Last week, the American Academy of Pediatrics updated its “Guidelines for Adolescent Depression in Primary Care” by calling for universal screening of teenagers to better identify those having symptoms of depression.
In the United States, studies show that only half of adolescents with depression are diagnosed before adulthood. And up to two-thirds of depressed teenagers don’t receive any care for their symptoms. Because there is a shortage of mental health professionals nationally limiting access to services, the new guidelines put primary care pediatricians on the front lines of diagnosis and treatment. In order to improve the ability of primary care providers to identify tweens and teens living with symptoms of depression, universal depression screening done annually is recommended for a problem that, Allison Aubrey says, is fairly common:
“What we’re endorsing is that everyone, 12 and up, be screened … at least once a year,” [Dr. Rachel] Zuckerbrot says. The screening, she says, could be done during a well-visit, a sports’ physical or during another office visit.
Zuckerbrot helped write the guidelines, which have been in development for a while. The U.S. Preventive Services Task Force also recommends depression screening, and many pediatricians have already woven the screenings into their practices.
“Teenagers are often more honest when they’re not looking somebody in the face who’s asking questions,” about their emotional health Zuckerbrot says. So, most pediatricians use a self-reported questionnaire that teens fill out themselves, either on an electronic device or on paper.
“It’s an opportunity for the adolescent to answer questions about themselves privately,” she says.
Patients of Pediatric Alliance who are 11 and older are familiar with the drill of screening for depression by answering the 9-question Patient Health Questionnaire (PHQ-9) at each annual well visit:
The questionnaires contain a range of questions. For instance, one version, asks: ‘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?’ Teens are also asked questions such as, ‘Are you having difficulty with sleep, either too much or too little?’ ‘Any problems with eating?’
The guidelines also call for improving initial therapeutic management by primary care providers including identifying mental health professionals in the community, having a thorough discussion of treatment options, and providing a safety plan:
The new recommendations also call for families with a depressed teen to develop a safety plan to restrict the young person’s access to lethal means of harm. Suicide is a leading cause of death for children aged 10 to 17, and “adolescent suicide risk is strongly associated with firearm availability,” according to an AAP report.
It’s often difficult for teenagers to find the right words to express their feelings and this is one reason a diagnosis of depression can be elusive. The key to timely diagnosis and appropriate therapy is good communication between teenagers, parents, friends, teachers, and pediatric providers. With depression, like so many human conditions, early recognition typically leads to better outcomes. That is a goal we should all work toward.