Urgent Need for Depression Screenings in America

In this month’s issue of Pediatrics, the U.S. Preventive Services Task Force, a government-appointed medical panel that sets guidelines on a number of health issues, advised doctors to regularly screen teens for depression. The U.S. Preventive Services Task Force’s recommendation for doctors to make screenings more consistent, therefore, is an acknowledgement that depression has evolved into a nationwide and pressing concern.

The majority of the responses to the task force’s recommendations for additional screenings have been supported and praised. The Las Vegas Sun reported that Dr. David Axelson, a psychiatrist who contributed to the study, suggested that pediatricians who see teens that are undiagnosed or untreated more often in a given year than psychiatrists “can help make [mental health screening] seem less stigmatizing” or less discriminating. Axelson recognized that pediatricians are not trained to do psychotherapy, but they can still play an important role in treating teens since they are able to prescribe depression medication and monitor patients they’ve referred to others for therapy.

However, though Axelson notes the positive impact that doctors can have in treating those who are clinically depressed, ultimately his suggestion is too idealistic and impractical to enforce, simply because doctors are not psychiatrists. Therefore, such doctors may not prescribe the best medications due to the fact that they diagnose the symptoms of their depressed patients differently. Psychiatrists are properly trained to recognize the degree of depression that is present in an individual. Furthermore, Axelson’s suggestion implies that patients should seek drug treatment, but that can be counterproductive, especially since some have been known to cause suicidal thoughts.

Dr. Ned Calonge, task force chairman, emphasized that the panel does not want its recommendations to lead to drug treatment alone. His statement is also an admittance that society tends to rely too heavily on pills and prescriptions to overcome physical and mental hardships. As many have learned from actor Heath Ledger’s death, his reported accidental overdose of pills led to a sudden end to his young acting career. This is an important lesson for all young adults to realize, namely that they should not depend only on pills and should not pressure their doctors to prescribe them more medication, if any, to deal with their depression.

However, there is a bump in the road that will more than likely slow the implementation of the task force’s advice, given that an independent report also published in this month’s issue of Pediatrics concluded that psychiatrists specializing in treating children and young adults are insufficient in number. In addition, the Las Vegas Sun reported that Calonge offered the idea that “routine depression testing should only occur if psychotherapy is also readily available” but the problem is that psychiatrists are scarce, so there will need to be an influx of psychiatrists in the incoming work force to compensate for the shortage of specialists to whom doctors would need to recommend their patients.

In the meantime, doctors will need to be properly trained to spot any red flags, but the methodology of how they will screen patients is still being debated. Calonge noted that some doctors only screen high-risk groups, but they will miss others who may be undiagnosed or untreated in the process, since depression is becoming pervasive. Dr. Ted Epperly, president of the American Academy of Family Physicians, suggested that screening questionnaires can be filled out by patients in the waiting room. Epperly’s suggestion makes sense on two fronts: One, doctors will still have their usual amount of time to handle patients with physical illnesses and will not need to waste time asking patients who may not be at risk and two, patients, by answering the questionnaire, will also recognize their lifestyle and see if they need to get help.

Yet, according to a survey conducted by the Centers for Disease Control and Prevention, 17 percent of adults do not have contact with a health care professional within a given year, most likely because there are over-the-counter medications available to treat illnesses or even because they cannot afford health insurance. The follow-up question that should be addressed to the task force is how they will get those individuals to be screened. The best possible solution to this issue is to have the screening also done at schools, since all students are required to attend. Of course, the way in which it will be done is debatable, but the basic principle is that every child and young adult will be screened.

Ultimately, the task force’s recommendations should be followed because screenings will allow those children and young adults to get proper treatment to cope with their issues. Since depression can lead to persistent sadness, social isolation, school problems and even suicide, screening to treat it early is crucial and a necessity. A strict and mandated order by an influential government-appointed medical panel to require screening will only help lower the number of individuals who are depressed.

According to its study, an estimated 6 percent of U.S. teens, or nearly two million individuals, are clinically depressed, which is a number that we can’t afford to ignore.

Kevin Phan is a first-year biological science major. He can be reached at phankt@uci.edu.