The new two-part guideline, published online Monday in Pediatrics, was developed by the American Academy of Pediatrics, the Canadian Pediatric Society, and psychiatric associations from both countries.
"We know that more than 50% of cases of adolescent depression do not get identified, and even fewer get treated. [S]ince pediatricians and primary care providers are at the front-line, seeing these kids either for a well visit, school physicals, camp physicals, sports physicals, or just for common illnesses, they are in a really good position to identify depression as well as manage and treat it," says Rachel Zuckerbrot, MD, lead author of the Guidelines for Adolescent Depression in Primary Care.
Nerissa Bauer, MD, a member of the guidelines' steering group, agrees, emphasizing that there is an urgent need for doctors to help identify and care for teenagers with depression.
"In the society in which we live, teens are much more prone to suffering from depression than ever, given social media and cyberbullying and the potential to be exposed to trauma every day in terms of social violence, gun violence, community violence," says Bauer, an associate professor of pediatrics at Indiana University School of Medicine in Indianapolis.
"[D]epression is definitely a topic that primary care physicians need to be familiar with and to be able to talk sensitively about in a timely way with our families. It's just part of promoting the optimal wellness of our patients, and at least we have the ability to ask the question," she adds.
The recommendation for universal screening is a change from the previous guidelines, published a decade ago, and is the first step in a larger strategy that should be followed when a doctor suspects a teenage patient might be depressed.
As was true for the 2007 guidelines, doctors need to evaluate teenagers for things that make depression more likely, including a family history, substance use, and other concerns. Primary care providers, including pediatricians, should also speak with the teenager's family or caregivers.
"I think involving families is something that we've always supported," said Zuckerbrot, an associate professor of clinical psychiatry at Columbia University Medical Center. "So while it's really important for pediatricians to remember to interview the patient alone, it is also important for them to bring the family back in and to involve the family as well."
The new recommendations also put a new emphasis on shared care for teenage depression because "patients really benefit" when mental health professionals and pediatricians work together, Zuckerbrot continued.
Again, Bauer agrees, saying that many doctors' practices now rely more on other professionals such as social workers and mental health therapists. "So the guidelines really emphasize the collaborative and interdisciplinary approach to getting teens help in a timely manner," she said.
Education is critical, not only for the patient, but also for families, who need to understand what the teenager is going through and to recognize warning signs that their child may be getting into trouble and needs help.
Zuckerbrot works for CAP PC, Child and Adolescent Psychiatry for Primary Care, now a regional provider for Project TEACH in New York state. She is also on the steering committee as well as faculty for the REACH Institute, and she and another guideline author receive book royalties from Research Civic Institute. Bauer has disclosed no relevant financial relationships.