Depression screening by primary care physicians important for adolescents

By Dr. Ananya Mandal, MDFeb 26 2018

According to the American Academy of Paediatrics’ new guidelines released this week, all adolescents should undergo a screening for depression annually. The guidelines is published titled, “Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management,” by the GLAD-PC Steering group.

The AAP recommends that in this move, screening children aged between 12 and 21 years for depression would assist the primary care doctors. The U.S. Preventive Services Task Force had earlier recommended screening of all 12 to 18 year old children for major depressive disorder. This latest report suggests that one in two adolescents are diagnosed with depression before they reach adulthood and 2 in 3 of teenagers with depression fail to receive adequate care. According to Dr. Rachel Zuckerbrot, a psychiatrist and associate professor at Columbia University, who was part of the team that wrote the guidelines, this remains a “huge problem”.

The AAP writes in the guidelines that these would assist the “clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment. ... Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.” This is the first update to this guideline in the past decade. Paediatricians are urged to talk to teenagers alone to detect signs of depression early. According to Zuckerbrot, these screenings for depression may well be done during sports physicals, office visits or well visits of the children. Detailed screening can help pinpoint the diagnosis say experts. Zuckerbrot added that there are several paediatricians who use self-reported questionnaires for their adolescent patients to fill out on their own. These explore their feelings of depression and sadness, loss of interest in activities, anger, aggression, sleep and diet patterns. Zuckerbot says that these could reveal more honest responses from these teenagers as they may be more comfortable answering this way compared to looking at someone’s face.

Depression also comes with a stigma and Kaiser Permanente in Colorado has launched their drive called “Find your Words” to reduce the stigma of depression among adolescents. The stigma may prevent the adolescents from seeking help in time. According to the Centers for Disease Control and Prevention (CDC), depression leading to suicide is the second highest cause of death among children and young adults aged 10 and 24 years. These new guidelines state, “Adolescents are at particular developmental risk, as this period is marked by a search for identity and independence, accompanied with emotional characteristics including curiosity, strong peer influences, immaturity, and mood swings…Each of these ordinary developmental stages and experiences put young people at a greater risk for impulsive and sometimes violent action, particularly for adolescents with a history of aggressive and violent behaviors, suicide attempts or depression.” Further firearm availability in the family may heighten the risk of suicide says the AAP.

Source: http://pediatrics.aappublications.org/content/early/2018/02/22/peds.2017-4081