Grand Rounds Blog Carnival Vol. 5, No. 36

Slightly off-topic, I've been included in this week's edition of Grand Rounds hosted by See First which is exciting to me, at least, as it's my first time. For those of you who don't know what I'm talking about, Grand Rounds is "a weekly summary of the best health blog posts on the internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week...It's the oldest and most popular medical blog carnival on the internet." It's featured at Medscape when there is a new host. More info, and the schedule for upcoming editions is available at Better Health Blog.

Thanks to See First for including my submission "Debate about ADHD Multimodal Treatment Study," and to Dr. Helen for linking back to my post.

Many Depressed Teens Go Untreated

According to a recent report from the 2007 SAMHSA National Survey on Drug Use and Health, during the past year, 8% of teenagers ages 12-17 experienced at least one episode of major depression defined as:
...a period of 2 weeks or longer in which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.
Even though 70% of the depressed teens reported severe impairment in daily functioning (chores at home, school or work, close relationships with family, or social life), only 39% received any mental health treatment!

Why did less than half of the depressed teens get help? The study points to at least one cause--lack of health insurance. Only 17% of uninsured, depressed teenagers obtained treatment. However, this does not explain why nearly 60% of teens covered by health insurance weren't treated.

The primary reason depressed teens don't get help is that neither they nor their parents recognize the source of their problems. It's easy to ascribe moodiness, irritability, lack of energy, and poor concentration to the stress and sleep deprivation experienced by today's over-scheduled teens.

In addition, the stigma of mental illness affects teenager's willingness to ask for help. Many suffer in silence and hide their pain from parents and friends. In an excerpt from Day for Night: Recognizing Teenage Depression, teens who have dealt with major depression describe the symptoms they had:

It's important for both teens and parents to become better informed about the symptoms and treatments for depression. The following publications from the National Institute on Mental Health are a good place to start. Because they are not currently available from NIMH, I've linked to pdf's on my website's Resources page:

Let's Talk About Depression

What to Do When A Friend is Depressed

Child Sexual Abuse Fact Sheet

The National Child Traumatic Stress Network recently updated their Child Sexual Abuse Fact Sheet - For Parents, Teachers, and Other Caregivers. It provides an overview of symptoms, disclosure, myths and facts, and safety education.

Myths and Facts

Free Dirty Forgotten Sad Child Creative Commons
Myth: Child sexual abuse is a rare experience.

Fact: Child sexual abuse is not rare. Retrospective research indicates that as many as 1 out of 4 girls and 1 out of 6 boys will experience some form of sexual abuse before the age of 18. However, because child sexual abuse is by its very nature secretive, many of these cases are never reported.

A child is most likely to be sexually abused by a stranger.

Fact: Children are most often sexually abused by someone they know and trust. Approximately three quarters of reported cases of child sexual abuse are committed by family members or other individuals who are considered part of the victim’s “circle of trust.”
Prevention Tips for Parents
  • Teach children accurate names of private body parts.
  • Avoid focusing exclusively on “stranger danger.” Keep in mind that most children are abused by someone they know and trust.
  • Teach children about body safety and the difference between “okay” and “not okay” touches.
  • Let children know that they have the right to make decisions about their bodies. Empower them to say no when they do not want to be touched, even in non-sexual ways (e.g., politely refusing hugs) and to say no to touching others.
  • Make sure children know that adults and older children never need help with their private body parts (e.g., bathing or going to the bathroom).
  • Teach children to take care of their own private parts (i.e., bathing, wiping after bathroom use) so they don’t have to rely on adults or older children for help.
  • Educate children about the difference between good secrets (like surprise parties—which are okay because they are not kept secret for long) and bad secrets (those that the child is supposed to keep secret forever, which are not okay).
  • Trust your instincts! If you feel uneasy about leaving a child with someone, don’t do it. If you’re concerned about possible sexual abuse, ask questions.

Howie Mandel on Stigma and Children's Mental Health

According to Mental Health America, 1 in 5 children and adolescents have a diagnosible mental health condition, yet only 1/3 of them get help. One reason is the stigma associated with having a mental illness.

Howie Mandel
, host of "Deal or No Deal," often talks about his own mental illnesses of obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). As ambassador for National Children's Mental Health Awareness Day (May 7, 2009), he speaks on the stigma of seeking help:

Because children and adolescents often don't tell anyone about troubling thoughts and feelings, it is up to adults to notice symptoms of possible mental illness. The U.S. Dept. of Health & Human Services' on-line publication Child and Adolescent Mental Health lists the following warnings signs:
A child or adolescent is troubled by feeling:
  • Sad and hopeless for no reason, and these feelings do not go away.
  • Very angry most of the time and crying a lot or overreacting to things.
  • Worthless or guilty often.
  • Anxious or worried often.
  • Unable to get over a loss or death of someone important.
  • Extremely fearful or having unexplained fears.
  • Constantly concerned about physical problems or physical appearance.
  • Frightened that his or her mind either is controlled or is out of control.
A child or adolescent experiences big changes, such as:
  • Showing declining performance in school.
  • Losing interest in things once enjoyed.
  • Experiencing unexplained changes in sleeping or eating patterns.
  • Avoiding friends or family and wanting to be alone all the time.
  • Daydreaming too much and not completing tasks.
  • Feeling life is too hard to handle.
  • Hearing voices that cannot be explained.
  • Experiencing suicidal thoughts.
A child or adolescent experiences:
  • Poor concentration and is unable to think straight or make up his or her mind.
  • An inability to sit still or focus attention.
  • Worry about being harmed, hurting others, or doing something "bad".
  • A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.
  • Racing thoughts that are almost too fast to follow.
  • Persistent nightmares.
A child or adolescent behaves in ways that cause problems, such as:
  • Using alcohol or other drugs.
  • Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.
  • Dieting and/or exercising obsessively.
  • Violating the rights of others or constantly breaking the law without regard for other people.
  • Setting fires.
  • Doing things that can be life threatening.
  • Killing animals.
The presence of one or more of the above symptoms indicates a need for further evaluation. Pediatricians and family physicians can refer families to psychiatrists or psychologists in their area who specialize in treating children and adolescents. For other resources, see Mental Health America's factsheet How Do I Find Treatment?