Anxiety and Adolescent Mental Health

Issue Impacting Teens Today: Anxiety

Despite the traditional image of adolescence being a carefree time, without adult responsibilities, experiencing clinical anxiety is a significant risk for teenagers and only appears to be increasing. Parodi (et al., 2022) reports that nearly one third of all adolescents experience the symptoms of a diagnosable anxiety disorder, and 8.3% of all teens in this age group report significant life impairment in one or more life spheres, due to anxiety (Parodi et al., 2022). Rather than ignoring anxious behavior as a phase, it is critical to treat it appropriately as early as possible, otherwise the teen may continue to miss out on critical life milestones and anxiety may persist into adulthood.

There is also evidence that certain groups are disproportionately affected, which nurses should keep in mind when engaging in preliminary screening for the disorder. For example, while overall the number of adolescents meeting the threshold for clinical anxiety-screening criteria increased from 34.1% in 2012 to 44% in 2018, the increase for females relative to males and LGBT+ teens were greater (Parodi et al., 2022). Even for groups such as African American teens which did not show such a substantial increase, clinicians should be aware that some groups may be more reluctant to report symptoms or may be the victims of underreporting, and nurses should still be aware of the issue in this subgroup (Parodi et al., 2022). Teens in rural areas are also less apt to be diagnosed with anxiety than those living in urban areas; again, whether this is due to greater screening in urban areas or an actual reflection of mental health trends remains hotly debated (Bhatia & Goyal, 2018).

Regardless, if left untreated, anxiety disorders in adolescents are associated with a wide range of negative and lasting long-term outcomes, including poorer educational performance and vocational challenges, comorbidities with other psychological disorders in adulthood, heighted risk for substance abuse, earlier death, lower levels of work productivity, and increased use of mental and physical healthcare resources (Parodi et al., 2022). Earlier treatment is better than the need for more intensive and wider ranging treatment later on.

Screening for Anxiety

On a basic level, simply asking a teen if they are experiencing stressors or anxiety is important, to initiate a discussion. This may include questions about school, social life, somatic symptoms like stomach issues and headaches, weight loss or weight gain, or a general assessment of the adolescent’s demeanor. Adolescents may not be forthcoming in discussing their anxiety, however, which is why the use of clinical screening tools can be extremely helpful. One of the simplest and more effective tools that can be performed as part of a regular assessment, particularly for teens at higher risk for anxiety (like sexual minorities) is the Generalized Anxiety Disorder 7-item (GAD-7) screening test.

The test asks the patient to rate, on a 1-4 scale from “not at all” to “nearly every day” if they have been feeling nervous, worrying, having trouble relaxing, feeling a sense of dread, and other general questions which can indicate a problem with anxiety or a diagnosable anxiety disorder (GAD-7, n.d.). A score of 8 or greater suggests the presence of an anxiety disorder, with the highest sensitivity for generalized anxiety disorders, and the lowest for PTSD. The test can be either administered by a nurse or taken by the patient online or on paper as part of the pre-screening for a health exam (GAD-7, n.d.).

However, although such preliminary screening may be a first step, clinicians should also be aware of adverse life events (such as loss of a parent, a recent move to a new school district), as well as any past history in the family of anxiety or other mental health disorders, given there is a genetic as well as an environmental component to anxiety. Anxiety is often comorbid with depression in adolescents (anxiety is as much as eight times more likely to occur in adolescents with a diagnosis), so screening for both disorders at the same time may be recommended (Bhatia & Goyal, 2018).

Ethically, the age of the patient should be taken into consideration when sharing information; older adolescents should have greater discretion in determining what is or what is not shared, although an adolescent expressing a wish to self-harm or with suicidal ideation, or whose substance abuse or other health concerns is a risk or self to others should merit breaking confidentiality. Additionally, reported sexual abuse must be directed to the appropriate authorities, if that is disclosed when the adolescent is asked for the reasons for his or her depression.