mental health specialists, and ongoing tracking of outcomes. Use those recommendations alongside your clinical assessment and the family's preferences.
Plan referral routes before screening begins. GLAD-PC Part I recommends establishing relevant links in the community. The USPSTF warns that inadequate support and follow-up may result in treatment failures or harms.
Suicide risk
Any answer above zero on PHQ-9 item 9, or a positive answer to a suicide screening question, needs direct follow-up from a qualified clinician. The total score does not change that.
NIMH's Ask Suicide-Screening Questions (ASQ) toolkit includes a pathway for youth in outpatient settings. After a positive ASQ screen, a trained clinician completes a brief suicide safety assessment to decide whether a full mental health evaluation is needed. GLAD-PC Part I also recommends establishing a safety plan.
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Talking with parents
If your practice screens every adolescent, say so, because it frames the questionnaire as routine care. Explain that a high score means the team needs more information, not that a diagnosis has been made. When possible, encourage the adolescent to decide what to share with a parent, within the limits of safety and state law.