Caring for Patients with Anxiety

This evidence repository is a collection of best available resources and evidence collated by a knowledge synthesis team at Alberta Research for Health Evidence (ARCHE) and the clinical content team.

The knowledge synthesis team utilizes a pyramid-shaped framework, built upon the “4S” hierarchy of evidence model, to provide detailed evidence appropriate to meet stakeholders’ needs. They search a combination of databases (Cochrane Library, PubMed, TRIP Database) and web-based search engines (Google, Google Scholar) to locate evidence for the knowledge pyramids. Publication types sought in the initial topic searches are organized into five levels that determine the order in which resources are presented:

1. Bottom Line Recommendations
2. Clinical Practice Guidelines And Pathways
3. Overviews and Summaries of Systematic Reviews
4. Systematic Reviews
5. Key Studies

Where applicable resources for families and parents are also listed.

The knowledge synthesis team collaborates with the clinical content team to select the most relevant guidelines, reviews, and key studies, which can be found below. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found here.

Thank you to the following clinical content experts and Knowledge Synthesis team who led the development of this evidence repository.

Amanda Newton, PhD, RN Professor, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta

Mohamed Eltorki, MBChB, MSc, FRCPC Associate Professor of Pediatrics and Pediatric Emergency Medicine, University of Calgary

Matthew Morrissette, MD, FRCPC Assistant Clinical Professor, Department of Psychiatry, University of Alberta

Alexa Bagnell, MD, FRCPC Professor Department of Psychiatry, Dalhousie University, IWK Health

Liza Bialy, BSc, MPH, Knowledge Synthesis Project Coordinator, Alberta Research Centre For Health Evidence, Department of Pediatrics, University of Alberta

Sarah Elliott, PhD, Assistant Director, Alberta Research Centre For Health Evidence, Department Of Pediatrics, University of Alberta

TREKK developed resources for healthcare providers and parents & families can be found here.

1. Klein B, Rajendram R, Hrycko S, et al. Anxiety in children and youth: Part 1-diagnosis. Paediatr Child Health. 2023;28(1):37-51.
2. Bobbitt S, Kawamura A, Saunders N, et al. Anxiety in children and youth: Part 2-the management of anxiety disorders. Paediatr Child Health. 2023;28(1):52-66.
3. Mangione CM, Barry MJ, Nicholson WK, et al. Screening for anxiety in children and adolescents: Us preventive services task force recommendation statement. JAMA. 2022;328(14):1438-44.
4. Srinath S, Jacob P, Sharma E, et al. Clinical practice guidelines for assessment of children and adolescents. Indian J Psychiatry. 2019;61(Suppl 2):158-75.

1. Pilkington K, Wieland LS. Self-care for anxiety and depression: A comparison of evidence from Cochrane reviews and practice to inform decision-making and priority-setting. BMC Complement Med Ther. 2020;20(1):247.
2. Bennett K, Manassis K, Duda S, et al. Treating child and adolescent anxiety effectively: Overview of systematic reviews. Clin Psychol Rev. 2016 Dec;50:80-94.

1. Siu A, Tran NA, Ali S, et al. Pharmacologic procedural distress management during laceration repair in children: a systematic review. Pediatr Emerg Care. 2024 Feb 1;40(2):88-97.
2. Shen T, Wang X, Xue Q, Chen D. Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review. Ital J Pediatr. 2023 Aug 31;49(1):109.
3. Robinson T, Delorenzo AJ, Howell SC, et al. Emergency Department distraction therapy for pain and anxiety in paediatric patients: A systematic review & meta-analysis of techniques potentially suitable for the prehospital setting. Pediatric Critical Care Medicine. 2022 Nov;23(Supplement 1):11S.

