Doctors urged to screen teens for major depression

Doctors should screen teenagers for major depression, a federal advisory group said Monday, but only if their young patients have access to mental health professionals who can diagnose them, provide treatment and monitor their progress.

That’s a big “if.”

Mental health services are in short supply for anyone, but especially teens, said Jeffrey Lieberman, a professor and chairman of psychiatry at the Columbia University College of Physicians and Surgeons in New York.

States have cut billions of dollars from mental health programs in recent years, according to the National Association of State Mental Health Program Directors.

Only 36% to 44% of children and adolescents with depression receive treatment, according to draft recommendations from the U.S. Preventive Services Task Force, a panel of experts who advise the federal government on medicine and health policy.

Often, that treatment comes only after people suffer a major breakdown, get arrested or see their lives unravel. People with depression wait an average of seven years between the time when they first develop symptoms and when they finally receive treatment, Lieberman said.

“When it comes to mental illness, we do too little, too late,” said Lieberman, who is not a member of the task force.

Mental Illness: The Cost of Not Caring

The task force looked specifically at studies of major depression — which lasts at least two weeks and significantly impairs a person’s ability to function at work, school or socially — in adolescents ages 12 to 18. Simple screening tests for major depression can also pick up mild or moderate forms, said task force member Alex Kemper, a professor of pediatrics at Duke University Medical School in North Carolina.

About 8% of teens reported having major depression in the past year, according to the report.

There wasn’t enough data on screening for depression in children under 12 for the task force to make a recommendation in this age group, Kemper said. The task force does recommend screening for depression in adults, as long as mental health services are available.

The task force doesn’t recommend screening for depression if there are no services available, Kemper said. Screening people but failing to provide treatment is unlikely to do much good.

Depression poses serious risks, increasing the risk of teen pregnancy, suicide and drug use, the task force found. Many people with depression or other mental illness “self-medicate,” using alcohol or drugs to try to feel better, Lieberman said.

Treating kids with depression — with counseling, medication or other services — can make a big difference by relieving teens’ symptoms and reducing their risk of suicide, Kemper said.

Lieberman said he'd like to see pediatricians and family doctors screen for other forms of mental illness, such as anxiety.

Some wonder if pediatricians have time to screen teens for depression, given that they’re already expected to talk to young people about so many topics, from sexuality to substance use.

A typical doctor’s visit lasts only 10 to 15 minutes, said Jonathan Winickoff, an associate professor of pediatrics at Harvard Medical School. An ideal way to screen for depression would be to ask teens to take a short survey on the computer, which can calculate the score electronically, before the teen’s appointment.

Kemper said he asks teens to fill out a nine-question screening test in the waiting room, with pen and paper, giving kids privacy so that their parents don’t see their results.

Linea Johnson said she hopes more doctors begin screening teens.

Johnson was 15 when she first became severely depressed. She describes herself as an overachiever who played piano in several local groups and was a star pitcher for her softball team. At first, Johnson could hide her feelings of hopelessness from her teachers and peers.

“I could pretend like I was smiling, and no one had any idea how I felt,” said Johnson, now 29, who wrote a memoir about her experience called Perfect Chaos. “But I felt horrible and would come home and just shut down every night. I would just lay in my room and listen to music in the dark and stare at the ceiling for hours.”

Eventually, Johnson’s depression led her to quit softball and stop socializing with her friends. Her mother, who teaches special education, recognized her daughter's symptoms and sought out a counselor. When Johnson was 19, she was diagnosed with bipolar disorder, in which people cycle between periods of depression and mania.

Today, Johnson is grateful for her mother’s persistence. “She had to call a million psychiatrists to find someone who could treat someone under 19.”