Updated guidelines for adolescent depression screening in primary care were released in March 2018 and have been endorsed by the American Academy of Pediatrics (AAP). These guidelines recommend universal screening by primary care providers for all patients 12 years of age and older at their annual well visits.
At Nemours duPont Pediatrics, our providers have been screening for depression, starting at age 12, for about four years. We’ve made it a routine part of adolescent care in all 12 of our practices in Delaware and are beginning to screen in our eight practices in Pennsylvania as well. We screen for depression in primary care because otherwise it can be missed. This is especially true if the patient’s symptoms are not obvious and the parent or guardian doesn’t express concern.
Kids who are in distress often don’t speak up. But they might if we ask the right questions. What seems like typical teen angst or moodiness may actually need to be addressed by a physician or mental health professional.
According to the AAP, one out of five teenagers experiences depression.
Depression Screening Tool
Nemours uses a quick nine-question screening tool that assesses suicidal ideation and the primary symptoms of depression such as:
- sadness or irritability
- feelings of hopelessness
- loss of pleasure
- difficulties with sleep or eating
The screening tool is built into the Nemours electronic health record, so it automatically alerts the provider to assess for risk if the child is 12 years or older. Children and teens who are identified as at risk for depression are often referred to the integrated behavioral health provider in the practice, sometimes right on the spot. Every Nemours duPont Pediatrics site in Delaware has, or soon will have. a psychologist or clinical social worker based at the practice. Children can also be seen by behavioral health providers at Nemours/Alfred I. duPont Hospital for Children.
A few years ago, a Nemours psychiatrist trained primary physicians at the various sites in how to follow up with additional assessment and treatment when the screening results are positive. She mentored providers in determining the level of guidance and support patients might need. Some providers were less comfortable with prescribing anti-depressant medication or referring children for crisis intervention, for example. Others needed help in counseling parents who might be wary of or insistent on behavioral therapy or medication for their kids. More experienced providers now coach and mentor their newer colleagues.
I believe Nemours does an excellent job with screening, and because we have psychology integrated into the pediatric practices, patients have access to care right in the comfortable setting they know. Last year, nearly 10,000 adolescents in Delaware were screened for depression as part of routine care at Nemours primary care practices. Children and teens with mild to moderate symptoms can often be managed in the primary care office without the need to refer out or add the child’s name to a long wait list. As we all know, there is a shortage of mental health professionals.
Anecdotally, I have seen young teens with mild to moderate depression get screened appropriately, treated with cognitive behavioral therapy and/or medication and show a good deal of improvement over a few months’ time. The screening allows us to catch issues and intervene early. When we look at what is happening on social media and in our schools, there’s a growing sense of urgency in meeting the mental health care needs of young people.
If you think your child might be depressed or has a problem with moods, schedule a visit to your child’s pediatrician.