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Should teenagers be routinely screened by doctors for depression?

By Judy Foreman
June 1, 2009
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Q. Should teenagers be routinely screened by doctors for depression?

A. Yes, according to a new report from the US Preventive Services Task Force - an independent panel of private-sector experts convened by the government.

The panel, whose recommendations are considered the "gold standard" for medical screening, said all 12- to 18-year-olds should fill out standard questionnaires for major depressive disorder, which can be seriously disabling and, in some cases, lead to suicide.

"We pay a lot of attention to physical health, even though the vast majority [of adolescents] are in one of the healthiest periods of life. However, we have never been very good as a nation about checking for mental and emotional problems, yet these are more likely in this age group than physical problems," said Laurie Flynn, executive director of the TeenScreen National Center for Mental Health Checkups at Columbia University. The group has set up mental health screening programs in more than 500 communities nationwide.

Dr. Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital and the author of the Pediatric Symptom Checklist, a leading child mental health screening questionnaire, agreed the new recommendations are "good news." Ten percent of children and adolescents have emotional disorders and many never get diagnosed and treated, he said.

But he cautioned against "a number of difficulties," including potential overdiagnosis. Many teens feel temporarily sad, anxious, or hopeless because of troubles at home or school, but do not have a depressive disorder, said Jellinek.

There aren't enough psychiatrists and psychologists available to help depressed teenagers, he said, and pediatricians - who are not trained to treat depression - might be tempted to write prescriptions for antidepressants "too readily," he worried.

"We . . . don't have a good system of caring for teenagers with depression," he said.

Bob Lichtenstein, director of the school psychology program at the Massachusetts School of Professional Psychology, shared that concern: "While universal screening may be valuable, it is essential that there be sufficient mental health services in place to meet the needs that are uncovered."

E-mail health questions to foreman@globe.com.

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