The American Academy of Pediatrics issued an update to its guidelines this week calling for universal screening for depression in adolescents “in an era of great clinical need and shortage of mental health specialists.”
Previous AAP research shows only about 50 percent of youth aged 10-21 are diagnosed before adulthood — and as many as 2 in 3 with depression fail to receive the care they need, the academy said.
Oftentimes those suffering from depression present their pediatricians with complaints that are less obvious of depression than others. This could include complaints from parents about their angry 16-year-old son who won’t speak to them or a teen daughter lacking energy and sleeping all the time.
“Even when depression is suspected, many pediatricians hesitate to make the diagnosis without mental health input. And even when a diagnosis is made, many feel at a loss, given the barriers to accessing the mental health system and lack of training on treatment of [major depressive disorder],” lead researchers Dr. Rachel A. Zuckerbrot and Amy H. Cheung wrote in a statement Monday.
The recommendations for the Guidelines for Adolescent Depression in Primary Care (or GLAD-PC), are the first-ever evidence- and expert consensus-derived guidelines to help primary care clinicians fill that void and better manage depression in youth. They will be published in the March edition of the journal Pediatrics.
The guidelines feature more situational and reliable depression scales, and aim to help pediatricians recognize symptoms of and distinguish between mild, moderate and severe forms of depression.
Depression screenings will require patients to self-report their symptoms.
"Teenagers are often more honest when they're not looking somebody in the face who's asking questions," Zuckerbrot told NPR. "It's an opportunity for the adolescent to answer questions about themselves privately."
These questions are fairly standard. For example, one version asked, “Over the past two weeks, how often have you been bothered by any of the following problems: feeling down, depressed or hopeless? Or, little interest or pleasure in doing things?”
According to NPR, other questions may ask, “Are you having difficulty with sleep, either too much or too little?” or “Any problems with eating?”
Zuckerbrot said the guidelines urge pediatricians to screen everyone 12 years and up at least once a year and provide assistance on how to negotiate roles and responsibilities between primary care and mental health.
“There's growing awareness in the U.S. of the need for young people to have good access to mental health care,” Dr. Doug Newton, a child psychiatrist at Kaiser Permanente in Colorado, told NPR. "As a nation this has become part of the dialogue.”
Families are also urged under the guidelines to develop a safety plan to restrict their young members from access to means of harm.
According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death for youth between the ages of 10 and 24, and results in approximately 4,600 lives lost each year.
Additionally, suicide rates among 15- to 19-year-old girls doubled between 2007 and 2015, reaching a 40-year high. That means for every 100,000 American girls in 2015, five committed suicide.