Mental health is a crucial component to overall health and well-being and mental health among children and adolescents continues to be a significant public health concern. According to a report in Morbidity and Mortality Weekly Report (MMWR), 20.9% of adolescents aged 12–17 years had ever experienced a major depressive episode and in 2019, 36.7% of high school students reported feeling sad or hopeless and 18.8% seriously considered attempting suicide. It is essential to be able to notice the signs and symptoms of depression in children and adolescents and know best practices in support and intervention.

Depression in children and adolescents often presents differently than it does in adults. Feelings of sadness and loneliness are common, but moodiness or irritability may be more predominant expressions of these underlying feelings.

Additional symptoms may include:

  • Loss of appetite or overeating
  • Sleep disturbances (e.g., excessive sleeping, insomnia, or day-night reversal)
  • Social withdrawal

Depression rates are soaring among children and adolescents and disproportionately among children of color, children who identify as LGBTQ, and children with special health care needs including cognitive and learning disabilities.

Depression can impact school attendance, school performance, and/or social interactions with peers and teachers. Depression negatively impacts a child’s development. Major depressive disorder in children is also associated with increased risk for the following:

  • Suicidal ideations, attempts and completion
  • Substance use
  • Cutting
  • Exposure to violence
  • Driving while impaired
  • Risky sexual behaviors and
  • Running away from home

How Schools Can Help

Schools can play an important role in supporting the resilience and mental health of children and youth. This can be done through the same promotion and prevention strategies to support general health.

Connectedness (Mental Health Promotion and Illness Prevention)
School staff can promote mental wellbeing by helping students feel connected to school and family through building strong relationships and bonds. Being connected to a community can help a child or teen feel cared for and valued. This sense of connectedness can promote mental health as well as prevent other outcomes such as substance use and suicide.

Depression Screenings (Mental Health Illness Prevention or Early Identification)
School-based health centers or nurses can administer depression screenings which can be helpful early identification of symptoms and timely referrals for further in-depth evaluations with mental health professionals. Examples of depression screenings include:

  • KADS (Kutcher Adolescent Depression Scale)
  • CDS (Columbia Depression Scale)
  • CES-DS (Center for Epidemiological Studies- Depression Scale for Children)
  • PHQ9 (Patient Health Questionnaire)

If a student is diagnosed with depression, school staff together with families and providers can help develop treatment or safety plans to help the student manage their depression symptoms.

Care Coordination Between Schools and the Pediatrician

Communication between school staff and the student’s pediatrician can help gather and share important information regarding behavioral concerns, withdrawal from social activities with friends or family, and changes in academic performance. This information together with appropriate screenings or evaluation can help assess the best individualized support or intervention needed.

Pediatrician’s Role

Pediatricians are key in supporting the mental health of youth experiencing or at risk of depression.

  • AAP has guidelines for adolescent depression in primary care. These guidelines can be used to address practice preparation, identification, assessment, and initial management of adolescent depression in primary care settings as well as treatment and ongoing management.
  • Pediatricians can educate, support and empower families for how navigate disclosing and addressing depression with schools from the clinical setting. Pediatricians can partner with a child’s behavioral health team, including their family, school, and treating behavioral health providers. Doing so can help broker communication to suggest and develop accommodations for a 504 disability accommodation plan and/or goals/services to be considered for an individualized education program (IEP) when and where appropriate.
  • Pediatricians can utilize strategies to promote relational health in families and mitigate toxic stress (REF: 2021 AAP Garner update policy statement); this along with screening practices to identify children with increased risk factors can lead to earlier identification and treatment of depression and emotional dysregulation symptoms in children prior to manifestation of a major depressive disorder.

Helpful Resources

AAP: Guidelines for Adolescent Depression in Primary Care
The Guidelines are to be used to address practice preparation, identification, assessment and initial management of adolescent depression in PC settings.

AAP: Mental Health Initiatives
These resources are designed to inform pediatricians on how to support the mental health of children.

Preventing childhood toxic stress: partnering with families and communities to promote relational health
This policy statement provides guidance on promotion of relational health to mitigate toxic stress in children.

CDC Adolescent and School Health: Mental Health
This website provides valuable resources on how schools, parents and health providers can support teen mental health.

Resource for Schools

School and Classroom Depression Strategies (
This Fact Sheet contains strategies designed to address potential symptoms of student depression and should be used in consultation and collaboration with your school’s mental health personnel or as part of a larger intervention approach.

Mental Health America: Back to School: Recognizing Depression
This resource provides information on how depression impacts school-aged children.

Psych 4 Schools: Depression
This resource covers the impact of depression on children. The information provided here is an excerpt of an eBooklet that is meant to assist teachers and other practitioners working with children who are depressed and help to prevent or reduce depressive symptoms in students.

School-Based Approaches to Prevent Depression in Adolescents
This review article examined school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms and enhance global functioning in adolescents. This article also provides strategies for school-based intervention programs.

Resources for Parents & Families

The following resources from American Academy of Pediatrics offer parent tips on teens’ Mental Health:

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American Academy of Pediatrics