Should We Institute Universal Depression Screening for Adolescents?
According to Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist and associate professor at Columbia University, who was interviewed by NPR for a story on the AAP's new guidelines, "Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them."
I agree with Dr. Zuckerbrot that we have a problem with teens getting the emotional healthcare they need. The statistics on teen depression and suicide continue to affirm our teens are struggling and the increase in violence from young people, who admit to being bullied and isolated, reinforce the need for something to be done. However, I think we must acknowledge the challenges such a screening would present.
1. There are not enough counselors trained to work with adolescents and their families.
I have been working with teenagers for 20+ years, and they do not think, feel, or act the same as children or adults. We have new research to help us understand this stage of development better and evaluate norms and processes. This research can guide us in developing treatment and discipline models that are different than the ones we have used in the past.
2. Quality professional counseling is expensive and often not covered by insurance.
If treatment is recommended after a required screening, how will families who are already struggling pay for care? The cost of counseling and the time investment involved with it may create a greater demand to use medication as a solution for mental health challenges, and while such medications have many benefits, we need to use caution when prescribing them to adolescents because their brains are still developing.
3. Adolescents are hypersensitive to what people say and believe about them and screening may be detrimental to their mental health, by adding a "label" to them.
These are not challenges without solutions. Here are a few things to consider:
1. Let's train counselors to specialize in adolescent care. Currently, most mental health training focuses on adults or children.
2. Let’s provide parenting support (classes or programs) so parents feel equipped to evaluate normal teen behavior and are aware of symptoms requiring intervention.
3. Let’s provide training and programs for people who work directly with the adolescent population (teachers, youth workers, mentor) so they can help parents determine the emotional well-being of the teenagers with whom they work closely.
4. Finally, let’s find a way to provide for our mental health as well as our physical health.