About 1 in 6 US adolescents reported moderate or severe anxiety symptoms in 2024, and many had no treatment

Most national figures on anxiety in young Americans come from asking parents whether a doctor has diagnosed it. A new analysis asked teenagers themselves. In a 2024 federal survey of 15,730 people aged 12 to 20, about 1 in 6 reported anxiety symptoms in the moderate or severe range. Among those with severe symptoms, about 4 in 10 had received no mental health treatment in the past year.

The study, published on October 12 in JAMA Pediatrics, rests on a seven-item screening questionnaire. A high score on a screener is a flag that someone may have an anxiety disorder. It falls short of a diagnosis, and the survey captured one moment in time. Those two facts shape how far the numbers can be pushed.

Why estimates of teen anxiety symptoms were missing

The US Preventive Services Task Force (USPSTF), an independent panel that issues guidance on preventive care, describes what is being counted. Anxiety disorder, it says, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. It matters for what tends to follow. In the panel’s words, anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression.

The review prepared for that panel listed wider costs: anxiety in children and adolescents is associated with impaired functioning, educational underachievement, and future mental health conditions.

How many young people are affected depends on how the question is asked. The standard national source has been a survey of parents. The Task Force cited it in 2022, reporting that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder.

That approach counts only anxiety that an adult has noticed and a clinician has named. The authors of the new paper saw a gap. Anxiety symptoms are common and burdensome, they wrote, yet contemporary nationally representative estimates of anxiety symptom severity, associated clinical conditions, and treatment utilization are lacking.

How the survey measured anxiety in adolescents

The new work lists Tanner Bommersbach as first author and Taeho Greg Rhee as senior author. It used the 2024 National Survey on Drug Use and Health, which the paper describes as a nationally representative survey of the US civilian, noninstitutionalized population. Nationally representative means that the people surveyed were chosen, and their answers weighted, so that the results reflect the country as a whole. Noninstitutionalized means that people living in places such as hospitals or detention centers were not included.

Participants included adolescents aged 12 to 20 years, a wider band than the usual 12 to 17. There were 15,730 of them, and 48.9% were female.

Anxiety was measured with the 7-item Generalized Anxiety Disorder questionnaire, known as the GAD-7. Generalized anxiety disorder (GAD) is a condition marked by persistent, hard-to-control worry about many things. The paper calls the questionnaire a brief self-report screener designed to identify probable generalized anxiety disorder and measure symptom severity. A screener is a quick test that picks out people who may have a condition and need a fuller assessment. Scores sort people into mild, moderate and severe bands.

The researchers then looked at what else was going on in the lives of those in each band: depression, suicidal thoughts, substance use, and whether they had received any mental health treatment in the past year.

What the survey found about teen anxiety

Of the 15,730 adolescents, 23.7% reported mild symptoms, 9.6% moderate symptoms and 7.2% severe symptoms. The percentages are national estimates, weighted to match the population. The paper’s summary is that approximately 1 in 6 US adolescents reported moderate or severe anxiety symptoms in 2024.

Put the other way, about 6 in 10 scored below the mild band.

The difference between the sexes was large. Moderate symptoms were reported by 13.4% of female adolescents and 6.0% of males. Severe symptoms were reported by 10.8% of female adolescents and 3.7% of males. Adding the two bands together, roughly 1 in 4 female and 1 in 10 male adolescents were in the moderate or severe range.

Severe anxiety symptoms rarely came alone. Among the adolescents who reported them, 65.8% met criteria for a past-year major depressive episode. A major depressive episode means a period of at least two weeks of low mood or loss of interest along with other symptoms of depression. Close to half, 48.2%, reported past-year suicidal thoughts. And 31.0% had used a substance in the past month.

The questionnaire’s developers had seen the same overlap. The team that created it in 2006 observed that GAD and depression symptoms frequently co-occurred in their patients, though the two could be told apart.

How many adolescents with anxiety symptoms went untreated

Of the adolescents with severe symptoms, 512, or 41.2%, received no mental health treatment during the preceding year. Among those with moderate symptoms the share was higher, at 48.3%.

Read the other way, a little under 6 in 10 of those with severe symptoms had received some treatment.

Who went without was not random. After taking other factors into account, mental health treatment was less likely among male adolescents, those from racial and ethnic minority groups, and those without insurance.

Earlier parent-reported data showed a similar shortfall. In the 2016 national survey of children’s health, treatment by a mental health professional in the previous year was reported for nearly 80% of children with depression, compared with 59.3% of those with anxiety problems. That paper’s authors concluded that treatment gaps remain, particularly for anxiety and behavior problems.

