Archive
More than one in five parents believe they have little influence in preventing teens from using illicit substances
Source: Substance Abuse and Mental Health Services Administration
A new report indicates that more than one in five parents of teens aged 12 to 17 (22.3 percent) think what they say has little influence on whether or not their child uses illicit substances, tobacco, or alcohol. This report by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows one in ten parents said they did not talk to their teens about the dangers of using tobacco, alcohol, or other drugs even though 67.6 percent of these parents who had not spoken to their children thought they would influence whether their child uses drugs if they spoke to them.
In fact national surveys of teens ages 12 to 17 show that teens who believe their parents would strongly disapprove of their substance use were less likely to use substances than other. For example, current marijuana use was less prevalent among youth who believed their parents would strongly disapprove of their trying marijuana once or twice than among youth who did not perceive this level of disapproval (5.0 percent vs. 31.5 percent).
Declines in State Teen Birth Rates by Race and Hispanic Origin
Declines in State Teen Birth Rates by Race and Hispanic Origin
Source: National Center for Health Statistics
Key findings
- Teen birth rates fell at least 15% for all but two states during 2007–2011—the most recent period of sustained decline; rates fell 30% or more in seven states.
- Declines in rates were steepest for Hispanic teenagers, averaging 34% for the United States, followed by declines of 24% for non-Hispanic black teenagers and 20% for non-Hispanic white teenagers.
- The long-term difference between birth rates for non-Hispanic black and Hispanic teenagers has essentially disappeared, and by 2011 their rates were similar.
Rates for Hispanic teenagers fell 40% or more in 22 states and the District of Columbia (DC); rates dropped at least 30% in 37 states and DC.
Teen birth rates fell steeply in the United States from 2007 through 2011, resuming a decline that began in 1991 but was briefly interrupted in 2006 and 2007. The overall rate declined 25% from 41.5 per 1,000 teenagers aged 15–19 in 2007 to 31.3 in 2011—a record low. The number of births to teenagers aged 15–19 also fell from 2007 to 2011, by 26% to 329,797 in 2011. Births to teenagers are at elevated risk of low birthweight, preterm birth, and of dying in infancy compared with infants born to women aged 20 and over (1–3), and they are associated with significant public costs, estimated at $10.9 billion annually (4). Recent trends by state and race and Hispanic origin are illustrated using the most current available data from the National Vital Statistics System.
Teens, Social Media, and Privacy
Teens, Social Media, and Privacy
Source: Pew Internet & American Life Project
Teens are sharing more information about themselves on social media sites than they have in the past, but they are also taking a variety of technical and non-technical steps to manage the privacy of that information. Despite taking these privacy-protective actions, teen social media users do not express a high level of concern about third-parties (such as businesses or advertisers) accessing their data; just 9% say they are “very” concerned.
Incidence of Childhood and Adolescent Melanoma in the United States: 1973–2009
Incidence of Childhood and Adolescent Melanoma in the United States: 1973–2009
Source: Pediatrics
OBJECTIVE:
Childhood and adolescent melanoma is rare but has been increasing. To gain insight into possible reasons underlying this observation, we analyzed trends in melanoma incidence diagnosed between the ages of 0 and 19 years among US whites by gender, stage, age at diagnosis, and primary site. We also investigated incidence trends by UV-B exposure levels.
METHODS:
By using Surveillance, Epidemiology, and End Results (SEER) program data (1973–2009), we calculated age-adjusted incidence rates (IRs), annual percent changes, and 95% confidence intervals for each category of interest. Incidence trends were also evaluated by using joinpoint and local regression models. SEER registries were categorized with respect to low or high UV-B radiation exposure.
RESULTS:
From 1973 through 2009, 1230 children of white race were diagnosed with malignant melanoma. Overall, pediatric melanoma increased by an average of 2% per year (95% confidence interval, 1.4%–2.7%). Girls, 15- to 19-year-olds, and individuals with low UV-B exposure had significantly higher IRs than boys, younger children, and those living in SEER registries categorized as high UV-B. Over the study period, boys experienced increased IRs for melanoma on the face and trunk, and females on the lower limbs and hip. The only decreased incidence trend we observed was among 15- to 19-year-olds in the high UV-B exposure group from 1985 through 2009. Local regression curves indicated similar patterns.
