Tuesday, December 08, 2009

Assessing Teenagers

Teenagers. They should be considered their own species (--note, no one asked me).

Perri Klass, M.D. has a nice piece in the New York Times about assessing teens for depression and suicide, "18 and Under--Asking the Hard Questions." It's mental health from the perspective of a pediatrician, and I like that she's thoughtful about the issues.

Here's an excerpt:

And before you get to the S’s, there is the E for emotion, which, Dr. Ginsburg said, should be much more than screening for depression. “If you start by asking boys if they’re depressed or sad, most boys will deny that,” he told me. “If you start by saying, ‘So, are you stressed out?’ — every boy, no matter how big and strong, every girl, no matter how much she wants to portray herself as being in control, will admit to stress.”

Markers for depression may help identify adults at risk for suicide, but they are not a reliable way to screen adolescents. “Only about half of kids who kill themselves are depressed in the way that we think about depression — sad, not taking care of themselves, not sleeping or sleeping too much, not eating or eating too much,” Dr. Ginsburg said. The other half may be impulsive, angry, disappointed, trying to get even.

Dr. Shain said adolescents often changed their ideas and their plans. So an assessment has to go beyond the feelings of the moment to include thoughts they have had, dangerous ways they have behaved and the important questions of intent and ambivalence.

“Sometimes you’ll get an ‘I don’t know’ answer,” he explained, “which might be ominous, might mean they don’t know or might mean they don’t want to tell you.”

If a teenager does acknowledge thinking about suicide, there are many more questions to be asked. Dr. Lydia A. Shrier, director of clinic-based research on adolescent and young-adult medicine at Children’s Hospital Boston, said some young people chronically struggled with these issues.