Volume 355:2717-2719 December 28, 2006 Number 26
Uncovering an Epidemic — Screening for Mental Illness in TeensRichard A. Friedman, M.D. Courtney, a 15-year-old from Portland, Oregon, always knew she was different from the other kids. "I had a sense that something was going on, but I was afraid to say anything because I didn't know anyone else had a similar problem," she said. Like thousands of U.S. teens, Courtney participated in a mental health screening program that was offered in her school. "Teenagers have a hard time asking for help," she explained. "Without the screening, I'm not sure how I would have gotten the help I needed."
Before screening, Courtney was part of a silent epidemic of mental illness among teenagers. We know from the National Comorbidity Survey that half of all serious adult psychiatric illnesses — including major depression, anxiety disorders, and substance abuse — start by 14 years of age, and three fourths of them are present by 25 years of age (see table).1 Yet the majority of mental illness in young people goes unrecognized and untreated, leaving them vulnerable to emotional, social, and academic impairments during a critical phase of their lives. Even those who receive treatment tend to do so only after a long delay: 6 to 8 years for patients with mood disorders and 9 to 23 years for those with anxiety disorders.
But it is not psychiatric morbidity that makes headlines; rather, it is the most extreme consequence of psychiatric illness: suicide. In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age. In 2005 alone, according to the Centers for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide, and 8.4% had attempted suicide at least once during the preceding year.
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Courtney participated in TeenScreen, a large, school-based mental health screening program that was developed under the direction of David Shaffer at Columbia University. The screening is conducted in two stages: teens fill out a short questionnaire and are then interviewed by a master's level social worker or clinical psychologist, who verifies that a positive result is really clinically significant. If it is, the clinician recommends a more comprehensive psychiatric evaluation to the teen and his or her parents. The screening is voluntary and requires the active consent of the parents and assent of the teen. Screening results are confidential and are not shared with school officials or teachers. And since all teenagers who undergo screening also receive a follow-up interview, they cannot be identified by their peers as having screened positive, a system that preserves privacy.
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http://content.nejm.org/cgi/content/full/355/26/2717?query=TOCSource InformationDr. Friedman is a professor of clinical psychiatry and the director of the Psychopharmacology Clinic at Weill Cornell Medical College, New York.
An interview with Cynthia Montgomery, whose son took his life at the age of 14, can be heard at www.nejm.org.
The New England Journal of Medicine is owned, published, and copyrighted © 2006 Massachusetts Medical Society. All rights reserved.
http://content.nejm.org/cgi/content/full/355/26/2717?query=TOC