The majority of teens’ mental illness is left vulnerable to emotional, social, and academic impairments. Those treated are found to do so only after a long time after the symptom has been shown.
But it is not a psychiatric morbidity that makes headlines; instead, it is the most extreme consequence of psychiatric illness: suicide. In the United States, suicide is the third-leading cause of death in teens, and according to the Center for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide.
These grim statistics argue strongly for early detection and intervention and provide a rationale for mental health screening among teenagers. The premise is that the primary risk factors for suicide — mood disorder, a previous suicide attempt, and alcohol or substance abuse — can be identified and treated.
Suicide has public health implications, for it is, in a sense, contagious: there is ample evidence of suicide clusters among teens, and the relative risk of suicide grows four times as high among teens between the ages of 15 and 19 years as in other age groups.
Finally, there is concern about the high sensitivity but relatively low specificity of the screening instruments, a combination that leads to many false positive results. The potential consequences of falsely identifying a teen as needing a more thorough psychiatric evaluation seem far less dire, however, than those of failing to identify a suicidal teenager. Stigma is real, but unlike suicide, it doesn’t kill.
I believe that voluntary mental health screening of teens should be universal. But we need to go beyond school-based screening if we are optimally to reach young people who are at risk for psychiatric illness and suicide. Pediatric clinicians are in an ideal position to detect mental illness in young people, and they should be better trained to probe for and recognize the signs and symptoms of major psychiatric disorders.
Categories: Mental Health