Adolescent Depression and Anxiety: Introducing Screening Tools in the School Setting

BACKGROUND: Adolescents often experience mental health problems that remain unidentified and continue into adulthood, which lead to adverse outcomes. In this population, anxiety and depression are prevalent, yet annual screening does not always occur.

LOCAL PROBLEM: The project site was an East Tennessee private middle school. Administration within this school reported an increased mental health burden in their students and a desire to implement a new process to increase identification of anxiety and depression symptoms. The purpose of this project was to implement a screening protocol to identify anxiety and depressive symptoms among adolescents in the school setting.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice Model was used to guide implementation. Four eighth-grade wellness classes at an East Tennessee private middle school were universally screened for anxiety and depression symptoms using an online Qualtrics survey via tablet during their class.

INTERVENTIONS: Adolescents with a score of 15 or higher for either the Patient Health Questionnaire 9-item (PHQ-9) or the Generalized Anxiety Disorder 7-item (GAD-7) were referred to the school counseling team for additional mental health support and provided local resources. Students were also referred if an answer was above zero on item nine of the PHQ-9. The Doctor of Nursing Practice (DNP) students informed the parents of all positively screened students via email following the conclusion of the project.

RESULTS: Of the 62 students that were screened, four were above the cut-off score on the GAD-7, three students were above the cut-off score for the PHQ-9, and six students were flagged for self-harm or suicide risk.

CONCLUSIONS: Implementation of this project fulfilled an unmet need for universal screening of adolescents for depression and anxiety symptoms. This intervention helped increase mental health identification among adolescents. This is a low-cost process that is feasible to implement in the school setting.