Uncovering an Epidemic — Screening for Mental Illness in Teens (NewEngJourMed)

[pinto]

Volume 355:2717-2719 December 28, 2006 Number 26

Uncovering an Epidemic — Screening for Mental Illness in Teens
Richard A. Friedman, M.D.

Courtney, a 15-year-old from Portland, Oregon, always knew she was different from the other kids. "I had a sense that something was going on, but I was afraid to say anything because I didn't know anyone else had a similar problem," she said. Like thousands of U.S. teens, Courtney participated in a mental health screening program that was offered in her school. "Teenagers have a hard time asking for help," she explained. "Without the screening, I'm not sure how I would have gotten the help I needed."

Before screening, Courtney was part of a silent epidemic of mental illness among teenagers. We know from the National Comorbidity Survey that half of all serious adult psychiatric illnesses — including major depression, anxiety disorders, and substance abuse — start by 14 years of age, and three fourths of them are present by 25 years of age (see table).1 Yet the majority of mental illness in young people goes unrecognized and untreated, leaving them vulnerable to emotional, social, and academic impairments during a critical phase of their lives. Even those who receive treatment tend to do so only after a long delay: 6 to 8 years for patients with mood disorders and 9 to 23 years for those with anxiety disorders.

But it is not psychiatric morbidity that makes headlines; rather, it is the most extreme consequence of psychiatric illness: suicide. In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age. In 2005 alone, according to the Centers for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide, and 8.4% had attempted suicide at least once during the preceding year.

<snip>

Courtney participated in TeenScreen, a large, school-based mental health screening program that was developed under the direction of David Shaffer at Columbia University. The screening is conducted in two stages: teens fill out a short questionnaire and are then interviewed by a master's level social worker or clinical psychologist, who verifies that a positive result is really clinically significant. If it is, the clinician recommends a more comprehensive psychiatric evaluation to the teen and his or her parents. The screening is voluntary and requires the active consent of the parents and assent of the teen. Screening results are confidential and are not shared with school officials or teachers. And since all teenagers who undergo screening also receive a follow-up interview, they cannot be identified by their peers as having screened positive, a system that preserves privacy.

<snip, full article at:>

http://content.nejm.org/cgi/content/full/355/26/2717?query=TOC

Source Information

Dr. Friedman is a professor of clinical psychiatry and the director of the Psychopharmacology Clinic at Weill Cornell Medical College, New York.

An interview with Cynthia Montgomery, whose son took his life at the age of 14, can be heard at www.nejm.org.

The New England Journal of Medicine is owned, published, and copyrighted © 2006 Massachusetts Medical Society. All rights reserved.

http://content.nejm.org/cgi/content/full/355/26/2717?query=TOC

[Deja Q]

1. May the shrinks diagnose them correctly.

When I was that age, I spoke out.

My parents at one time asked if I was on drugs. (Wasn't, am not, will never be. Sometimes things are made illegal for good reasons and with drugs, I'll readily accept that...)

I'm not going to talk about what other kids did to me. Suffice to say it helps explain why I'm so painfully introverted all the time and suicidal half the time.

Many misdiagnosed me. And despite any number of drugs for the classified diagnosis having the opposite effect, they pressed on with their nonsensical belief.

Mind you, Asperger's Syndrome wasn't official in the US until 1994 - despite being accepted in other Western countries since 1944. (and even after 1994 few shrinks cared...) The important thing is, too many people with those fancy pieces of paper are the "by the book" nitwits who shouldn't be in practice. Partly because they'd rather do "medicine by numbers" than really getting involved, which any doctor worth even a penny ought to be doing.

[China_cat]

2. Aren't all teenagers nuts?

[HereSince1628]

3. I think all teenagers should be screened before they get a chance for any job or benefits

Sorry, I'm all for getting health care to people who need it. But, I must say in this period of TIA, I'm not sure if I want schools requiring and a government agency conducting screenings and keeping records on individuals for 40 years.

It's a sign of the times that what should be a good thing immediately trips alarms.