Depression is rising among teenagers, but diagnosis and treatment have a ways to go to catch up
A recent study published in the medical journal “Pediatrics,” has found that depression is on the rise among teenagers, particularly in girls. It also found that the percentage of young people with a major depressive episode who are seen by a primary care provider for those occurrences has not increased concurrently.
Washington University psychiatrist Dr. Anne Glowinski wrote an accompanying commentary about that very study. On Monday’s St. Louis on the Air, Glowinski joined the program to discuss the growing prevalence of depression in adolescent populations. She also discussed how pediatric providers can better recognize the disease in youth.
Depression on the rise among teens
Glowinski said that although genetics play a large role in whether or not a child develops depression, scientists are just now coming to understand that depression isn’t caused by genetics alone. Environmental factors, such as the kind of parenting that someone receives, drug use, social pressures and anything that increases stress on a child can contribute.
The increasing rates of depression are concerning, particularly when viewed with rates of suicide, which are also trending up. Being depressed and having suicidal ideations (thoughts of suicide) often go hand-in-hand, Glowinski said.
Young women have historically been harder hit by depression in the past, and that is certainly still the case in this study.
While many have speculated this is because of social media use, Glowinski said that cause is unclear.
“I don’t think social media is creating vulnerability but it is tapping into specific vulnerabilities that young women have when developing,” Glowinski said. “We often hear a narrative of girls hurting each other but I have to tell you that the reality is that, especially after puberty, girls are more at risk for a range of trauma including sexual assault. Traumatic events which we know are highly rated to depression start diverging a little bit in terms of the nature of boys and girls. Boys are more likely to get into trouble, they are more physically reckless but girls are more likely to be hurt by other people.”
Problems with diagnosis and treatment
Child psychiatry is the most underserved medical specialty in the United States, said Glowinski. That means psychiatrists depend on pediatricians and teenagers’ primary care providers to identify and manage cases of depression when it is first identified.
The only problem? Pediatricians are struggling to identify the mental illness. The training regime for pediatricians in childhood psychiatric disorders is slim, Glowinski said. While the American Academy of Pediatrics is concerned about the rise in mental disorders and has even gone so far as to make mandates to providers about those disorders, there hasn’t been a lot of action to follow the mandates.
Glowinski has experimented with voluntary training of pediatricians to see if she could inch the needle on properly diagnosing the disease. Using pediatricians-in-training at Washington University and volunteers from the community, she set up simulations that mimicked realistic clinical situations and debriefed participants afterward on diagnosing and treating those that showed signs of depression.
Increased confidence and behavior changed with the pediatricians involved in the research after going through these simulations, she said.
In order to implement something like this more broadly, an entire system of communication between pediatricians and psychiatrists needs to be standardized. Likewise, formal training needs to be implemented for pediatricians at the outset of medical training.
In the meantime, a good place to start may be implementing the Patient Health Questionnaire, a series of nine questions that help doctors analyze the severity of a patient’s depression.
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