CONCLUSIONS:
These results may help elucidate possible risk factors for adolescent melanoma, but additional individual-level studies will be necessary to determine the reasons for increasing incidence trends.
Mental Health Surveillance Among Children — United States, 2005–2011
Mental Health Surveillance Among Children — United States, 2005–2011
Source: Morbidity and Mortality Weekly Report (CDC)
Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12–17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005–2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.
Attention-deficit/hyperactivity disorder (6.8%) was the most prevalent parent-reported current diagnosis among children aged 3–17 years, followed by behavioral or conduct problems (3.5%), anxiety (3.0%), depression (2.1%), autism spectrum disorders (1.1%), and Tourette syndrome (0.2% among children aged 6–17 years). An estimated 4.7% of adolescents aged 12–17 years reported an illicit drug use disorder in the past year, 4.2% had an alcohol abuse disorder in the past year, and 2.8% had cigarette dependence in the past month. The overall suicide rate for persons aged 10–19 years was 4.5 suicides per 100,000 persons in 2010. Approximately 8% of adolescents aged 12–17 years reported ≥14 mentally unhealthy days in the past month.
Future surveillance of mental disorders among children should include standard case definitions of mental disorders to ensure comparability and reliability of estimates across surveillance systems, better document the prevalence of mental disorders among preschool-age children, and include additional conditions such as specific anxiety disorders and bipolar disorder. Standard surveillance case definitions are needed to reliably categorize and count mental disorders among surveillance systems, which will provide a more complete picture of the prevalence of mental disorders among children. More comprehensive surveillance is needed to develop a public health approach that will both help prevent mental disorders and promote mental health among children.
The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature
The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature
Source: Archives of Suicide Research
In this review, we explore social contagion as an understudied risk factor for non-suicidal self-injury (NSSI) among adolescents and young adults, populations with a high prevalence of NSSI. We review empirical studies reporting data on prevalence and risk factors that, through social contagion, may influence the transmission of NSSI. Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics. Preliminary research suggests iatrogenic effects of social contagion of NSSI through primary prevention are not likely. Thus, social contagion factors may warrant considerable empirical attention. Intervention efforts may be enhanced, and social contagion reduced, by implementation of psychoeducation and awareness about NSSI in schools, colleges, and treatment programs.
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Preventing Youth Violence and Dropout: A Randomized Field Experiment
Preventing Youth Violence and Dropout: A Randomized Field Experiment
Source: National Bureau of Economic Research
Improving the long-term life outcomes of disadvantaged youth remains a top policy priority in the United States, although identifying successful interventions for adolescents – particularly males – has proven challenging. This paper reports results from a large randomized controlled trial of an intervention for disadvantaged male youth grades 7-10 from high-crime Chicago neighborhoods. The intervention was delivered by two local non-profits and included regular interactions with a pro-social adult, after-school programming, and – perhaps the most novel ingredient – in-school programming designed to reduce common judgment and decision-making problems related to automatic behavior and biased beliefs, or what psychologists call cognitive behavioral therapy (CBT). We randomly assigned 2,740 youth to programming or to a control group; about half those offered programming participated, with the average participant attending 13 sessions. Program participation reduced violent-crime arrests during the program year by 8.1 per 100 youth (a 44 percent reduction). It also generated sustained gains in schooling outcomes equal to 0.14 standard deviations during the program year and 0.19 standard deviations during the follow-up year, which we estimate could lead to higher graduation rates of 3-10 percentage points (7-22 percent). Depending on how one monetizes the social costs of crime, the benefit-cost ratio may be as high as 30:1 from reductions in criminal activity alone.
Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study
Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study
Source: Pediatrics
OBJECTIVE: To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs.
METHODS: Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone.
RESULTS: Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status.
CONCLUSIONS: Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.
Young men’s attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services.
Source: BMC Psychiatry
Background
This mixed-methods study was designed to explore young Australian men’s attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.
Methods
National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).
Results
Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.
Conclusions
The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men’s views and everyday technology practices, and leverage the influence of peers.
