- of Psychiatry, Washington University in St Louis, Missouri
Division of Child and Adolescent Psychiatry, Department
Published: November 2016 in Pediatrics
“In this month’s issue of Pediatrics, Mojtabai and colleagues sound an alarm with two critical public health updates; depression is significantly on the rise in adolescents, with a 12-month prevalence of 11.3% in 2014 versus 8.7% in 2005. Furthermore, despite this disturbing development, the percentage of young people with a history of past-year major depressive episodes seen by primary care providers for depression care is only ∼10% and has not appreciably budged in the past decade.
The second point is disappointing because it occurs despite a 2007 American Academy of Pediatrics statement, which could have possibly had an impact on the comparison between 2005 and 2014. This statement strongly encouraged all pediatricians to recognize and identify the risk factors for suicide, then the third leading cause of death for adolescents 15 to 19 years old, of which depression was and remains the most substantial. These low and stagnating rates of youth depression treatment provided in primary care settings are not fully surprising, however. Other studies have documented at least partially convergent findings; 55.1% of pediatricians in 2004 versus 60% in 2013 reported screening or inquiring about depression, whereas 17.5% in 2004 versus 24.3% in 2013 reported treating, managing, or comanaging depression, similar to a 2008 study reporting that the same large majority of ∼75% pediatricians did not consider treating youth depression as among their responsibilities. This is congruent with and not better than an earlier 2001 study in which 26% to 27% of primary care pediatricians felt responsible for treating depression in children and adolescents and most commonly cited the probably highly intercorrelated lack of training and lack of confidence as obstacles to providing such treatment.
The combination of these two findings leaves us with some new urgency. The causes behind a rise in adolescent depression should be investigated scientifically. The other problem, that of ever-increasing untreated youth depression, concerns all of us at a time when suicide is now the second leading cause of death for adolescents aged 15 to 19 years. Depression is a sizeable and growing deadly threat to our US adolescent population. The prioritization of youth depression treatment of our US population health is imperative. In fact, the American Academy of Pediatrics recently updated its 2007 statement on recognizing suicide risks with a recommendation to routinely screen youth aged 11 to 21 for depression. Sadly, even if this important update influences primary care providers to screen more youth, there will never be enough qualified mental health specialists to take care of the 2.8 million or more adolescents per year, who, if screened and identified, will need treatment and monitoring for depression.”