Commenting on last Friday’s PediaBlog (Howzitgoin’?), pediatrician Tony Kovatch (Pediatric Alliance — Arcadia) finds limited usefulness in the 9-question Patient Health Questionnaire (PHQ-9) screening tool for depression employed by office-based providers of teen health care:
I think that adolescents look upon the depression screening questionnaire as “just another snap quiz” imposed on them by the adults they distrust; the observations and intuitions of parents, siblings, and close friends carry more validity that a serious problem may be emerging. It would be valuable if AAP research could comprise some general profiles of those at highest risk of mental health problems (type A personality, disrupted family unit, chronic illness in family, positive family history of suicide or institutionalization, etc.) “Profiling” may be a dirty word these days, but, on the flip side, some children are not as resilient as their peers.
The report in Pediatrics that we examined provides a general profile of who is at highest risk for major depressive episodes (MDE). This large study of more than 350,000 adolescents and young adults found that:
- Teen and young adult females were more likely than males to have MDE.
- Non-hispanic whites were more likely affected than non-hispanic blacks among teenagers and young adults.
- Adolescents with depression were more likely to be older teens, not in school, not employed, and from either single-parent or no-parent households.
- Young adults with MDE were more likely to be unemployed or employed part-time, single (widowed, divorced, separated, or never married), and less likely to have an annual family income of more than $20,000.
- Substance abuse disorders are a common co-morbidity for both teenagers and young adults.
Living with chronic illness, dysfunctional family dynamics and volatile friendships, a history of physical and/or sexual abuse, and psychological abuse from social media sources should also not be overlooked as important risk factors for anxiety and depression. And the ubiquitousness of firearms in this country cannot be overemphasized as existential hazards for teenagers and young adults who contemplate suicide.
Child and adolescent psychiatrist and author, Fadi Haddad, M.D., advises parents who are concerned about their teenager’s mood:
Talk about the real stuff
Sometimes conversations between parents and teens can be all about achievements, schedules and chores. Go beyond that. Find out what keeps them up at night, and ask, “What’s the best part of your day?” Become attuned to their emotional world so that you understand what their dreams are, what they struggle with and how their life is going.
As teenagers gain independence they also seek more privacy, which makes it more difficult for parents to keep tabs on their mood and behavior:
Give them space, but pay attention
Give teens space to grow and separate from you, but also watch for changes in behavior. Are they giving up activities they used to enjoy? Are they staying up all night or eating differently? Is your outgoing kid now withdrawn? If you’re worried, say so. Show interest in their internal life without judgment.
Responding to a teenager’s mood with anger is the default reaction that parents need to try hard to suppress, says Dr. Haddad. And help (as Dr. Kovatch suggests in his comment) may be a phone call to your pediatrician away:
Don’t put off getting help
If you’re worried about an adolescent, talk to a school counselor, therapist or doctor. It’s better to get help early, rather than when trouble has firmly taken hold.
Finally, Dr. Haddad says it’s just not the child who may need help:
Treat the whole family
When a kid is in crisis, many times it’s not enough to treat the child—you have to change the family dynamic. It’s possible that something about the home environment was causing the child stress, so be open to acknowledging that and getting family counseling if needed.