Teens are far from exempt from suffering mental health issues. Studies show one in five teenagers struggle with depression, but most go undiagnosed and untreated, in part because teenagers are so rarely screened for mood disorders. That should change, according to new guidelines from the American Academy of Pediatrics — the new guidelines recommend pediatricians screen all teenagers for depression during their annual pediatric checkups.
The American Academy of Pediatrics first published guidelines regarding adolescent depression screening in 2007, noting that "only 50% of adolescents with depression are diagnosed before they reach adulthood." The guidelines added, "In primary care (PC), as many as 2 in 3 depressed youth are not identified by their PC clinicians and do not receive any kind of care. Even when diagnosed by PC physicians, only half of these patients are treated appropriately."
But, as the AAP now notes, one of the reasons pediatricians hesitate to diagnose depression in adolescents is that they don't have the training and access to a mental health system to accurately pinpoint and treat mental illness in teens. Teens may mistake depression as a symptom of puberty and changing hormones; parents may mistake symptoms of depression for mononucleosis, or basic teen blues. "I sought training in mental health because I got sick of hearing the families’ stories and feeling the only thing I could do was provide tissues," one pediatrician told AAP.
The new guidelines, which will be published in the March edition of Pediatrics, suggest pediatricians start screening children annually, starting when they are 12 years old. The guidelines aim to help pediatricians recognize symptoms of depression; to distinguish between mild, moderate, and severe forms of depression using "reliable depression scales," and to categorize different symptoms depending on the patient's age and stage of development. "[It] will be more than just 'I feel sad on a scale of 1 to 5,' it'll be much more detailed, and ask for more situational and informational stuff, so that we can be much more specific in our diagnosis," family psychologist Dr. Jennifer Hartstein told TODAY.
The screenings will require patients to self-report symptoms. Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist, told NPR teenagers are more likely to be honest when they don't have to speak directly to a doctor. "Teenagers are often more honest when they're not looking somebody in the face who's asking questions, " she said. "It's an opportunity for the adolescent to answer questions about themselves privately."
The questions appear to be fairly standard in depression screening, asking patients to rank how strongly they've felt "down, depressed or hopeless" over the last two weeks, or whether they've had difficulty eating or sleeping, according to . It is noteworthy that the guidelines are not meant to replace outside mental health treatment, but merely to catch depression in time to help teenagers get the treatment they need, whether it be therapy, psychiatry, or some other form. "So many teens don't have access to mental health care," Hartstein said to TODAY. "It has to start with their pediatrician, and these changes really point in that direction."
When I was a teenager, I struggled with depression—in one particularly difficult semester, I stopped doing homework, I skipped class, my grades plummeted, and I stayed up all night downloading Doors videos. I didn't have the language available to understand what it was I was going through, and since teens are notoriously moody, hostile, and otherwise difficult, my parents didn't pick up on what was happening, either. It wasn't until well into adulthood that I realized what it meant to suffer from depression, and I might have saved myself a fair bit of suffering had someone caught it earlier. Hopefully, these guidelines and screenings spare someone else from the same fate.