In an update to its 2014 and 2016 recommendations, the U.S. Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents 12 to 18 years of age who do not have MDD or signs or symptoms of depression or suicide risk. Benefits of screening children 11 years or younger lack supporting evidence, as did screening for suicidal ideation.
“Suicide is the second-leading cause of death among youth aged 10 to 19 years,” the authors write. “The rate of suicide deaths is highest among Native American/Alaska Native youth and lowest among Black youth, compared with White youth. Native American/Alaska Native youth die by suicide at a rate of 2.5 deaths per 100,000 persons (younger youth) and 16.1 deaths per 100,000 persons (older youth). White children and adolescents have a similar rate of dying by suicide compared with Black children and adolescents of the same age (1.3 vs 1.4 deaths per 100,000 persons for White and Black children, respectively); however, the suicide rate among White adolescents is nearly double the rate among Black adolescents (8.4 deaths per 100,000 persons and 4.2 deaths per 100,000 persons, respectively). Important risk factors for suicide are mental health disorders and adverse childhood experiences (eg, family history of suicide or mental health disorders, previous suicide attempts, life stressors, history of trauma, parent-child conflict, or legal problems). Suicide risk varies by gender or sex and type of behavior. Male youth had a higher rate of suicide completion (17.9 deaths per 100,000 persons) than female youth (5.4 deaths per 100,000 persons); however, the risk of suicide attempts was greater in female youth than in male youth. Lesbian, gay, bisexual, transgender, and queer adolescents demonstrate higher rates of suicidal ideation and attempts compared with heterosexual adolescents.”
A separate article provides an updated evidence report and systematic review. Commenting on the review and the USPSTF recommendations, an editorialist writes: “Even if all adolescents who have or are at risk for suicidal behavior and depression could be identified, providing follow-up and evidence-based interventions for these adolescents promises to be a lofty goal, especially given constraints in training and the overall workforce and limited access to mental health professionals. After suicide and depression screening, physicians and other primary care clinicians will need to further evaluate depressive symptoms and other psychiatric symptoms and behaviors, including suicidal behavior. Ascertainment of suicide risk and development of safety planning is increasingly becoming the responsibility of primary care clinicians, who require training and support to accomplish such tasks. Initiatives such as the Massachusetts Child Psychiatry Access Program, which provides training and consultative support to primary care practices, are needed, but supportive efforts (such as education and consultation on mental health issues) must also be examined for their potential benefits and harms.”