Suicidal behavior is among the most critical of medical emergencies for adolescents. Among US youth aged 15 to 24 years, intentional self-harm (suicide) is the second leading cause of death and accounted for 6807 deaths in 2018. 1 Recent statistics are ominous regarding significant increases in suicidal behavior among adolescents; from 2009 and 2019, there were significant increases in the prevalence of those who reported having seriously considered attempting suicide (13.8% to 18.8%) and

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... attempted suicide (6.3% to 8.9%). 2 These increases occurred prior to the COVID-19 pandemic. A study that evaluated emergency department visits for suspected suicidal behavior among persons aged 12 to 25 years before and during the COVID-19 pandemic found that the mean number of weekly visits for suspected suicide attempts increased from February through March 2021, compared with the same period in 2019, with a 50.6% increase among girls and a 3.7% increase among boys. 3 The cornerstone of suicide prevention is screening for suicidal behavior, which includes inquiry into the presence of suicidal ideation, plan, intent, and actual attempts. Little controversy exists regarding screening teens who are at high risk for suicidal behavior, such as those with depression and other psychiatric disorders. 4 Universal screening in primary care, ie, screening every teenager who seeks care in the primary care setting, is another matter. The immense number of adolescents to be screened and identifying those with suicidal behavior demand the efforts of mental health professionals and primary care professionals. To guide physicians and other health care practitioners in making decisions about clinical preventive services such as screening, the US Preventive Services Task Force (USPSTF) makes evidence-based recommendations. In this issue of JAMA, the USPSTF presents an updated Recommendation Statement on screening for depression and suicide risk in children and adolescents, 5 along with an updated Evidence Report and Systematic Review by Viswanathan et al 6 that serves as the basis for current recommendations. In 2014, the USPSTF published recommendations on screening for suicide risk in adolescents and adults 7 and in 2016, on screening for depression in children and adolescents. 8 In the 2016 report, the USPSTF recommended screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years and further specified that screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. For children 11 years or younger, the USPSTF concluded that then-current evidence was insufficient to assess the balance of benefits and harms of screening for MDD in children 11 years or younger. In the 2014