Is your teenager depressed? Important annual screening tool identified


The American Academy of Pediatrics (AAP) approved the update yesterday guidelines that will help paediatricians and other primary care providers provide better care to adolescents at risk for depression.

The updated guidelines are needed, pediatricians believe, as research indicates that only 50% of teens with depression are diagnosed before they become adults. The data also indicates that pediatricians fail to diagnose and treat 2 in 3 adolescents with depression . The downstream consequences can be catastrophic, ultimately leading to social isolation, as well as suicide.

The guidelines have been updated for young people aged 12 to 21 and focus not only on the early identification of adolescents at risk for depression, but also on the need for annual screening, regardless of the factors. risk or family history of depression.

In accordance with the guidelines, one of the main objectives is to initiate earlier screening – at the onset of pubertysince this is the age at which many adolescents begin to show symptoms early, according to Harold S. Koplewicz MD, renowned child psychiatrist, editor-in-chief of the Journal of Child and Adolescent Psychopharmacology and president of the Child Mind Institute.

Screening annually, as opposed to screening only when symptoms or potential behaviors may arise, will help focus depression during these critical years of brain development.

“There are brain changes that occur early in puberty and peak in depression at ages 13 to 14,” Koplewicz explained, “in the same way that there is a significant risk of schizophrenia. To [age] 18 years old and bipolar disorder at [age] 20. “

75% of all psychiatric illnesses occur before the age of 24 and 50% before the age of 14 , pediatricians should therefore clearly be the first line of defense in identifying these disorders, ”Koplewicz added.

Educating the family on their own about depression, how it may present itself, as well as the unusual physical or medical complaints that are often clues to its onset is a crucial part of the updated guidelines.

Depression in adolescents presents itself differently from adults, according to Koplewicz, and it is essential that parents and caregivers recognize this.

“So here’s the challenge,” Koplewicz explained. “When adults are depressed, they usually look sad, they are lethargic, they have trouble sleeping.they have decreased sleep and appetite, decreased ability to hunt or feast on things that give them pleasure.

But teens have a whole different picture when they’re depressed. “ Teens are more likely to be irritable than depressed when they are depressed . They are susceptible, super sensitive, easily dismissedthey tend to sleep too much and overeat. And while they lose their appetite for the ‘hunt’ if someone brings them food, they will eat, ”Koplewicz said.

According to Jaime Friedman, MD, pediatrician at Children’s Primary Care Medical Group in San Diego and spokesperson for AAP.

PHQ-9 is a specific tool that pediatricians can use not only for screening but also to track the severity of depression. Consisting of 9 questions, it takes about 3 minutes to answer, Friedman explained.

“I think it’s absolutely necessary to screen for depression in adolescents,” Friedman said. “Many pediatricians already include screening in their check-ups. I don’t use an official quiz like the PHQ-9, but I’ll probably start. “

“I think it’s very important to screen teenagers for depression. We already do this in subtle ways, for example by observing and asking certain questions, but now we have data indicating that many adolescents are being forgotten. We also have data that some screening tools are effective in detecting those who need additional care. These tools are easy to integrate by asking teens to fill them out before their dates, ”Friedman added.

Friedman explained that “depression is most often diagnosed between adolescence and middle age. The problem with teenagers is that they become more and more independent, so parents may not notice the signs. They are also a high risk age group and are more likely to engage in risky or impulsive behavior, which puts them at risk for drug use or suicide. “

But simple changes to a self-administered questionnaire can make big gains in the management of depression in adolescents. “We now have data indicating that adding a few questions to an annual visit or a sports visit may recover teens who would otherwise be missed,” Friedman proposed.

“Again, many pediatricians are already doing this, but setting the standard for this will help attract more children in need of help. The next challenge will be to have more access to mental health care providers! she added.

Another pediatrician agreed with this advice, offering additional insight into the new screening guidelines.

“I think the most important finding of the revised guidelines is that the AAP encourages a universal screening process for all children 12 and over for depression. This is very important because depression in adolescents is on the increase, as is suicidality, ”said Hansa Bhargava, MD, pediatrician affiliated with Emory University, senior medical director at WebMD and spokesperson for AAP.

“Universal screening will increase the likelihood that the diagnosis will be made during a preventive visit or an acute care visit. In addition, it will likely encourage more pediatricians to engage in CME or education about mental illness, a growing problem, ”Bhargava added.

“Depression in adolescents can present itself in a vague way and often neither the family nor the teenager recognizes that it can be that. A formal self-assessment tool will help both the pediatrician and the patient to ensure that the diagnosis is made and that the adolescent receives the care that will make him feel better, ”Bhargava suggested.

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