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New guidelines: Kids as young as 10 should be screened for depression

Feb. 27, 2018 | By Anne Saker

Stepping up medicine’s effort to address the rising U.S. tide of youth depression, the nation’s biggest group of child doctors has urged all pediatricians to screen all children for depression annually from age 10 to 21 and to treat the disorder more aggressively.

At least one of every five adolescents experiences depression, and the illness likely is a factor in a recent spike of youth suicides in Hamilton County and nationwide. This week, the American Academy of Pediatrics updated 10-year-old guidelines for primary-care providers to assess patients for depression.

“These guidelines are intended to assist primary care clinicians in family medicine, pediatrics, nursing and internal medicine, who may be the first (and sometimes only) clinicians to identify, manage, and possibly treat adolescent depression,” the academy said in a statement.

The academy first recommended universal depression screening in 2007. One key change in the updated guidelines is dropping the recommended age for a first screening from 12 to 10. In January 2017, Gabriel Taye of Westwood died by suicide at age 8.

But the academy also acknowledged this week that doctors and caregivers in the busy first line of clinical medicine often do not have the time, space or focus to do regular depression screenings. “As many as two in three youth with depression are not identified by their primary-care clinicians and fail to receive any kind of care,” the academy said, and even when diagnosed, only half of patients get the right treatment.

The guidelines help pediatricians be aware and face their patients’ mental health, said Dr. Emily Harris, a pediatrician-psychiatrist for children and teens at Cincinnati Children’s Hospital Medical Center.

“These updated guidelines kind of reinforce the idea that if a pediatrician has some type of way to identify a problem and get the initial stages of treatment going, the outcome is much better,” Harris said. Early intervention can “alter the trajectory for an illness. If it’s not picked up for a long time, it can build, it can cause negative pathways to be build that continue into adulthood. What we have here is a unique opportunity to intervene.”

But a longstanding national shortage of mental-health specialists puts a heavy burden on front-rank medical providers. Dr. Paul Crosby, chief medical officer of Lindner Center of Hope in Mason, said, “The reality is that the vast majority of mental health care is provided by primary care providers. That’s just how it is.”

The call for universal depression screening in children will likely come as a challenge for primary care providers, Crosby said. But he added: “Anything that moves that needle of detection closer to zero is an improvement from where we’re at right now. Adolescence is a vulnerable time. Mood disorders in particular start to emerge … and that initial onset peak occurs in adolescence.”

The guidelines distinguish among mild, moderate and severe forms of depression. Recommendations include:

  • Provide a treatment team that includes the patient, family and access to mental health expertise.
  • Offer education and screening tools to identify, assess and diagnose patients.
  • Give counseling on depression and options for management of the disorder.
  • Develop a treatment plan with specific goals in functioning in the home, peer and school settings.
  • Develop a safety plan, as needed, which includes restricting lethal means, such as firearms in the home, and providing emergency communication.

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