Presymptomatic Screening for Risks to Children's Mental Health : Ethical Considerations from a European Focus Group Study with Mental Health Professionals.

The development of presymptomatic screening for risks to children's mental health holds the promise to prevent or reduce the burden of mental disorders by enabling timely preventive actions. However, such screening programmes also raise ethical concerns related to false positive results, increased anxiety, harmful effects on a child's sense of self, and stigmatization. Stakeholders can provide valuable insights into these ethical concerns from their engagement with practice. Therefore, in this study we conducted six focus group discussions with professionals in the child mental health domain (in clinical, educational, or policy settings) to investigate their views on presymptomatic screening and identify ethical considerations. The discussions took place in six European countries. Three main themes were identified: 1) Promises and concerns about screening for risks to children's mental health, 2) Additional considerations about biomarker screening, and 3) Implications for healthcare systems and society. Ethical considerations included the benefits of screening outweighing the harms, informed and autonomous decision-making, the actionability of screening outcomes, stigmatization, and medicalization. Our findings underscore the importance of exercising caution in the development and implementation of presymptomatic screening for risks to children's mental health. Implications for practice and future research are discussed.