While anxiety and depression rates among children and teens reached crisis levels during the pandemic, the numbers have been high for the past decade. As a result, when parents bring their children in for their annual checkup, parents can expect their children to be asked to complete screening questionnaires for anxiety and depression.
Anxiety and depression in children and teens are common conditions; for some it’s situational and for others it’s chronic, says Dr. Yann Poncin, a child and adolescent psychiatrist at Yale Medicine and assistant clinical professor of child psychiatry. In the U.S., nearly 10 percent of children and adolescents have an anxiety disorder, and 14 percent had a major depressive disorder before the pandemic, said Lori Pbert, a volunteer member of the U.S. Preventive Services Task Force who recommended the screenings. “We don’t want them to suffer in silence,” said Pbert, a professor in the department of population and quantitative health sciences at UMass Chan Medical School. “Anxiety disorders are missed. The average time to start treatment is 23 years.”
Anxiety and depression are not signs of weakness; they are neurological conditions with a biological component, says Dr. Javeed Sukhera, a child and adolescent psychiatrist and chair of psychiatry at Hartford’s Institute of Living. “We know that early mental health promotion and prevention positively impacts the well-being of both parent and child and leads to better outcomes later in life,” he says. “Not acting early can have long-lasting consequences.”
How does screening work?
Pediatricians can choose from a range of approved screening tools that include instructions for interpreting the scores, Pbert says. Some are designed for the child or adolescent to complete and others for the parent. Typically, the patient fills out the questionnaire when they arrive for a checkup, and the pediatrician discusses any concerns with the patient and parent.
Screening is the first step toward addressing a mental health disorder or concern, and depending on the severity, the doctor may recommend the next steps. Many pediatricians are in continuing education about behavioral health and may be able to administer medication while the patient waits for a therapist, Pbert says. In Connecticut, pediatricians can call Access Mental Health CT, talk to a psychiatrist, and get counseling.
Pediatricians are seeing more patients with mental illness and greater disease severity. “In the last few years, because of the pandemic, we’re seeing a tremendous need to support everyone’s mental health,” said Dr. Nerissa Bauer, a behavioral pediatrician who was part of the AAP team that recommends mental health screening. “Pediatricians are leading the way.” She tells parents that if they’re concerned about their child, “always, always go back to your pediatrician.”
Because of the severe shortage of mental health providers, “we’ve gained a lot more knowledge about how to manage anxiety and depression and how to manage it in our offices,” including medication management, says Toscano. For example, Bauer says half of the country’s pediatricians diagnose and administer medications for patients’ ADHD.
While continuing education is necessary to maintain clinicians’ licenses, doctors choose which areas to study. Some only perform the screening test and refer patients to a psychiatrist for evaluation and medication management, Poncin says. Pediatricians don’t need additional training to perform the screening tests for anxiety and depression, Pbert says. Pediatrician screening is the first step; when a patient screens positive, she says, they should be referred to a mental health doctor to receive a diagnosis.
Therapists shortage
The pandemic widened cracks in children’s behavioral health systems and diminished its ability to meet families’ needs, said Jeffrey Vanderploeg, president and CEO of the Child Health and Development Institute in Farmington. “Record numbers of young people are experiencing behavioral health problems, and at the same time clinicians are leaving the field, citing low pay and burnout,” he says. “No other sector of the health care system has so many providers that don’t accept insurance because of low fees.” Providers can live better by requiring ‘self-payment’. Because of this, those who cannot afford it are unable to access mental health care.
Despite Connecticut’s medical schools and high-quality hospitals, people wait an average of three months to see a mental health professional, Poncin says. (It may take much longer elsewhere in the country.) Shortages are forcing pediatricians to assess the severity of their patients’ mental health and work with their local mental health agencies to get those in crisis seen sooner. “I don’t think the screening will make a huge dent in the numbers. The numbers are already bad,” says Poncin.
Connecticut needs to expand services in areas that meet the needs of youth and families,” says psychologist Vanderploeg. “We must prioritize efforts to expand prevention, early intervention and treatments with the strongest evidence of effectiveness. These strategies have the best chance of improving results and achieving long-term cost savings.”