Life can be challenging for teens. They must juggle schoolwork, family life and friends. Feelings of sadness, frustration and irritability are common. But for some teens, those emotions take a more extreme turn. Their negative feelings don’t come and go, punctuated by periods of satisfaction or happiness. Instead, those intense feelings can point to a disease called depression — one that may require treatment. The American Academy of Pediatrics, or AAP, has now asked its member doctors to start screening for signs of this in all preteens and teens.
It’s easy to think that depressed people simply feel sad or hopeless. For many teens that may be true. But depression in teens can be hard to spot. Some kids withdraw from friends and family. Others respond with angry outbursts. Some teens may skip school or stop eating or sleeping. Some may start abusing alcohol or drugs. Teachers, parents or even a teen’s close friends may find it hard to tell whether these behaviors are just part of being a teen or signs of something truly serious.
Each year, an estimated 5,000 Americans between the ages of 15 and 24 take their own lives. “The rate of suicide for this age group has nearly tripled since 1960,” according to Mental Health America, or MHA. Indeed, it says, suicide has become “the third leading cause of death in adolescents and the second leading cause of death among college-age youth.” Founded in 1909 and based in Alexandria, Va., MHA describes itself as “the nation's leading community-based nonprofit dedicated to addressing the needs of those living with mental illness.”
There is a link between mental illness and suicide in teens. That’s according to the American Academy of Child and Adolescent Psychiatry, based in Washington, D.C. “The majority of children and adolescents who attempt suicide have a significant mental health disorder,” it says — “usually depression.” And as a disease, depression can last for a decade or longer.
Even depressed teens may not realize they have this problem. And the share of those affected is high. More than three million Americans between the ages of 12 and 17 experienced depression in 2016. However, most likely went untreated. A 2001 study by researchers at Harvard and Yale universities found that half of all teens with depression don’t get help until they become adults. And only one in three will have been diagnosed by their primary care doctor, another study reported.
The new guidelines aim to improve those numbers. AAP is asking pediatricians to undertake mental-health training. It wants them to become more aware of the signs of depression. It’s also asking these doctors to screen for mental-health problems at regular annual check-ups of every teen. Where depression is suspected, doctors can then work with mental-health professionals to find out how to treat any disorders so that their patients can feel good again.
The AAP’s new guidelines were published in AAP News on February 26.
Peers can help
“It’s a great start,” says Teri Langan Dee. This mental-health professional in Lincoln, Neb., sees many adolescents with depression. “I have had very few pediatricians reach out to me to coordinate treatment,” she says. The new guidelines should change that by making it easier for doctors and mental-health professionals to work together. That means more cases of depression likely will be caught and treated, Dee notes.
Teens concerned about giving embarrassing answers in front of their parents need not worry. The AAP guidelines ask doctors to interview their patients alone.
Teens should be honest with their answers. “I can only work with what you give me,” Dee says. “If you’re not honest, you won’t benefit.”
Dee says peers should also scout for signs of depression. Keep an eye on your friends, she recommends. Watch for symptoms of isolation or hopelessness. Or irritability, anger and excessive drama. That last issue can be hard, because drama affects most teens. But here, the symptom to worry about is drama that emerges when interacting with almost everyone. Even skipping classes can be a sign that something serious is going on. Any of these behaviors could be a symptom of depression.
So how can people tell what behavior reflects mental growing pains and what’s a sign of disease? One key is a sharp change in behavior, Dee says. Another warning sign: a persistence in that new behavior — meaning that it sticks around for two weeks or more.
Researchers at the University of Michigan in Ann Arbor support the idea of friends helping friends. They trained teens from 10 high schools in a peer-to-peer program on depression awareness. These teens then took what they had learned into their schools to educate the rest of the student body. At the end of the study, students in all 10 schools were more understanding of mental-health problems. And — more importantly — they were better able to identify people who might be suffering from depression.
Are certain people at higher risk of depression?
Some individuals seem to have a family history of depression. It can show up in parents and their children. If these people have an imbalance in certain brain-signaling compounds, they may need medicines to correct the problem.
Other people may find themselves as social outcasts owing to physical or mental traits that make them appear different from most of their classmates. Such people often experience bullying. They can develop low self-esteem. This can include girls who may enter puberty at a young age. Because their bodies don’t match their emotional development, people who mature early often experience depression that can last into adulthood.
Overall, knowing who — and how — to help is essential for successfully treating depression in teens, therapists say.
