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, and a new analysis asked teenagers themselves instead. 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 flags that someone may have an anxiety disorder, which 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 anxiety disorder as a group of related conditions marked by excessive fear or worry, which show up as emotional and physical symptoms. Anxiety in childhood also casts a long shadow: the panel notes that children and teenagers with an anxiety disorder face an increased likelihood of a later anxiety disorder or depression. The review prepared for the panel tied anxiety in children and adolescents to impaired functioning, poorer schooling 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, and when the Task Force cited it in 2022, the figure was 7.8% of children and adolescents aged 3 to 17 with 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 among US adolescents and carry a heavy psychiatric burden, they wrote, yet contemporary nationally representative estimates of how severe those symptoms are, what conditions come with them and how often they are treated are lacking.

How the survey measured anxiety in adolescents

Tanner Bommersbach is the first author of the new work and Taeho Greg Rhee the senior author. They drew on the 2024 National Survey on Drug Use and Health, which is designed as a nationally representative survey of the US civilian population. Its participants are chosen, and their answers weighted, so that the results reflect the country as a whole, though people living in places such as hospitals or detention centers are not included. The participants here were adolescents aged 12 to 20 years, a wider band than the usual 12 to 17, and there were 15,730 of them, of whom 48.9% were female.

Anxiety was measured with the GAD-7, a seven-item questionnaire named for generalized anxiety disorder, a condition marked by persistent, hard-to-control worry about many things. The paper calls it a brief self-report screener built to identify probable cases of that disorder and to measure symptom severity. Like any screener, it is a quick test meant to pick out people who may have the condition and need a fuller assessment, and its 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, with the percentages weighted to match the national population. That works out to approximately 1 in 6 US adolescents reporting moderate or severe anxiety symptoms in 2024, while about 6 in 10 scored below the mild band.

Female adolescents reported far more symptoms than males. Moderate symptoms were reported by 13.4% of female adolescents and 6.0% of males, and severe symptoms 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 major depressive episode in the past year, a stretch of at least two weeks of low mood or lost 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 in 2006, noting that generalized anxiety 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 other factors were taken 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. The authors of that analysis 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, while the proportion of visits with any therapy fell from 48.8% to 32.6%.

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, which shares an author, Mark Olfson, with the new paper, tracked what it called caregiver-reported, clinician-diagnosed anxiety among children aged 6 to 17 in a different national survey. From 2016 to 2023, the share with anxiety rose from 8.2% to 12.8%, most steeply 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 to 17, 7.1% had current anxiety problems.

The picture, then, has two layers. Somewhere between 7% and 13% of children have an anxiety diagnosis that a parent reports, while 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 but would not meet the criteria for a disorder on a full assessment, and 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 on 2,740 adult patients in 15 primary care clinics in the United States. Measured against a diagnosis made by a mental health professional, the cut-off they chose correctly flagged 89% of people who had the disorder (its sensitivity) and correctly cleared 82% of those who did not (its specificity).

Evidence in younger people is thinner. A 2023 study tried the questionnaire in 1000 children, adolescents and young adults aged 8 to 20 who had depression or suicidal thinking and were already in treatment. It picked out any anxiety disorder with acceptable sensitivity and specificity, but those were young people in clinics, and a screener can behave differently in a general population survey.

Screening itself has official backing in the US, since in 2022 the panel recommended that children and adolescents aged 8 to 18 be screened for anxiety. It was a new recommendation at the time, and the evidence behind it was indirect. The accompanying review covered 39 studies, none of which looked at the direct benefits or harms of screening for health. The case rested on two separate links: indirect evidence suggested that some screening instruments could be 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 and assigned them to cognitive behavioral therapy (a structured talking treatment that teaches ways to change anxious thoughts and behavior), the antidepressant sertraline, both, or a placebo pill for 12 weeks. 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, and the authors reported that the combination had a superior response rate. Those results apply to children with a diagnosed disorder who entered a trial, and 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.