Improving Access and Early Identification of Anxiety Disorders through Annual GAD-7 Screening in High Schools: A Scoping Review

Authors

• Joshua Richard Yumul BSN, RN, University of Tennessee Health Science Center
• Cindy Thao MSN, RN, University of Tennessee Health Science Center
• Justin Doyle Borden BSN, RN, University of Tennessee Health Science Center
• Rebecca Lizette Johnston BSN, RN, University of Tennessee Health Science Center
• Bobby Bellflower DNSc, NNP-BC, FAAN, FAANP, FNAP, University of Tennessee Health Science Center

DOI

10.21007/con.dnp.2026.0143

Faculty Advisor

Bobby Bellflower, DNSc, NNP-BC, FAAN, FAANP, FNAP

Document Type

Poster

Publication Date

Spring 5-1-2026

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Background: Anxiety disorders affect nearly one-third of adolescents in the United States, yet many cases remain undiagnosed due to inconsistent screening and limited access to school-based mental health services. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is a validated screening tool, but its routine use in high school settings is not well established.

Purpose: This scoping review aimed to synthesize current evidence on the use of the GAD-7 in high schools to support early identification of anxiety disorders and improve access to mental health care.

Methods: A comprehensive literature search was conducted using PsycINFO, ERIC, PubMed, CINAHL, and Google Scholar. Inclusion criteria focused on peer-reviewed studies involving adolescents aged 13–18, use of the GAD-7, and relevance to school-based screening. Ten studies met the inclusion criteria and were critically appraised. Data were extracted on population characteristics, screening practices, outcomes, and implementation factors.

Results: Findings indicate that anxiety disorders are highly prevalent among adolescents, with higher rates observed in females and those exposed to social and economic stressors. The GAD-7 demonstrated strong reliability and validity across diverse populations. School-based screening using the GAD-7 was associated with improved identification and referral of at-risk students; however, actual engagement with mental health services remained limited. Schools were identified as critical access points for early detection, though gaps persist in referral systems and service utilization.

Conclusions: Annual GAD-7 screening in high schools shows promise for improving early identification of anxiety disorders. However, screening alone is insufficient without integrated referral pathways, adequate resources, and coordinated mental health support. Future research should focus on implementation strategies and outcomes related to screening programs, including referral rates, treatment engagement, and academic impact.

Recommended Citation

Yumul BSN, RN, Joshua Richard; Thao MSN, RN, Cindy; Borden BSN, RN, Justin Doyle; Johnston BSN, RN, Rebecca Lizette; and Bellflower DNSc, NNP-BC, FAAN, FAANP, FNAP, Bobby , "Improving Access and Early Identification of Anxiety Disorders through Annual GAD-7 Screening in High Schools: A Scoping Review" (2026). Doctor of Nursing Practice Projects. Paper 142. http://dx.doi.org/10.21007/con.dnp.2026.0143.
https://dc.uthsc.edu/dnp/142