“Mental health is often overlooked by parents and other adults in the teen’s world,” Dee says. The new guidelines should make it easier for teens to get the help they need.
adolescent Someone in that transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.
annual Adjective for something that happens every year.
behavior The way something, often a person or other organism, acts towards others, or conducts itself.
compound (often used as a synonym for chemical) A compound is a substance formed when two or more chemical elements unite (bond) in fixed proportions. For example, water is a compound made of two hydrogen atoms bonded to one oxygen atom. Its chemical symbol is H2O.
depression A low spot, such as in a field or the surface of a rock. (in medicine) A mental illness characterized by persistent sadness and apathy. Although these feelings can be triggered by events, such as the death of a loved one or the move to a new city, that isn’t typically considered an “illness” — unless the symptoms are prolonged and harm an individual’s ability to perform normal daily tasks (such as working, sleeping or interacting with others). People suffering from depression often feel they lack the energy needed to get anything done. They may have difficulty concentrating on things or showing an interest in normal events. Many times, these feelings seem to be triggered by nothing; they can appear out of nowhere.
development (in biology) The growth of an organism from conception through adulthood, often undergoing changes in chemistry, size and sometimes even shape.
disorder (in medicine) A condition where the body does not work appropriately, leading to what might be viewed as an illness. This term can sometimes be used interchangeably with disease.
high school A designation for grades nine through 12 in the U.S. system of compulsory public education. High-school graduates may apply to colleges for further, advanced education.
mature (adj.) Connoting an adult individual or full-grown and fully developed (non-juvenile) form of something. (verb) To develop toward — or into — a more complex and full-grown form of some individual, be it a plant, animal or microbe.
mental health A term for someone’s emotional, psychological and social well-being. It refers to how people behave on their own and how they interact with others. It includes how people make choices, handle stress and manage fear or anxiety. Poor mental health can be triggered by disease or merely reflect a short-term response to life’s challenges. It can occur in people of any age, from babies to the elderly.
pediatrics A field of medicine that has to do with children and especially child health. A doctor who works in this field is known as a pediatrician.
peer (noun) Someone who is an equal, based on age, education, status, training or some other features. (verb) To look into something, searching for details.
physical (adj.) A term for things that exist in the real world, as opposed to in memories or the imagination. It can also refer to properties of materials that are due to their size and non-chemical interactions (such as when one block slams with force into another).
primary An adjective meaning major, first or most important.
psychiatry (adj. psychiatric) A field of medicine where doctors study and treat diseases of the human mind. Treatments may consist of talking therapies, prescription drugs or both. People who work in this field are known as psychiatrists.
puberty A developmental period in humans and other primates when the body undergoes hormonal changes that will result in the maturation of reproductive organs.
risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)
screening A health test that is done early, before any symptoms are present. That can help find disease when it is easiest to treat. Screenings can include blood tests (such as for HIV, diabetes or high cholesterol), X-rays or scans (such as mammograms for breast cancer).
social (adj.) Relating to gatherings of people; a term for animals (or people) that prefer to exist in groups. (noun) A gathering of people, for instance those who belong to a club or other organization, for the purpose of enjoying each other’s company.
symptom A physical or mental indicator generally regarded to be characteristic of a disease. Sometimes a single symptom — especially a general one, such as fever or pain — can be a sign of any of many different types of injury or disease.
trait A characteristic feature of something. (in genetics) A quality or characteristic that can be inherited.
Website: Mental Health America. Depression in teens homepage. Resources, warning signs and hotline.
Website: American Academy of Child and Adolescent Psychiatry. Suicide in Children and Teens homepage. October 2017.
Journal: S.V. Parikh et al. The Michigan Peer-to-Peer Depression Awareness Program: School-based prevention to address depression among teens. Psychiatric Services. Published online March 1, 2018. doi: 10.1176.appi.ps.201700101.
Journal: R.A. Zuckerbrot et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. Vol. 141, March 2018, p. e20174081. doi: 10.1542/peds.2017-4081.
Journal: J. Mendle et al. Age at menarche, depression, and antisocial behavior in adulthood. Pediatrics. Vol. 141. December 2017. doi: 10.1542/peds.2017-1703.
Journal: R.C. Kessler, S. Avenevoli and K.R. Merikangas. Mood disorders in children and adolescents: an epidemiologic perspective. Biological Psychiatry. Vol. 49, June 2001, p. 1002. doi: 10.1016/S0006-3223(01)01129-5.
Journal: B.J. Burns et al. Children's Mental Health Service Use Across Service Sectors. Health Affairs. Vol. 14, Fall 1995. doi: 10.1377/hlthaff.14.3.147.