Several years ago, a friend confided in me that her then pre-teen had been diagnosed with depression. At the time I wondered out loud how a parent would know if their teenager was suffering from depression as opposed to normal teen angst, and she assured me that, “You just know.” But that may not be true. Research shows that only half of adolescents with depression are diagnosed before they reach adulthood. Only two in three depressed teens are diagnosed by their primary care physicians and only half of those receive the appropriate treatment.
The American Academy of Pediatrics issued updated guidelines this week calling for universal screening for depression for everyone between the ages of 12 to 21. The guidelines suggest that screenings should be done annually, “during a well-visit, a sports’ physical or another office visit.”
Therefore primary care pediatric providers must be the line of first defense in identifying, assessing and treating depression in their adolescent populations. The new Guidelines for Adolescent Depression in Primary Care (GLAD-PC) are based on current research and on the consensus of experts in the field but, in addition to following these guidelines, primary care physicians must be guided by their clinical judgement is making decisions about a patient’s care.
Some things that we know about depression in adolescents:
- The risk of depression increases as a child transitions to adolescence and, in the last 30 years, there has been an increase in the prevalence of depressive symptoms in adolescents in industrialized countries. Recent suicide trends in the United States suggest that depression in adolescents and young adults continues to increase.
- There is a shortage of clinicians and there are barriers to children’s access to the mental health care afforded to adults.
- Depression is the leading cause of suicide and the number of children and adolescents admitted to children’s hospitals for suicide ideation or self-harm more than doubled during the last decade.
- Depression rates appear to be connected in some way to use with researchers seeing “a sudden increase in teens’ symptoms of depression, suicide risk factors and suicide rates in 2012 — around the time…smartphones became popular.” The reasons for this link have not been completely discovered, but there are a number of theories including the pressure social media puts on teens to always “be on.”
- Adolescent girls experience more major depressive episodes than their male counterparts (adult women also experience higher rates of depression than men).
- Depression in teens may manifest itself differently than it does in adults. Adolescents may complain about being stressed or down but they also may report feeling irritable, angry or argumentative. Teen depression may manifest in physical complaints such as migraine, stomach pain and fatigue.
The GLAD-PC guidelines include recommendations for the:
- Identification of depression in youth at high risk
- Systematic assessment procedures using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria
- Patient and family psychoeducation
- Establishing relevant links in the community
- Establishing of a safety plan
The new guidelines “are intended to assist clinicians in family medicine, pediatrics, nursing, and internal medicine who may be the first (and sometimes only) clinicians to identify, manage, and possibly treat adolescent depression.”
Hopefully pediatricians will be able to implement the updated guidelines and use them to better identify and appropriately treat depression among teenagers. We need to reduce the stigma surrounding mental illness and get help to these kids who desperately need it.