Say it ain’t so

By Christine Stapleton

Will someone please tell me that the last paragraph of an Associated Press article about a recommendation to screen all teens for depression is WRONG?

“Routine depression testing should occur only if psychotherapy is also readily available, the panel said.”

Does that mean that we should not bother testing teens who do not have access to psychotherapy? Does that mean we are going to just write off those teens who cannot afford or whose parents do not believe in psychotherapy?

I cannot believe that this is the recommendation of the U.S. Preventative Services Task Force, a government-appointed medical panel which sets guidelines for doctors. The panel’s new guidelines appear in the April issue of Pediatrics.

The article says an estimated 6 percent of U.S. teens are clinically depressed but it says nothing about the number of teens with dysthymia - a low-grade, long-lasting depression that I suffered in my teens and that would unexpectedly morph into a clinical depression.

The article says that a “simple questionnaire can accurately diagnose depression in primary-care settings such as a pediatrician’s office.” However, there are a lot of kids out there who very rarely - or never - make it to a pediatrician’s office. These kids are vaccinated at school or at the public health department. These teens only see a doctor in an emergency room because they are uninsured and their parents wait until they are very ill before taking them for medical care.

About 10 percent of kids under 18 had no health insurance in 2007, the most recent data available. About 28 percent of young adults, 18-24 year-olds, are uninsured - making them the least likely of any age group to have health insurance. These are 2007 data. We can only imagine what the numbers are today as we edge toward double-digit unemployment.

Who is going to determine if “psychotherapy is readily available?” What is “readily available?” Just because there is a pediatric psychotherapist within a 5, 10 or 25 mile radius of the teen does not mean psychotherapy is “readily available.” Someone has to make sure the teen can read the questionnaire. Someone has to drive that teen to therapy (if the parents have a car or can afford bus fare). Someone has to pay for therapy. Someone has to be willing to let their teen see a therapist. Here is the kicker, are doctors going to administer this “simple questionnaire” if they cannot bill for it? How much will doctors be reimbursed? What should a doctor do if the questionnaire reveals that the child is depressed?

It is wonderful that depression screening for teens is finally being recommended. God knows how many young lives it will save. I can only imagine what my life would have been like if my depression had been diagnosed when I was a teen. But let’s not dangle “we-shoulds” out there unless we have a firm plan for doing it - like we have for routine child vaccinations.

I hope the panel’s recommendation includes a plan for paying for and treating teens with depression. I hope that teens are screened and screened often. I hope we take depression screening as seriously as vaccinations. I hope this recommendation does not fizzle away with all the budget cuts.

I will read the article in Pediatrics. Until then, I hope this newspaper article is wrong.

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