Adolescent Mental Health Screening in the 21st Century

In the ever-evolving landscape of youth mental health, a revolutionary paradigm is emerging, centered on adolescent screening and prevention within a public health approach (Moran, M., 2022; Stiffman, and colleagues, 2010). This innovative approach introduces multisectoral treatment options. With a variety of paths for treatment, we ultimately have the power to treat root causes more effectively and appropriately. While this concept has not yet gained widespread traction in the field, it holds immense promise.

While there are growing calls to screen universally for depression and anxiety (U.S. Preventive Services Task Force, 2022a and 2022b), barriers to universal screening still impede its implementation. One significant concern within the healthcare sector is the unspoken question of follow-up once adolescents are screened. This inquiry arises frequently, leading to a thorough exploration of a distinct treatment category, an early intervention approach that transcends traditional diagnostics and has the potential to alter the trajectory of mental health conditions. This entails short-term interventions, such as a few sessions addressing recent loss and grief, as opposed to a formal diagnosis of depression, for example, and subsequent self-medication and addiction. The implications of this innovative approach are profound when treating the patient but fall short within a system that reimburses diagnosis at a far greater rate than preventative measures.

Despite the significant technological advancements, including the widespread adoption of virtual and Zoom-based therapy during the COVID era, one might question why we are not witnessing notable improvements in the mental health of our children. One answer lies in the absence of comprehensive and readily accessible screening tools. These tools can provide informative insight that can help clinicians, families, and patients choose better options for care. Earlier identification of mental health disorders leads to more effective interventions with shorter durations.

In the present scenario, a pediatrician is allotted a brief window of between 11 and 20 minutes to engage with a patient. The existing screening tools use antiquated pen and paper measures that operate independently. The result is that separate screening occurs for depression, ADHD, anxiety, and social determinants of health. Through the use of 21st-century technology implemented before the well-child visit, mental health information can be collected for all of these concerns. This allows for meaningful correlations and connections to give the provider a more robust picture of the child's mental health before the appointment begins.

While there is a growing call for mental health screening, it often falls short most of the time by delaying the screening requirement to age 12 or older. Since half of all lifetime cases of mental illness begin before the age of 14, a practitioner and the family have limited information on the unique qualities of the child before signs and symptoms are present. Regrettably, these screening barriers lead to a dearth of longitudinal information, which is a reliable predictor of future mental health.

Before the pandemic, there was a concerning deterioration in youth mental health, highlighted by a 27 percent surge in anxiety and a 24 percent rise in depression from 2016 to 2019, as reported in a JAMA Pediatrics study. The absence of baselines and treatment paths informed by year-over-year metrics is evident in statistics like the 11-year gap from onset to diagnosis, with signs and symptoms potentially manifesting as early as age four. This means that for a 6-year-old exhibiting symptoms today, proper diagnosis and or treatment may not occur until the age of 17, resulting in prolonged suffering from kindergarten through high school. Calls for action to reform youth mental health have also intensified, with Surgeon General Vivek Murthy branding the existing crisis as "the defining public health crisis of our time," and major organizations like the CDC advocating for universal screening of anxiety in youth.

Further complicating matters, it is estimated that in the U.S., there are 350 individuals for every mental health provider. However, these figures come with certain flaws, as they include active mental health professionals who may no longer be accepting new patients. The increasing demand for therapy and a severe shortage of providers raises the critical question of what steps to take after screening – the "what now?" scenario.

This raises the question: What does an early intervention entail? How can we support children before signs and symptoms escalate to a severe stage?

Here is the good news! A public health approach that includes tech-backed screening, prevention, and early intervention can expand the choice of possible healthcare solutions.

Additionally, schools, general practitioners, pediatricians, and mental health providers can begin to share the burden of care. This approach can help reveal root causes and shorten the pathway to health and well-being for our adolescents.