Screening teens

Writing under the headline “Pros and cons of screening teens for depression,” Brendan Borrell examined some of the issues that sometimes roar around surveying youths to identify those who are depressed or at risk for depression. Mr. Borrell’s article, which is one in a series of articles about depression appearing in the Los Angeles Times, addressed concerns such as parental reservations about testing of their children without permission, false positive identification of a high percentage of students, and the absence of adequate treatment for many who need help.

Mr. Borrell established the importance of the issue in his lead:

By the time a teenager graduates high school, about one out of nine of his or her peers has attempted suicide. Suicide is the third leading cause of death among young people, behind car accidents and homicide, and 10% to 12% of teens ponder suicide every day.

As Mr. Borrell reported, the US Preventative Services Task Force (USPFTF) recommended screening of adolescents (ages 12-18)—but not children (ages 7-10)—for major depressive disorder, given that accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up services are available. It is important to note that false positives are an inevitable consequence of screening in just about any assessment system; the very purpose of screening—quick evaluation to identify cases where further assessment is merited—means that some cases will turn out, upon subsequent, more-intensive, and -detailed assessment, not to meet the standards for a diagnosis of the condition (depression, in this case).

Some parents strongly disagree not only with the screening itself, but with the possibility that a result of screening might be recommendations that their children take medications. This concern sometimes centers on TeenScreen, an intensively researched program for identification and prevention of mental health problems among youths. Some people argue with Scientological fervor that screening programs such as TeenScreen are fronts for pharmacology companies seeking to promote use of their products.

Although there are substantial problems in the quality of mental health care for depressed adolescents (see Teresa Kramer and colleagues’ report from 2008), pharmacotherapy is not always indicated and, although there are risks with some medications (e.g., the widely reported increase in suicidal attempts for some youths taking selective serotonin reuptake inhibitors, SSRIs), medication is not always a bad course of action.

Link to Mr. Borrell’s article. Link to the USPSTF recommendations. Learn more about TeenScreen from the TeenScreen Web site and a Wikipedia entry. Read previous coverage from EBD Blog on 25 Jan 2007.

Kramer, T. L., Miller, T. L., Phillips, S. D., & Robbins, J. M. (2008). Quality of mental health care for depressed adolescents. American Journal of Medical Quality, 23, 96-104. [abstract]

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