A NIH Post from couple years ago got me to thinking about teen suicide. I don’t work with children or adolescents, so I don’t get as much education about kids. But I stumbled on this post again and got to thinking about it. And, of course, that means I have to write a post about it 😉
As many as one in five U.S. teenagers experience an episode of major depression by the time they turn 18.
I find this both bothersome and unsurprising. Adolescence is the most difficult time of a person’s life. Everything in that time of life is in chaos. They are beginning to come to a different understanding of the world as the childhood views flake away. Their hormones are raging. They are struggling to figure out who they are and what they want to do in their lives. Then there are the pains of relationships. Those first loves are full of awkwardness and newness. It is easy for a person to become overwhelmed. It is essential for them to have a solid support structure. However, even without excellent support they are still at risk for depression.
I’m not sure why depression is so overlooked in this age group. I find it surprising that they are not regularly screening them since they are at such an increased risk. I think that it what is so bothersome to me. What can we do to make this better? How do we increase the rate of diagnosis before they commit suicide? And I have no idea what the answers are. I think there is a lack in research for both the detection and the treatment for depression in adolescents. But it is difficult to do research in any age group of children. What parent wants their child to be part of an experimental treatment? Not many. Because of that, the few studies that have been done are only with very small groups and thus is it difficult to give them weight. When there are only 100 people in a study… yeah, the numbers there aren’t that solid. But it is better then nothing.
The other challenge is that there aren’t as many providers willing to work with any age group of children. That’s partly because a provider is more likely to be wrongfully sued when working with children. It is also partly because it is emotionally more difficult to see children in such difficult situations. Lastly, it is because working with children is much more complex. When you work with children you also have to work with the parents. This can be a challenge because the parent is in an emotionally difficult place (since their kid is having a difficult time and possibly a crisis) and it can be hard to communicate with them effectively.
The idea of a team approach for care makes sense to me. It has worked well for adults. I see no reason that it wouldn’t work well with children. They are not that different then adults. Sometimes, I think that people think children are aliens. We talk about them as though they are completely different then adults. They are different, just like men and women are different. But there is more the same between children and adults then there is different.
It saddens me that people believe that the only people who can provide them or their family good care is a doctor or a nurse. Yes, it is doctors and nurses that people most of encounter. But there are so many people out there with other licenses and degrees that can help people as well if not better then doctors and nurses. I think it is important that we move in the direction of team approached care. It reduces the cost of care. It places patients with the people that are best able to meet their needs. It reduces the case loads of doctors. It increases the amount of collaboration on a patient’s case. When a patient has a case manager, they are more likely to get the things they need because there is someone who is constantly checking in with the patient and making referrals to the services they need. These are the people that make sure all the needed pieces are coming together. Sadly, most facilities don’t have case managers. And most insurances don’t cover them. But we are moving in that direction.
Far more teens responded to collaborative care (67%) than usual care (39%), with half of the collaborative care group experiencing complete remission of their depressive symptoms compared to just one-fifth of the usual care group.
While this is a small study and the results really cannot be generalized, I think these numbers are still something to take notice of. It strongly suggests that more research is needed and that I reconfiguration of our approach is needed.