1. Sakurai H, Inada K, Aoki Y, et al. Management of unspecified anxiety disorder: Expert consensus. Neuropsychopharmacol Rep. 2023.
2. Ribas Roca J, Everett T, Dongarwar D, et al. Racial-ethnic disparities in benzodiazepine prescriptions for anxiety in US emergency departments. J Racial Ethn Health Disparities. 2023;10(1):334-42.
3. Reppucci ML, Tong S, Simon SL, et al. Factors associated with new mental health diagnoses and resource utilization among pediatric patients following trauma admission. J Pediatr Surg. 2023;58(1):118-24.
4. Kass M, Alexander L, Moskowitz K, et al. Robust parental preferences in mental health screening in youth from a multinational online survey. medRxiv. 2023.
5. Hoffmann JA, Pergjika A, Liu L, et al. Standardizing and improving care for pediatric agitation management in the emergency department. Pediatrics. 2023.
6. Powell DS, Lanzillo EC, Jay SY, et al. Self-reported symptoms of anxiety predict positive suicide risk screening in adolescents presenting to the emergency department. Pediatr Emerg Care. 2022;38(1):22-5.
7. Burt H, Doan Q, Landry T, et al. The impact of universal mental health screening on pediatric emergency department flow. Acad Pediatr. 2022;22(2):210-6.
8. Li BCM, Wright B, Black T, et al. Utility of MyHEARTSMAP in youth presenting to the emergency department with mental health concerns. J Pediatr. 2021;235:124-9.
9. Coleman KD, Chow Y, Jacobson A, et al. An evaluation of short anxiety measures for use in the emergency department. Am J Emerg Med. 2021;50:679-82.
10. Lea Mortensen M, Ekelund K, Hallas P. Barriers and facilitators among health care professionals in the Emergency Department for treating paediatric patients’ pain and anxiety. A qualitative survey study. Int Emerg Nurs. 2021 Nov;59:101067.
11. Hiscock H, Connolly AS, Dunlop K, et al. Understanding parent-reported factors that influence children and young people’s anxiety and depression presentations to emergency departments: A multi-site study. Emerg Med Australas. 2020;32(5):724-30.
12. Esposito JM, Fein JA, Marshall J, et al. Improving mental health communication from the pediatric emergency department to primary care. Pediatr Emerg Care. 2020;36(9):424-9.
13. Doan Q, Wright B, Atwal A, et al. Utility of MyHEARTSMAP for universal psychosocial screening in the emergency department. J Pediatr. 2020;219:54-61.e1.
14. Gerson R, Malas N, Feuer V, et al. Best practices for evaluation and treatment of agitated children and adolescents (beta) in the emergency department: Consensus Statement of the American Association for Emergency Psychiatry. West J Emerg Med. 2019 Mar;20(2):409-418.
15. Hudson JL, Murayama K, Meteyard L, et al. Early childhood predictors of anxiety in early adolescence. J Abnorm Child Psychol. 2019;47(7):1121-33.
16. Rochat CP, Gaucher N, Bailey B. Measuring anxiety in the pediatric emergency department. Pediatr Emerg Care. 2018;34(8):558-63.
17. Musey PI, Jr., Lee JA, Hall CA, et al. Anxiety about anxiety: A survey of emergency department provider beliefs and practices regarding anxiety-associated low risk chest pain. BMC Emerg Med. 2018;18(1):10.
18. Yap MB, Pilkington PD, Ryan SM, et al. Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: A delphi consensus study. J Affect Disord. 2014;156:67-75.
19. Broeren S, Muris P, Diamantopoulou S, et al. The course of childhood anxiety symptoms: Developmental trajectories and child-related factors in normal children. J Abnorm Child Psychol. 2013;41(1):81-95.
20. Ramsawh HJ, Chavira DA, Kanegaye JT, et al. Screening for adolescent anxiety disorders in a pediatric emergency department. Pediatr Emerg Care. 2012;28(10):1041-7.
21. Ginsburg GS, Riddle MA, Davies M. Somatic symptoms in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(10):1179-87.
22. Campo JV and Fritz G. A management model for pediatric somatization. Psychosomatics. 2001; 42(6):467-476.

1. Pettitt RM, Brown EA, Delashmitt JC, et al. The management of anxiety and depression in pediatrics. Cureus. 2022;14(10):e30231.
2. The Centre for Addiction and Mental Health (CAMH). Panic disorder. 2013.

1. Caring for Kids. Anxiety and anxiety disorders.
2. Centers for Disease Control and Prevention. Anxiety and depression in children.
3. Anxiety Canada. Anxiety resources.
4. Child Mind Institute. How anxiety affects teenagers.
5. ConnexOntario. Mindyourmind.
6. Kids Help Phone. https://kidshelpphone.ca/
7. Kelty Mental Health Resource Centre. https://keltymentalhealth.ca/