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Depression is a growing threat to American children and teens. As many as 1 in 5 teens experience depression at some point during adolescence, but parents often miss the clues, and as many as two out of three young people with depression go undiagnosed, research shows.
Because so many young people with mental illness don't get help or treatment, pediatricians should routinely look for signs of depression in their young patients, according to updated guidelines from the American Academy of Pediatrics.
"So many teens don't have access to mental health care," said family psychologist Dr. Jennifer Hartstein. "It has to start with their pediatrician, and these changes really point in that direction."
With the new guidelines, pediatricians are being asked to more carefully screen their patients ages 12 and over during their annual checkups. It's the first update to the guidelines in a decade and comes amid a disturbing rise in suicide rates among adolescents, especially teen girls.
"[It] will be more than just 'I feel sad on a scale of 1 to 5,' it'll be much more detailed, and ask for more situational and informational stuff, so that we can be much more specific in our diagnosis," said Hartstein, an adjunct professor at Ferkauf Graduate School of Psychology, part of Yeshiva University in New York.
The guidelines encourage pediatricians to talk to their young patients alone — teens may be more open about their feelings without a parent in the room — and then talk separately with parents or caregivers. If the doctor determines that the teen has moderate or severe depression, the pediatrician can offer treatment or consultation with a mental health specialist.
Depression can be difficult to spot. But with a growing number of young people reporting severe depression and with so few getting treatment, the American Academy of Pediatrics is encouraging pediatricians to get more training in how to assess, identify and treat depression.
What teen depression looks like
The challenge for parents — who may mistake signs of depression for normal, moody teenage behavior — is recognizing symptoms even before their child sees the doctor. Children, adolescents and teens don't typically say "I'm depressed," or may use confusing language when they talk about their feelings, recent research has found.
Instead, teens and adolescents use words such as feeling “down” or “stressed,” researchers at the University of Illinois at Chicago College of Medicine and College of Nursing found in a 2017 study.
While parents may expect a child with depression to feel sad, young people with depression are actually more likely to report being angry or irritable.
According to the National Alliance on Mental Illness, other signs of adolescent or teen depression include:
- sleep problems (they often sleep more)
- loss of interest in friends
- changes in appetite
- hopeless or guilty thoughts
- changes in body movements, such as feeling edgy or slowed down
- frequent physical illnesses
But any of these signs could also simply be part of the emotional bumps of being an adolescent. An important clue is whether the symptoms last at least two weeks or longer.
Stigma is a major barrier to getting help for depression or other mental illness. Wit the new guidelines, the hope is parents and caregivers with become more comfortable having conversations about mental health at home and, when needed, work with the doctor on a care and treatment plan for their child.
NBC News correspondent Kate Snow contributed to this report