Why are we Afraid to Screen Adolescents for Depression?

Department of Mental Health Law and Policy, University of South Florida, USA

*Corresponding Author:

Roger A Boothroyd
Chair and Professor, Department of Mental Health Law and Policy
Louis de la Parte Florida Mental Health Institute
MHC 2719, University of South Florida, FL 33612-3807, USA
Tel: 813-974-1915
Fax: 813-974-9327
E-mail: boothroy@usf.edu

Received Date: March 25, 2013; Accepted Date: March 25, 2013; Published Date: March 27, 2013

Citation: Boothroyd RA, Armstrong MI (2013) Why are we Afraid to Screen Adolescents for Depression? J Child Adolesc Behav 1:e103. doi: 10.4172/2375-4494.1000e103

Copyright: © 2013 Boothroyd RA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Depression is the fourth leading cause of global burden of disease [1]. Depression is present in all regions of the world, significantly affecting the younger and older age groups (World Health Organization [WHO], 2000; Institute for Health Metrics and Evaluation [IHME], 2013) [2]. It is estimated that upwards of 8% of adolescents meet criteria for depression [3]. Depression during adolescence is a disabling condition that is associated with serious long-term morbidities and an increased risk of suicide [3-6]. It has been reported that among adolescents with major depression, as many as 7% commit suicide in their early adult years [7]. Yet despite these alarming statistics, adolescent depression often goes undiagnosed despite the availability of screening tools that have been demonstrated to be effective (National Institute for Health Care Management [NIHCM], 2010).

In the United States, the Affordable Care Act of 2010, recent federal legislation, places a strong emphasis on access to clinical preventive services including screening for depression [4]. New private health plans and insurance policies are required to offer depression screening for adolescents as well as adults at no cost to the consumer. This mandate is a step in the right direction but it leaves open issues such as: if adolescents are screened as at risk, will physicians and other health care professionals know where to refer these youth; will these youth have immediate access to comprehensive assessments and services; what services and supports will be in place for their families, peers, and teachers?

Critics of adolescent depression screening initiatives raise questions about whether the costs of these programs will outweigh the benefits. They raise concerns regarding whether schools are appropriate settings in which to conduct depression screenings. They argue that depression screening programs infringe on the rights and privacy of adolescents and parents. Critics question the effectiveness of depression screening measures. They cite the lack of available service options to treat adolescents who have identified needs. Critics worry that the prescribing of antidepressants to adolescents will increase dramatically and cite evidence of the harmful effects of SSRIs (e.gCritics of adolescent depression screening initiatives raise questions about whether the costs of these programs will outweigh the benefits. They raise concerns regarding whether schools are appropriate settings in which to conduct depression screenings. They argue that depression screening programs infringe on the rights and privacy of adolescents and parents. Critics question the effectiveness of depression screening measures. They cite the lack of available service options to treat adolescents who have identified needs. Critics worry that the prescribing of antidepressants to adolescents will increase dramatically and cite evidence of the harmful effects of SSRIs (e.g. increased suicide ideation, preparatory acts) in adolescents. Finally, critics cite the negative impact on adolescents that positive screenings will have in terms of stigmatization.

No matter what side of the debate one is on, the idea that doing nothing is somehow better than doing something just doesn’t make any sense. In 2009, the United States Preventive Service Task Force recommended screening of adolescents [8]. The task force found adequate scientific evidence that the treatment of depression in adolescents decreases in major depressive symptoms. So what are we afraid of? We have the ability to effectively screen adolescents for depression. We have effective interventions foe adolescent that improve the long-term course of the depression. As far as stigma goes, it will only decrease if we openly deal with the issue of depression as opposed ignoring it.

References

1. World Health Organization (2009) Global Burden of Disease. Geneva, Switzerland.
2. Institute for Health Metrics and Evaluation (2013) The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA: IHME,USA.
3. Eapen V, Črnčec R (2012) Strategies and challenges in the management of adolescent depression. Curr Opin Psychiatry 25: 7-13.
4. Koh HK, Sebelius KG (2010) Promoting prevention through the Affordable Care Act. N Engl J Med 363: 1296-1299.
5. National Institute for Health Care Management (2010) Improving early identification & treatment of adolescent depression: Considerations & strategies for health plans. Washington, DC:
6. Williams SB, O’Connor E, Eder M, Whitlock E (2009) Screening for child and adolescent depression in primary care settings: A systematic evidence review for the U.S. Preventive Services Task Force. Pediatrics 123: e716 -e735.
7. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, et al. (1999) Depressed adolescents grown up. JAMA 281: 1707-1713.
8. US Preventive Services Task Force (2009) Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics 123: 1223-1228.