Improved identification of youth depression needed
By Liz Lockhart
There are dangerous implications when teenagers who are depressed do not get the care they need, a new study shows. All too often this can result in suicide.
Experts hope that their findings will lead to more proactive screening by primary care specialists and the improved identification of youth depression. Researchers believe that care could then be provided by the primary care physician and, where necessary, the individual could then be referred to a mental health specialist.
The team of researchers are from Seattle Children’s Research Institute, the University of Washington (UW) and Group Health Research Institute. Their study has been published in the journal Academic Paediatrics.
The study found that only 13% of teens with suicidal thoughts received mental health visits through their health care network. Only 16% received services in the year after having suicidal thoughts, despite being eligible for and having access to mental health care without a referral.
Mental health care was insufficient even when factoring in the care teens may receive from their primary care physician. Only 26% of teens with suicidal thoughts in the study received services during the year prior (including antidepressants and care received through an outside source).
‘Teen suicide is a very real issue today in the United States. Until now, we’ve known very little about how much of how little suicidal teens use health care services. We found it particularly striking to observe such low rates of health care service use among most teens in our study’ said Carolyn A. McCarty, Ph.D., the lead author.
According to their reports, suicide is the third leading cause of death for people aged 15 to 24 and the fourth leading cause of death for children between the ages of 10 and 14.
The identification of teens who have suicidal thoughts (suicidal ideation) is critical to the prevention of suicide. Many experts consider suicidal thoughts ‘normal’ during adolescence, this study confirms that teens with suicidal ideation, experience more functional impairment such as interpersonal difficulties, mental health problem and school problems.
The research found that these impairments were found to be persistent into a six-month follow-up period. These problems can intensify the need for mental health care.
McCarty and co-researchers examined the use of health care services among teens aged 13 to 18 who were patients at Group Health Cooperative. 198 teens were studied, including 99 teens who indicated that they had had suicidal thoughts and 99 control teens, matched on age and gender.
In addition to interviews conducted with the teens and their parents, administrative date spanning two years were collected from medical records.
The use of mental health services was low among both the control group and those with suicidal thoughts. 86% of the youths with suicidal ideation had seen a health care provider and yet only 13% had a mental health speciality visit and only 7% received antidepressant medication. 10% of those without suicidal ideation had received mental health visits within the Group Health Cooperative system in the prior year.
Respondents with suicidal ideation had significantly more severe depression, a greater prevalence of lifetime diagnosis of depression and anxiety and higher incidence of chronic paediatric disease.
With all the mental health services questions combined, 26% of the teens with suicidal thoughts received services the prior year, and 16% received services in the following year.
‘We know that asking teens about suicidal ideation does not worsen their problems,’ said McCarty. ‘It’s absolutely crucial for a teen who is having thoughts of self-harm or significant depression to be able to tell a helpful, trustworthy adult.’
‘These findings underscore the need for clinicians to be aware of the potential for suicide in adolescence,’ McCarty added.
There are effective treatments for depression and effective screening tools are available. McCarty said that primary care physicians and health care providers should be specifically assessing suicidal ideation in the context of depression screening or teenagers.
