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Teens & Depression: How Primary Care Docs Can Intervene

By: Kelley Talbot

Depression is hitting many teens and children hard.

It is now as likely for 10-14-year-olds to die from suicide as from a traffic accident. The prevalence of depression among 12-17-year-olds has increased significantly since 2005. About 12.5 percent of American teens experienced depression in 2015.

Maybe equally surprising is that unmet mental health needs are as high today as they were 20 years ago. Nearly 80 percent of youth in need of mental health services don’t get them.

But try to ask questions about teen depression vs. normal moodiness causes, and the best treatment choices, and you’ll unleash a tsunami of fiercely held beliefs. Just take a look at the comments section from this New York Times article. To summarize here, these comments reflect the tangled web of issues confronting teens and parents with questions about depression.

  • Is it depression, or just teen angst?
  • Is it better for them to tough it out – will a label of “depressed” and a prescription make it worse or even be dangerous?
  • Where can I find treatment? Will it be right for my teen? How much will it cost?

Pediatricians and primary care doctors have a critical and unique role in framing mental health conversations for families and connecting them to appropriate care.

Specifically, the American Academy of Pediatrics cites their “longitudinal, trusting, and empowering relationship” with patients and parents – essential for delicate conversations. Framing matters – because how doctors talk about depression, medication and therapy will influence if, when, and what type of treatment teens and parents seek.

Primary care providers (PCPs) are well-positioned to improve the recognition and treatment of depression among children and adolescents, given the frequency with which this population sees their PCPs and their comfort in discussing health behavior concerns with their clinicians. Interventions delivered to depressed adolescents by PCPs and within the primary care setting have demonstrated effectiveness.”

-Amy Cheung, Current Psychiatry Reports

While these providers increasingly recognize the role they can and should be playing, they cite many hurdles to making it workable. Many primary care doctors aren’t confident in their mental health expertise, aren’t confident there are enough specialists to refer patients to, worry about the time it will take to help these patients, and have concerns about getting paid (even in the age of parity). So what’s being done to get depressed teens help? What new tools are being developed to support pediatricians and PCPs?

First, the AAP and the AAFP now recommend screening adolescents for depression and suicide risks. The AAP has created an extensive toolkit to assist in screening and supporting patients, even as they raise the alarm about specialist shortages. The National Alliance on Mental Illness has also developed tools for physicians, encouraging them to screen, evaluate, refer and follow up. It also points out that families are hungry for information – they want fact sheets and brochures, lists of websites, and lists of local support groups.

5 Most Helpful Things a Doctor Can Say

  1. There is hope
  2. You are not alone
  3. It’s not your fault
  4. I understand
  5. You child has many strengths

– From the National Alliance on Mental Illness

There’s a clear unmet need for depressed teens to be diagnosed and treated, and a need for pediatricians and PCPs to help fill that gap. It will take system-wide change to ensure that mental health care is available, affordable, and reimbursed. While efforts are slowly implemented to address those challenges, patients and providers can benefit in the interim from the increasing number of resources to start mental health conversations and provide appropriate screening and referrals. Difficult as it may be to have these conversations or change office practice, they will prevent suicides of teens who feel helpless and hopeless.