Screening for Depression and Suicide Risk in Children and Adolescents: A Draft Systematic Review Update Adapted from the USPSTF Review for the Japan Preventive Services Task Force

抄録

Background: Depression and suicide-related outcomes in children and adolescents are major public health concerns with potential lifelong consequences. Although the U.S. Preventive Services Task Force (USPSTF) has recommended depression screening for adolescents, evidence for suicide risk screening remains insufficient, and applicability to Japan is uncertain. To inform the Japan Preventive Services Task Force (JPPSTF), we conducted an updated systematic review, adapted from the USPSTF review, incorporating Japanese- and English-language evidence.

Methods: This update followed the USPSTF analytic framework and key questions. We evaluated evidence on the benefits and harms of screening for depression and suicide risk in children and adolescents, the accuracy of screening instruments, and the benefits and harms of treatment for screen-detected or otherwise relevant populations. We searched PubMed, the Cochrane Library, and Ichushi-Web for English- and Japanese-language studies. Two or more reviewers independently conducted study selection, data extraction, and risk-of-bias assessment, with disagreements resolved through discussion. Newly identified evidence was qualitatively synthesized with the USPSTF review to inform the Japanese context.

Results: A total of 21 studies were included. Two studies suggested that universal school-based screening improved identification of adolescents at risk and initiation of mental health services. Five studies on screening accuracy showed heterogeneous performance across instruments and settings. One study found no evidence that suicide-related screening questions increased short-term distress or suicidality. Thirteen studies of treatment interventions suggested that several psychological, digital, and school-based approaches may improve depressive symptoms and/or suicide-related outcomes, although findings wereheterogeneous. Five studies addressing treatment harms showed no consistent evidence of major short-term harm, but harms were incompletely and inconsistently reported.

Conclusions: Current evidence suggests that screening and selected treatment interventions may be beneficial for children and adolescents with depression or suicide risk, particularly when linked to appropriate follow-up and care systems. However, the evidence base remains limited, especially for suicide risk screening, harms, and applicability to Japanese preventive care settings. These findings provide an updated evidence base to support the JPPSTF in developing contextually relevant recommendations.