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Doctors should screen every child over 12 for depression at least once a year, the American College of Pediatricians urges in new guidelines it issued this week. About two percent of American children are estimated to suffer from depression, but recent studies suggest that the condition goes undiagnosed in as much as 60 percent of people under 18. The new guidelines recommend that all pediatricians give their patients a survey to screen for early warning signs of depression and other mental health and behavioral issues. Rates of depression, anxiety and suicide among teenagers have all risen at a breakneck pace in the last several years, making headlines and stirring up controversy. The vast majority of depressed people never become a danger to themselves or others, but people who suffer from the mood disorder were found to be three times more likely to commit a violent crime than the general population in a large Swedish study. Many have speculated that more thorough healthcare screens might have helped to prevent the deaths of 17 people who were killed by 19-year-old Nikolas Cruz in Florida, who, some have said, showed signs of depression that went undiagnosed. Dr Rachel Zuckerbot, a clinical psychologist at Columbia University who co-authored the recommendations.
Irrespective of what’s going on, we should always be focused on the mental health of children,’ she says. They are the future, their mental health should be point unto itself. The ACOP is not the first organization to recommend universal screening: the US Preventative Services Task Force recommends the same practice. These children ‘suffer in silence,’ until their behavior raises substantial questions, ‘but by making mental health screening universal, we don’t have to ask if they suspect depression or not. We don’t need to wait until they are a risk to themselves or others to ask about depression,’ Dr Zuckerbot says.
An overactive immune system may trigger the mental-health condition by causing widespread inflammation that leads to feelings of hopelessness and unhappiness, the expert believes. The immune system may fail to ‘switch off’ after an illness or traumatic event, he adds. Previous research suggests people who suffer severe emotional trauma have signs of inflammation, which implies their immune systems are constantly ‘fired-up’. Until recently, such a process was denied as a cause of depression as scientists believed the brain and the immune system operated separately.
Yet, recent studies suggest a link between nerves in the brain and immune function. Professor Ed Bullmore, head of the department of psychiatry at the University of Cambridge, said: ‘In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms. In experimental medicine studies if you treat a healthy individual with an inflammatory drug, like interferon, a substantial percentage of those people will become depressed,’ The Telegraph reported. Previous figures suggest around 60 per cent of people who visit a doctor with chest pain are actually suffering from anxiety. Professor Sir Robert Lechler, president of the Academy of Medical Sciences, said: ‘You’re not just a little bit miserable if you’ve got a long-term condition, there is a real mechanistic connection between the mind, the nervous system and the immune system.
Experts add the outdated approach of separating mental and physical health conditions is holding back medical advances. The ACOP guidelines suggest a few models for primary care providers to implement surveys that might more easily uncover signs that children may be depressed. This format, the organization hopes, will also alleviate some stress and barriers to action for the pediatricians themselves. Pediatricians are asked to do a load of things in annual visits or health maintenance visits: they are asked to ask teens and families about a wide range of subjects, so it is hard to focus on a single one,’ in the short period of each appointment, Dr Zuckerbot says.
So pediatricians may worry: ‘What would we do if we actually got positive answers and don’t have time to do anything about it? The ACOP guidelines are intended to make it easier and more efficient for pediatricians to ask depression screening questions and for patients to answer them. Though the association does endorse any one particular screening questionnaire, it does refer doctors to several examples. Survey questions come at the issue from a number of angles. One version, for example, asks outright if a patient is feeling depressed, as well as asking more ambiguous questions, like whether they have felt less interest or pleasure in activities in the last two weeks. Moreover, ‘families think pediatricians are there for vaccinations and sore throats,’ Dr Zuckerbot says, ‘but they need to know they’re also there for mental health, which is just another part of health and really needs to be thought of as standard of care in primary care world,’ she says. The comments below have not been moderated.