Some other tips to keep in mind when approaching adolescent depression in your practice:
Review the updated GLAD-PC guidelines.
Choose a validated depression-specific screening tool that works within your practice with a focus on length, language and cost of the screening tool.
Work with your clinic to discuss how to best incorporate this screening tool. Consider how patients to be screened will be identified, who will distribute the screening tool, how results will be scored and shared with the family, and safety plan protocols for positive screens (including discussion of ensuring no access to firearms, locking up medicines, and removal of sharp objects such as razors, knives etc.).
Review expectations with clinic staff on the use of split visits to ensure teenagers have access to time alone with the medical provider.
Introduce the concept of split visits with families by sending a welcome letter for all families as patients enter adolescence that explains the concept of confidentiality.
Collaborate with social work, mental health providers, and adolescent medicine specialists in the community for referrals, coordination of care, and timely communication.
Don't overlook the schools for a source of support, as well as chapters of national organizations, such as The National Alliance on Mental Illness, National Federation of Families for Children's Mental Health, and Mental Health America.
Do ask all teens about social media use and sleep.
Routinely ask teen patients about what they see as their strengths and areas they'd like to work on. Ask about their plans for the future, which can give you insight into their self-concept as well as reveal potential red flags when they can't verbalize any.
Although outside the scope of the updated GLAD-PC guidelines, providers should not overlook the specific mental health needs of LGTBQ (lesbian, gay, bisexual, transgendered, and questioning) youth, those from households with undocumented/illegal parents, and homeless or foster care youth.
It can be daunting to think about what to do if a patient answers "yes" during an adolescent depression screening, especially if the teen also has thoughts of suicide. But we must ask, and we must be ready to respond.
Taking a deep breath before responding to that first patient of mine who screened positive for depression, I started with a simple assurance. "I really appreciate you sharing this information with me," I told her, "and I want you to know that I can help." The teen looked up, said nothing, but nodded.
I asked about any self-harm attempts, details of any specific plans, and reminded her that because of her disclosure, I had to break confidentiality for her safety. I asked whether she felt strong enough to talk to her parents, or if she wanted me to do it for her with her in the room. She agreed that she would be the one to do it.
I asked her parent to step back in the room, who looked a bit worried since we kept her waiting a while. But as she sat down and put her hand on her daughter's shoulder, I knew that we were going to be able to get this girl the help she needed.
The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.
Bauer, MD, MPH, FAAP, is an Executive Committee member of the American Academy
of Pediatrics (AAP) Section of Developmental and Behavioral Pediatrics. An Associate
Professor of Pediatrics at Indiana University School of Medicine, Dr. Bauer
also served on the Guidelines for Adolescent Depression in Primary Care
(GLAD-PC) steering group. Follow her on Twitter @nerissabauer and on her blog,
Let's Talk Kids' health (www.letstalkkidshealth.org)