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It may be easy to miss the clues if parents and pediatricians don’t know what to look for, the researchers told a conference.
"Teens rarely stated they were depressed, but described bursts of feeling stressed and sad that often came and went," said Daniela DeFrino of the University of Illinois at Chicago College of Medicine and College of Nursing.
DeFrino and colleagues went through in-depth interviews done with 369 teenagers taking part in an ongoing health study paid for by the National Institute of Mental Health.
The teens, considered at risk for depression, gave indirect clues to their state of mind, such as:
- "I always find somehow to go back to stressful mode."
- "I get really mad at people very easily. They don't understand why I'm upset. Sometimes I don't either."
I'm down. I'm stressed.
"Much of what a teen is feeling and experiencing is easy to attribute to the ups and downs of teen angst," DeFrino said in a statement. “But sometimes there is so much more under the surface that can lead to depression.”
They used words such as “down” or “stressed,” the team found. They also reported feeling angry or irritable, a loss of interest in activities they used to enjoy, and either sleeping too much or having trouble sleeping, DeFrino’s team will report to a meeting this weekend of the Pediatric Academic Societies in San Francisco.
The 369 teenagers mentioned homework pressure and expectations of success. Teens whose moods had worsened talked about arguments with parents, verbal and emotional abuse, divorce, separation, neglect, sexual abuse or moving.
Two-thirds of the teens had visited doctors for ulcers, migraines, stomach pains and fatigue.
Pediatricians, nurses and other medical providers need to be aware of these opportunities to check on a child’s mental health, DeFrino said.
"Teens may be experiencing a lot of internal turmoil and difficult life stresses that we can easily overlook if we don't probe with sensitive questioning and understanding," she said. "Reframing these feelings as outward symptoms of pre-depression by the primary care provider would allow for connection to and discussion about the importance of mental health with the teen and parent."
Depression is the leading cause of suicide and a second study found the number of children and adolescents admitted to children's hospitals for thoughts of suicide or self-harm more than doubled during the last decade.
"Research to understand factors contributing to these alarming trends is urgently needed," said Dr. Gregory Plemmons, of the Monroe Carell Jr. Children's Hospital at Vanderbilt University.
His team checked records from 32 children's hospitals across the U.S. between 2008 and 2015 for children 5-17.
They found 118,363 cases where suicide or self-harm was mentioned. Rates rose from 0.67 percent of ER visits in in 2008 to 1.79 percent in 2015.
About half the patients were 15 to 17. Another 37 percent were 12 to 14 and nearly 13 percent were 11 or younger.