Are the Kids Alright? Screening for Mental Health Issues

No one wants a child to suffer in silence, especially when it comes to mental health. But it happens far too often. Consider these statistics from a report published by the American Academy of Child and Adolescent Psychiatry (AACAP) in 2023:

• 1 in 5 children aged 3 to 17 experiences a mental, emotional or behavioral disorder in a given year
• 1 in 2, or just 50%, receive the mental health treatment they need

That gap is what pediatricians are trying to address when we perform depression, anxiety and suicide risk screenings during a typical clinic visit.

Increasing Screening 

Before the pandemic, we routinely screened adults for depression and some providers also started screening teenagers. During and after the pandemic, we saw a dramatic increase (63.5%) in the antidepressant dispensing rate for adolescents and young adults. In hindsight, we could see how isolating children and taking away support systems – their friends, classmates and activities – impacted their mental health. 

That shift drove home the realization that pediatricians should be screening everyone age 11 and up and possibly starting at age 8 for depression, anxiety and suicide risk. 

Parents are sometimes surprised that we ask these screening questions during a typical clinic visit. Why do we do this every single time we see patients of this age group, despite it not always being convenient? 

One reason is that we might not see this patient again for months, so it’s best to do the screening – even if they are being seen for something like strep throat. 

Things can also change rapidly for children. Asking screening questions helps uncover important issues, such as if they feel unsafe, and whether there might be abuse, a lack of food or other issues. 

Parents sometimes object because we ask these screening questions without a parent in the room. We do this because it’s important for the child or teen to feel comfortable speaking up, and that’s sometimes not possible in the presence of a parent. 

This is another reason why having a regular pediatrician is so important. When I see patients and their parents regularly, there’s a level of trust that makes these conversations possible. 

Screening Tools

Fortunately, we have several good screening tools which provide well-defined guidelines for what a clinician should do next in terms of recommending services and support. The PHQ-2, or Patient Health Questionnaire-2, uses just two questions: 

• Over the past two weeks, have you felt down, depressed or hopeless? 
• Over the past two weeks, have you felt little interest or pleasure in doing things? 

The PHQ-9 is a longer version, and other screening tools we use include the GAD-7 for generalized anxiety disorder and the Columbia Suicide Severity Rating Scale, which assesses for the presence and severity of suicidal thoughts, plans and behaviors. 

If you as a parent are concerned, these screening tests are easily available and free online. Simply add up the numbers to determine the score and what it means. 

Treatment Options

The good news is that if issues are discovered, services are available for children and teens. 

While counseling can be hard to find in some places, online or virtual counseling is increasingly available and allows you to get counseling in the privacy of your own home. There’s also school counselors and some local options that are free or affordable. We are fortunate in North Dakota to have a number of pediatric psychiatrists to choose from and inpatient services, if needed. 

When it comes to medication, children and parents are sometimes reluctant. It’s still seen as a taboo subject and even a weakness in the Midwest. My response is that medicine alone is not a good option. You also need to learn coping mechanisms. 

I recommend medication along with counseling to learn coping skills and build a support system. The goal is to not have to take the medication for the rest of your life. 

Closing the Gap

The next time a pediatrician talks to your child about depression, anxiety or suicide risk, please know that we’re trying to ensure that all children who need mental health services receive them. The earlier we deal with these issues, the better a child’s life will be as they grow toward adulthood. 

If you have any concerns, your child’s pediatrician or your own primary care provider is a great place to start. You can also dial 988 for the Suicidde and Crisis Lifeline 24/7 to be connected to free and confidential emotional support for people in a suicidal criss or emotional distress. 

Sources:

American Academy of Child and Adolescent Psychiatry (AACAP). (2023). Facts for Families: Children's Mental Health. 

Kao-Ping Chua, Anna Volerman, Jason Zhang, Joanna Hua, Rena M. Conti; Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022. Pediatrics March 2024; 153 (3): e2023064245. 10.1542/peds.2023-064245