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One in five teens suffer from depression at some point, but many go undiagnosed.

All teens aged 12 years or older should be screened for depression each year, according to new guidelines issued by the American Academy of Pediatrics (AAP) this week.

Doctors can use the new recommendations, an update of 2007 guidelines, to diagnose and treat depression in teens.

One of the biggest changes to the guidelines was a call for all children to be screened annually for depression. “It recommends that all kids, beginning at age 12, have an annual screening for depression whenever they come in for their well-child visit,” Dr. Nerissa Bauer told BuzzFeed News. Bauer is an Associate Professor of Pediatrics at Indiana University School of Medicine and an AAP liaison who reviewed the guidelines.

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It’s not always obvious when an adolescent is suffering from depression, and providers may miss certain symptoms if they are not actively looking.

Doctors Should Screen All Kids For Depression Starting At Age 12, Experts Say

“You can’t just look at a child and tell that they’re depressed; that’s why we need screenings,” Bauer says. Untreated depression can lead to problems at home or school, and increase the risk of suicide.

In the screening process, the teen and parent(s) are each given a list of questions about symptoms to complete separately. The questionnaire can be given in paper or electronic form, so people can answer privately. “The pediatrician can then use the responses to guide a discussion with the child about symptoms related to depression in a more targeted way,” Bauer says.

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As many as 2 in 3 teens with depression are not identified by primary care providers and only 50% of adolescents with depression are diagnosed before they reach adulthood.

Doctors Should Screen All Kids For Depression Starting At Age 12, Experts Say

Stigma and barriers to care, in addition to a lack of training and awareness among primary care providers, may contribute to these statistics.

“In general, mental health is harder for some pediatricians to handle — they may not have gotten the right training or enough exposure to mental illness and they might not know exactly what to do with a positive screening result,” Bauer says. The guidelines also provide guidance for primary care providers to help them better diagnose depression in teens, determine the severity of the depression, and work with families and/or schools to come up with a safety plan.

“Mental health problems are complex and sometimes it takes a while to diagnose, but these guidelines are intended to raise awareness and help primary care providers feel confident in their ability to identify and handle a positive screening,” Bauer says.

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Depression among teens is a growing problem in the US.

Doctors Should Screen All Kids For Depression Starting At Age 12, Experts Say

According to the National Institute of Mental Health (NIMH), an estimated 3.1 million adolescents aged 12 to 17 in the US had at least one major depressive episode in 2016, and 60% did not receive any treatment.

“Depression and depressive symptoms can be a result of things happening around us; and there’s a lot of uncertainty and violence in the world right now, which can be scary,” Bauer says. While social media can be a great way for teens to connect, Bauer says, it can also allow kids who wouldn’t bully in-person to bully online. “There are a lot of stressful situations teens have to navigate in today’s world that put them at a higher risk for depression,” Bauer says.

These new guidelines have been in development for a long time, and depression screenings for children are not new. The U.S. Preventive Services Task Force (USPSTF) already recommended screenings for major depressive disorder in adolescents aged 12 to 18. However, the new AAP guidelines come at a time when people are increasingly concerned about the mental health of adolescents.

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“Parents: if you’re ever concerned about a child’s mood, do not wait — bring them to the doctor to get checked out and monitored,” Bauer says.

Doctors Should Screen All Kids For Depression Starting At Age 12, Experts Say

It’s normal for teens to feel sad or moody sometimes, especially with the hormone rollercoaster that is adolescence — but regular sadness is not the same as depression, and it’s important to know the difference. “What we look for with depression is the presence of symptoms for at least two weeks,” Bauer says.

According to the NIMH, symptoms of depression can include feeling sad, empty, hopeless, or angry but may also include one or more of the following:

  • Not caring about things or activities you used to enjoy
  • Losing weight without dieting or gaining weight from overeating
  • Having trouble falling or staying asleep, or sleeping way more than usual
  • Trouble concentrating or issues with memory
  • Feeling extremely guilty or worthless
  • Thinking about or attempting suicide

Because teens may not be able to identify or communicate symptoms of depression, the new guidelines help providers look out for other signals. These include conflict in the home, poor academic performance, and withdrawing from friends and family. “We need to not assume we can spot a depressed child by looking at them, and as a pediatrician we have to check in on the child’s mental and emotional health,” Bauer says.

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If you or someone you know is struggling with depression, there are ways to seek help safely and confidentially.

Doctors Should Screen All Kids For Depression Starting At Age 12, Experts Say

If you are a teen and think you are depressed, you should tell a parent or guardian, teacher, counselor, or a doctor who you trust. But that isn’t always easy, so here are some additional resources that might help.

  • 7 Cups and IMAlive are free, anonymous online text chat services with trained listeners, online therapists, and counselors.
  • Vent and Paralign are community-based apps where you can express yourself anonymously and connect with people who might be feeling the same way.

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