Teen Depression Screening Advised
The U.S. Preventive Services Task Force, made up of expert appointees who create guidelines for doctors, now recommends routine depression screening for all American teens in an effort to better diagnose and treat nearly 2 million kids who are affected.
About 6 percent of U.S. teenagers are clinically depressed, but most remain undiagnosed and untreated, said the panel. Having determined that detailed, simple questionnaires accurately diagnose depression, the task force wants primary-care physicians and pediatricians to begin screening all teen patients on an annual basis, not just those who appear to be at risk or in crisis.
According to Dr. Ned Calonge, task force chairman, depression is so common, “you will miss a lot if you only screen high-risk groups.” Recommending the use of well-researched questionnaires that focus on depression tip-offs including mood, anxiety, appetite and substance abuse, Calonge and his colleagues stress that since “depression can lead to persistent sadness, social isolation, school problems and even suicide, screening to treat it early is crucial.”
Addressing the fact that some antidepressants have been linked to increased suicidality, the task force stresses that medication alone is not appropriate, and that talk-therapy is vital to successful diagnosis and treatment. Fortunately, childhood and adolescent depression respond well to treatment plans that include medication and talk-therapy.
Recently passed mental health parity laws mandate equal coverage for mental and physical illnesses which guarantees better coverage for children seeking mental health care. This shift in coverage combined with task force recommendations will force pediatricians and family physicians to get more involved in mental health care.
In response to the task force’s report, Dr. Alan Axelson, a Pittsburgh psychiatrist, wrote a report on behalf of the American Academy of Child and Adolescent Psychiatry in which he recommends that pediatricians work closely with child psychiatrists, even sharing office space when possible. The Academy also says insurers should compensate pediatricians for any mental health services they provide.
Because families usually get to know their pediatricians, “having those doctors offer mental health screening can help make it seem less stigmatizing.” Axelson said, adding that “Most pediatricians aren’t trained to do psychotherapy, but they can prescribe depression medication and monitor patients they’ve referred to others for therapy.”
If you have children or teens, check with your family doctor to learn how he screens for depression in young patients.
April 2nd, 2009 at 6:58 am
I’m not convinced this is the answer.
First, there’s a broader issue mental illness in general. Most people begin to exhibit symptoms of their disorder in their teens. Parents, teachers, law enforcement, clergy all need to be educated about mental illness. We can now look back and see our son became symptomatic at 13, and no one we sought help from recognized it. I hear so often from parents, “If only someone had told us.”
Second, physicians aren’t really trained in recognizing or treating mental illness. The other problem with this proposal is often when a child reaches the teen years, annual check-ups, except for sports, are stopped.
Third, all teens are “depressed” at some point. A girl in the hormone rages of PMS whose boyfriend went out with her best friend will be “depressed.” A boy who has been cut from the basketball team after years of practice and training will be “depressed.” Both of these kids may answer a survey with “I’d be better off dead.” “I think about killing myself.” But, neither of these kids are in the throes of major depression or bi-polar depression. Although they may need a knowledgeable counselor to talk, they don’t need medication.
Fourth, depression medication for teens is a HUGE issue. So many anti-depressants are inappropriate for teens. It needs to be handle by a psychiatrist, not a general physician or pediatrician.
I guess it is a start to recognizing mental illness. Education is needed more than written surveys. A teacher and/or parent who see the teen daily, who has been taught to recognize symptoms, can better see the symptoms of depression or other mental illnesses than filling-in a few bubbles in a doctor’s office.
April 2nd, 2009 at 7:23 am
I’m glad you shared your thoughts, Susan. You make valid points and raise very real concerns.
I am thrilled that medical practitioners are beginning to address teen depression as the major health risk it is and has long been. But training and tools are vital to the success of this effort.
No question…as I said in the last paragraph of my post, parents and caregivers need to learn exactly how their doctors screen patients for depression. If those parents or caregivers aren’t satisfied with the doc’s tools and training, another practitioner may need to be involved.
April 2nd, 2009 at 7:37 am
The answer for teens and mental health issues is not to have the doctor screen for them, but to educate those who see the teens frequently about the signs and symptoms of mental health issues.
The time a doctor gives for an appointment is not even close to sufficient to know if the teen is actually depressed, and whether or not medication will help.
Back when I was in high school, I had some issues with depression in my final year, none of the teachers really saw it because they didn’t know what to look for, and when I went to a guidance counsellor for help, she told me point-blank “We don’t deal with that, we don’t know where you should go, talk to your parents, maybe.”
We need to educate teachers about the signs of mental health problems, so that they can talk to the affected students or their parents about any concerns they might have, as the teachers see the students day in and day out, where a doctor only sees someone for half an hour or less, and has no idea how the person usually acts, behaves, expresses themselves, etc.
April 2nd, 2009 at 8:05 am
Great insights, Dan. Unfortunately, your experience is more the rule than the exception. I’ve done several all-hands trainings in local high schools and was amazed by how little staff and faculty know about mental health issues. Educating those front-liners IS the next best step.
Thank you for sharing and I hope you continue in good health.
Kate