Evidence-based Screening for Mental Health Disorders in Children, Teens is Critical During Pandemic

There are widespread mental health concerns among children and teens currently, with 1 in 4 to 5 having a mental health problem, said Bernadette Melnyk, PhD, RN, CPNP, PMHNP, FAAN, during a session at the National Association of Pediatric Nurse Practitioners Virtual Conference 2021. The most commonly occurring mental health disorders in this population are anxiety, depression, and ADHD.

However, it is estimated that less than 50% of children and teens with a mental health disorder receive any treatment. This is of particular concern considering suicide remains the second leading cause of death in people aged 10 to 34 years in the United States.

“If every clinician, advanced practice provider, and physician could get great at providing evidence-based screening and intervention for just anxiety and depression in children, teens, and young adults, we could really put a dent in these mental health problems,” Melnyk said during the session.

Furthermore, during the struggles many have endured during the COVID-19 pandemic, there is an additional mental health epidemic that has emerged within the pandemic, Melnyk explained. The CDC and the Morbidity and Mortality Weekly Report released data showing 25% of Americans aged 18 to 25 years have thought about suicide since the start of the pandemic, highlighting the critical need for mental health promotion and development of resiliency skills so that a paradigm shift can occur around this issue.

“Because so many people are suffering from depression and anxiety related to the COVID-19 pandemic, we are seeing a rise in substance use, unhealthy eating, and a decline in physical activity. If we do not address these mental health problems urgently now, we are also going to see downstream affects in chronic disease in 3 to 5 years from now,” Melnyk said during the session.

There are a variety of risk factors for mental health disorders in children and teens. Poor self-esteem is a significant predictor, although it is often not screened for by providers. For this reason, every contact with a patient should be seen as a potential opportunity to screen for mental health disorders, especially during the pandemic, according to Melnyk. Asking a single screening question during a session such as, “On a scale from 0 to 10, how good do you feel about who you are?” can be an effective tool for assessing patient risk.

There are other valuable screening tools providers can use as well, such as the Pediatric Symptom Checklist, which has been found to be a valid and reliable first screen, as it is a short form with 17 items that takes approximately 5 minutes to complete.

For assessing risk for depression and anxiety disorders, the PHQ-9, GAD-7 and SCARED screening tools are also valuable. Additionally, the CRAFFT screen is used for assessing substance use risk, while the ACE screen helps to assess adverse childhood experiences.

If the results of the screening tool demonstrate further investigation is needed, a clinical interview should then be conducted with further evaluation completed by a health care provider.

“But we have to remember that screening is not diagnosis alone. Screening just raises a red flag that requires a good comprehensive interview and evaluation by the health care provider,” Melnyk said during the session.

Melnyk highlighted a strong outline that is available for the integration of behavioral health into primary care using the Screening, Brief Intervention and Referral to Treatment (SBIRT) model. SBIRT details that the starting point should be a screening for a mental health disorder in the primary care setting, which is then followed by a brief intervention that can be provided in the primary care location.

If necessary, a referral to a mental health provider or a consultation service can proceed this, with subsequent treatment offered by the primary care provider, integrated psychologist, mental health provider, or specialty care based on the needs of the patient.

“I like to add another letter to SBIRT, and that is H for Hope. I never let a child, teen, or young adult leave me without instilling hope that there are fabulous, evidence-based treatments to help them,” Melnyk said.

In the primary care setting, the 2 most common mental health disorders that providers observe are anxiety disorders and depressive disorders. However, there are now a rising number of trauma, stress-related, and obsessive compulsive disorders emerging.

“But again, if we could just get really good at delivering cognitive-behavioral-health based interventions for children and teens with depression and anxiety, we would avoid long wait times to mental health providers,” Melnyk said during the session. “Unfortunately, a lot of people feel that if you’re not born with resilience, you can’t develop it, and that couldn’t be further from the truth. All throughout life, you can build resiliency skills and cognitive behavioral skills that are wonderfully protective factors against mental health disorders.”

REFERENCE

Melnyk B, Lusk P. Evidence-based Screening and Mental Health Interventions for Primary Care. Presented at: National Association of Pediatric Nurse Practitioners Virtual Conference 2021; March 27, 2021; virtual. https://napnap21.org/community/#/session-stream/42207. Accessed March 31, 2021.