The kind of care on offer has also shifted. A study of visits to US doctors’ offices from 2006 to 2018 found that visits with an anxiety diagnosis roughly tripled as a share of all visits by young people. Over the same years, the proportion of visits with any therapy decreased from 48.8% to 32.6%. The authors summed up the rise in diagnoses as accompanied by a decrease in the proportion of visits with therapy.

How the symptom estimates compare with diagnosed anxiety in children

One in 6 is well above the usual figures for anxiety in young people, and the reason is mostly what is being counted.

A study published in June tracked what it called caregiver-reported, clinician-diagnosed anxiety among children aged 6 to 17 in a different national survey. It shares an author, Mark Olfson, with the new paper. From 2016 to 2023, anxiety increased from 8.2% to 12.8%, and the rise was steepest among girls and adolescents. Across those years, 4.5% of children had anxiety rated moderate and 1.0% severe.

The 2016 survey on its own gave a lower figure again. Among children aged 3-17 years, 7.1% had current anxiety problems.

So the picture has two layers. Somewhere between 7% and 13% of children have an anxiety diagnosis that a parent reports. About 17% of adolescents report moderate or severe symptoms on a questionnaire. The age ranges differ as well, with the new study reaching up to 20 and the parent surveys reaching down to 3 or 6.

The gap between the layers will include teenagers with an anxiety disorder nobody has diagnosed. It will also include teenagers who score high on a screener and would not meet the criteria for a disorder on a full assessment. The study cannot say how many fall into each group.

What is known about anxiety screening and treatment in children

The questionnaire at the center of the study was built for adults. Its developers tested it in 15 primary care clinics in the United States, on 2,740 adult patients. Against a diagnosis made by a mental health professional, the cut-off they chose had a sensitivity of 89% and a specificity of 82%. Sensitivity is the share of people with the condition that a test correctly flags. Specificity is the share of people without it that the test correctly clears.

Evidence in younger people is thinner. A 2023 study tried the questionnaire in 1000 children, adolescents, and young adults (8-20 years-old) with depression or suicidal thinking who were already in treatment. It showed acceptable sensitivity and specificity in detecting the presence of any anxiety disorder. Those were young people in clinics, though, and a screener can behave differently in a general population survey.

Screening itself has official backing in the US. The panel’s 2022 statement reads: the USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. It was a new recommendation at the time, and the evidence behind it was indirect. The accompanying review covered 39 studies and found that no study reported on the direct benefits or harms of screening on health outcomes. Its case rested on two separate links: indirect evidence suggested that some screening instruments were reasonably accurate, and treatment helped those who were diagnosed.

On treatment, the best-known trial enrolled 488 children aged 7 to 17 with anxiety disorders. They were assigned to cognitive behavioral therapy, the antidepressant sertraline, both, or a placebo pill for 12 weeks. Cognitive behavioral therapy is a structured talking treatment that teaches ways to change anxious thoughts and behavior. The share rated much or very much improved was 80.7% with both treatments, 59.7% with therapy, 54.9% with sertraline and 23.7% with placebo. The authors reported that a combination of the two therapies had a superior response rate.

Those results apply to children with a diagnosed disorder who entered a trial. They do not show what would happen if every teenager with a high questionnaire score were treated.

What the teen anxiety estimates cannot show

A screener, not a diagnosis. The questionnaire identifies probable cases of one disorder and grades symptoms. Nobody in the survey was examined by a clinician. The 16.8% figure describes reported symptoms.

Built for adults. The questionnaire was developed in adult patients. The 2023 test in young people was carried out among those already in treatment.

One point in time. The survey was a single snapshot from 2024. It cannot show whether symptoms are rising or falling, or whether anxiety led to depression and substance use or the reverse.

Self-report. Every answer, including whether treatment was received, came from the young person. Some will have under-reported and some over-reported.

Who was left out. The survey covers the civilian population living in households. Young people in hospitals, residential care or detention were not part of it.

What counts as treatment. The results describe any mental health treatment in the past year. They say nothing about its type, amount or quality.

Ages 12 to 20. The band includes 18- to 20-year-olds, so the figures are not directly comparable with surveys that stop at 17.

Sertraline, tested in the trial above, is a prescribed medicine. Do not stop or change a prescribed medicine without talking to your doctor.

Whether worry or fear in a particular young person amounts to an anxiety disorder is assessed by their doctor.

What the survey adds to the parent-reported counts is the teenagers’ own account: a sizeable minority describing symptoms, and more than 4 in 10 of them saying they had received no treatment.