A great threat to children
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Is it not the time for educational requirements that reflect the urgent needs of our pediatric patients? In this month’s issue of Pediatrics, Mojtabai and colleagues sound an alarm with 2 critical public health updates; depression is significantly on the rise in adolescents, with a 12-month prevalence of 11.3% in 2014 versus 8.7% in 2005. Furthermore, despite this disturbing development, the percentage of young people with a history of past-year major depressive episodes seen by primary care providers for depression care is only ∼10% and has not appreciably budged in the past decade.
The second point is disappointing because it occurs despite a 2007 American Academy of Pediatrics statement, which could have possibly had an impact on the comparison between 2005 and 2014. This statement strongly encouraged all pediatricians to recognize and identify the risk factors for suicide, then the third leading cause of death for adolescents 15 to 19 years old, of which depression was and remains the most substantial. These low and stagnating rates of youth depression treatment provided in primary care settings are not fully surprising, however. Other studies have documented at least partially convergent findings; 55.1% of pediatricians in 2004 versus 60% in 2013 reported screening or inquiring about depression, whereas 17.5% in 2004 versus 24.3% in 2013 reported treating, managing, or co-managing depression, similar to a 2008 study reporting that the same large majority of approximately 75% pediatricians did not consider treating youth depression as among their responsibilities. This is congruent with and not better than an earlier 2001 study in which 26% to 27% of primary care pediatricians felt responsible for treating depression in children and adolescents and most commonly cited the probably highly inter correlated lack of training and lack of confidence as obstacles to providing such treatment.
The combination of these 2 findings leaves us with some new urgency. The source behind a rise in Youth depression should be investigated scientifically. The other problem, that of increasing untreated youth depression, all of us at a time that suicide is now the second leading cause of death for teenage boys and girls aged between 15 to 19 years. Depression is a substantial and ever-growing deadly danger to our INDIAN adolescent population. The prioritization of youth depression treatment of our INDIAN population health is imperative. In fact, the American Academy of Pediatrics recently updated its 2007 statement on recognizing suicide risks with a recommendation to routinely screen youth aged 11 to 21 for depression. Sadly, even if this important update influences primary care providers to screen more youth, there will never be enough qualified mental health specialists to take care of the 2.8 million or more adolescents per year, who, if screened and identified, will need treatment and monitoring for depression.
The most recently updated Accreditation Council for Graduate Medical Education program requirements for graduate medical education in Pediatrics and Child and Adolescent Psychiatry are such that trainees in neither specialty are clearly required to gain a fixed set of skills to defend from the plague of youth depression at population level. In the Pediatrics requirements, the 1 specialty were learning to treat youth depression could be a large focus, it is not listed as 1 of the 13 key subspecialties from which 4 educational units are required. It is listed among 13 other sub specialties, from which up to 3 can be selectively chosen for rotation, in competition with all the key sub specialties. In the Child and Adolescent Psychiatry requirements, outpatient collaborative care is not mentioned.