By Richard Haber, MD
Primary care physicians are on the frontline when it comes to mental health issues in children and adolescents. With a burgeoning patient population, and ever fewer child psychiatrists to support them, primary care physicians are increasingly called upon to diagnose and treat these conditions despite the lack of formal training.
First, the scope of the problem. Dr. Amy Cheung reported the rates of depression and suicidality (suicidal ideas and/or attempts) in adolescents 15-18 using Statistics Canada data1. The total population surveyed was 38,500, of whom 2,866 were adolescents aged 15-18. The diagnosis of a major depressive illness was based on a structured interview using DSM-IV criteria (see Table 1). Cheung estimated lifetime prevalence for a major depressive illness at 7.6% (adolescent females) and 4.3% (adolescent males). The suicidality rate was 13.5% overall, 8.8% (adolescent males) and 18.4% (adolescent females) 2. Surprisingly, only about 50% of adolescents committing suicide have been previously identified as depressed3.