New guidelines highlight need for teen depression screening

March 15, 2018 | Debbie Gardner
debbieg@thereminder.com

Reminder Publications submitted photo.

HOLYOKE – The statistics are troubling. According to the website suicide.org, 20 percent of all teens will experience depression before they reach adulthood, but only 30 percent of depressed teens will have their condition recognized and receive treatment. More alarming, every 100 minutes a depressed teen takes their own life, making suicide the third leading cause of death among young people between 15 and 24 years of age.

In late February, the American Academy of Pediatrics (AAP) addressed this growing concern by releasing an updated set of guidelines to help pediatricians and other primary care practitioners  provide better screenings for depression in teens. These guidelines, published in the March 2018 issue of Pediatrics, are targeted to youth between the ages of 10 and 21, and distinguish the difference between mild, moderate and severe forms of Major Depressive Disorder. For the first time, these guidelines also endorse a universal depression screening for all children 12 years of age and older.

“This is a long-recognized problem, and a major unaddressed health issue for youth; it’s a huge missed opportunity for us to intervene earlier,” said Dr. Gaurav Chawla, chief medical officer, Providence Behavior Health Hospital, Mercy Medical Center. He added that though many area pediatricians have been performing some version of mental health screening with their patients, these new guidelines provide physicians with a “path forward” in establishing a depression screening protocol within their own care setting.

“Two out of three adolescents who are depressed will not get recognized in primary care if we do not do things differently,” he added. “The message here is there are lost opportunities, missed opportunities [and] there are ways to start addressing [depression] from the level of family to primary care, and the majority of children will receive help in this setting.”

Dr. Nerissa S. Bauer, associate professor of pediatrics, Indiana University School of Medicine, said the AAP has had a group of physicians and other care providers reviewing their teen depression guidelines since they were last released in 2007.  As a member of that group, she noted that although the recent rise in teen-related violence did not initiate the group’s desire to update these screening recommendations, “we always take [community] circumstances into account.

“Exposure to violence and trauma raises the stakes for teens, which makes it important to offer annual, routine screenings to all teenagers,” Bauer said.  “My hope is that with these revised guidelines [families realize] there is no concern too small. If a parent or teen doesn’t feel comfortable, if a teen does not feel like him or herself, to not wait, to call the child’s pediatrician and have them conduct the screening.”

Chawla said that depression often looks different in children at different ages. In younger children symptoms can include sadness, crying, loss of interest in activities, clinginess, and unexplained headaches and stomachaches. In teens, depression sometimes present as behavior problems – running away, violence, increased troublemaking, neglect of hygiene,  or an attraction to drugs or alcohol abuse, all can be”signs the child is in distress and calling for help.”  Hopelessness or changes in eating and sleeping habits can be clues that something is going on for any age group, he added.

Any significant behavior change that lasts more than two weeks, Chawla noted, should be a trigger to contact the child’s pediatrician or primary care physician for screening.

Untreated depression, Chawla continued, “can lead to pretty significant negative outcomes for an individual,” especially if the condition becomes chronic. “It changes the way that child sees the world and it affects their own identity in a way that their self-worth, their choice of peers, their choice of professions, their academic performance – almost everything can be affected while they are in this formative stage of their life,” he added.

Chawla said though a positive screening result may be scary to the teen and his or her parents; there are multiple resources available to help the pediatrician develop a plan of care.  Among these resources is the state-funded Massachusetts Child Psychiatry Access Program – which provides pediatricians and other primary care physicians with “clinicians they can call and discuss their findings on the screenings, and other types of clinical impressions” for a consult. Chawla said this service provides a quick turnaround, often all the doctor needs to initiate a plan of care.

In Western Massachusetts, Chawla said pediatricians also have four other community health organizations they can access to provide patients with services. Among these are Behavioral Health Network Inc. in Springfield, The Center of Human Development, which has several offices in Springfield, Clinical Support Options, which has offices in Springfield and Northampton, and Service Net, which offers services both in Western Massachusetts and Connecticut. There is also a network of clinicians who work in private practice that pediatricians can contact. If parents or care providers are concerned about a teen’s welfare, several of the organizations also maintain crisis response teams that are available 24-7, and in severe situations, parents can bring their teen to an emergency ward, where a crisis team can be called.

Chawla also stressed that if a parent has initially missed the signs of depression in their child, they should not feel guilty.

Parents are often so close to the situation, “even if you were a mental health professional, you would have a harder time seeing that in your child,” he said.

Bauer said she is pleased the topic of teen depression – and the new screening guidelines– is now receiving so much media attention.

“[These guidelines] were written for providers, but with the help of media and different outlets, I hope it is helpful for families and for the teens themselves, as well as those who interact with teens – educators, coaches and others – so that we are all on the same page” when it comes to teen depression awareness.

Bauer maintains an online blog that addresses many children’s health issues, including recent posts on teen depression. For more information on the subject visit letstalkkidshealth.org and type “teen depression” in the search bar.

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