Anxiety in Adolescents: Screening and Support Strategies

The Growing Problem of Teen Anxiety

Despite the traditional image of adolescence as a carefree time free of adult responsibilities, clinical anxiety represents a significant and growing risk for teenagers. Parodi et al. (2022) report that nearly one-third of all adolescents experience the symptoms of a diagnosable anxiety disorder, and 8.3% of all teens report significant life impairment in one or more spheres of their lives as a result of anxiety. Rather than dismissing anxious behavior as a passing phase, it is critical to treat it as early as possible; otherwise, the teen may continue to miss out on key developmental milestones, and anxiety may persist well into adulthood.

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, heightened 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 invariably better than the need for more intensive, wide-ranging intervention later on.

Disparities and At-Risk Populations

There is considerable evidence that certain groups are disproportionately affected by anxiety, and nurses should keep these disparities in mind when conducting preliminary screening. The overall number of adolescents meeting the threshold for clinical anxiety-screening criteria increased from 34.1% in 2012 to 44% in 2018; however, the increases for females relative to males and for LGBT+ teens were even greater (Parodi et al., 2022). Clinicians should also be aware that some groups may be more reluctant to report symptoms or may be subject to underreporting. For example, although African American teens did not show as substantial an increase in reported anxiety rates, nurses should remain attentive to the issue in this subgroup, as underdiagnosis remains a concern (Parodi et al., 2022).

Teens in rural areas are also less likely to be diagnosed with anxiety than those living in urban areas. Whether this reflects greater screening access in urban settings or an actual difference in mental health trends remains a matter of ongoing debate (Bhatia & Goyal, 2018). Understanding these disparities helps clinicians target outreach and screening efforts more effectively.

Screening for Anxiety in Adolescents

On a basic level, simply asking a teen whether they are experiencing stressors or anxiety is an important first step in opening a discussion. This may include questions about school, social life, somatic symptoms such as stomachaches and headaches, changes in weight, or a general assessment of the adolescent's demeanor. Because adolescents may not be forthcoming about their anxiety, the use of clinical screening tools can be extremely helpful. One of the simplest and most effective tools — particularly for teens at elevated risk, such as sexual minorities — is the Generalized Anxiety Disorder 7-item (GAD-7) screening test.

The GAD-7 asks patients to rate, on a scale from "not at all" to "nearly every day," whether they have been feeling nervous, worrying excessively, having trouble relaxing, experiencing a sense of dread, and other indicators that may signal an anxiety disorder (GAD-7, n.d.). A score of 8 or greater suggests the presence of an anxiety disorder; the test demonstrates the highest sensitivity for generalized anxiety disorder and the lowest for PTSD. It can be administered by a nurse or completed by the patient online or on paper as part of pre-screening for a routine health examination (GAD-7, n.d.).

While preliminary screening is an important first step, clinicians should also consider adverse life events — such as the loss of a parent or a recent change in school — alongside any family history of anxiety or other mental health disorders, given that anxiety has both genetic and environmental components. Anxiety is frequently comorbid with depression in adolescents; indeed, anxiety is up to eight times more likely to occur in adolescents who have already been diagnosed with depression (Bhatia & Goyal, 2018). For this reason, screening for both disorders simultaneously is often recommended.