College Enrollment and Work Activity of 2012 High School Graduates
College Enrollment and Work Activity of 2012 High School Graduates
Source: Bureau of Labor Statistics
In October 2012, 66.2 percent of 2012 high school graduates were enrolled in colleges or universities, the U.S. Bureau of Labor Statistics reported today. Recent high school graduates not enrolled in college in October 2012 were more likely than enrolled graduates to be working or looking for work (69.6 percent compared with 38.2 percent).
Disparities in access to healthcare for teens
Disparities in access to healthcare for teens
Source: National Voices Project
Survey participants were asked how much availability there is in their communities for children and teens to receive healthcare services. More than half of all respondents note that there is “lots of availability” for teens to have hospital care (55%) and primary care (56%) in their communities, but across all healthcare services, only 30% of respondents reported “lots of availability” for mental health care. Healthcare availability for children was very similar.
National Teen Driving Report Finds Safety Gains for Teen Passengers
National Teen Driving Report Finds Safety Gains for Teen Passengers
Source: Children’s Hospital of Philadelphia
A new report on teen driver safety released today by The Children’s Hospital of Philadelphia (CHOP) and State Farm® shows encouraging trends among teen passengers. In 2011 more than half of teen passengers (54 percent) reported “always” buckling up. From 2008 to 2011, risky behaviors of teen passengers (ages 15 to 19 years) declined: the number of teen passengers killed in crashes not wearing seat belts decreased 23 percent; the number of teen passengers driven by a peer who had been drinking declined 14 percent; and 30 percent fewer teen passengers were killed in crashes involving a teen driver. Overall, the report measured a 47 percent decline in teen driver-related fatalities over the past six years. Still, as recent high-profile multi-fatality crashes with teen drivers illustrate, crashes remain the leading cause of death for U.S. teens.
Vital Signs: Repeat Births Among Teens — United States, 2007–2010
Vital Signs: Repeat Births Among Teens — United States, 2007–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Background: Teen childbearing has potential negative health, economic, and social consequences for mother and child. Repeat teen childbearing further constrains the mother’s education and employment possibilities. Rates of preterm and low birth weight are higher in teens with a repeat birth, compared with first births.
Methods: To assess patterns of repeat childbearing and postpartum contraceptive use among teens, CDC analyzed natality data from the National Vital Statistics System (NVSS) and the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007–2010.
Results: Based on 2010 NVSS data from all 50 states and the District of Columbia, of more than 367,000 births to teens aged 15–19 years, 18.3% were repeat births. The percentage of teen births that represented repeat births decreased by 6.2% between 2007 and 2010. Disparities in repeat teen births exist by race/ethnicity, with the highest percentages found among American Indian/Alaska Natives (21.6%), Hispanics (20.9%), and non-Hispanic blacks (20.4%) and lowest among non-Hispanic whites (14.8%). Wide geographic disparities in the percentage of teen births that were repeat births also exist, ranging from 22% in Texas to 10% in New Hampshire. PRAMS data from 16 reporting areas (15 states and New York City) indicate that 91.2% of teen mothers used a contraceptive method 2–6 months after giving birth, but only 22.4% of teen mothers used the most effective methods. Teens with a previous live birth were significantly more likely to use the most effective methods postpartum compared with those with no prior live birth (29.6% versus 20.9%, respectively). Non-Hispanic white and Hispanic teens were significantly more likely to use the most effective methods than non-Hispanic black teens (24.6% and 27.9% versus 14.3%, respectively). The percentage of teens reporting postpartum use of the most effective methods varied greatly geographically across the PRAMS reporting areas, ranging from 50.3% in Colorado to 7.2% in New York State.
Conclusions: Although the prevalence of repeat teen birth has declined in recent years, nearly one in five teen births is a repeat birth. Large disparities exist in repeat teen births and use of the most effective contraceptive methods postpartum, which was reported by fewer than one out of four teen mothers.
Implications for Public Health Practice: Evidence-based approaches are needed to reduce repeat teen childbearing. These include linking pregnant and parenting teens to home visiting and similar programs that address a broad range of needs, and offering postpartum contraception to teens, including long-acting methods of reversible contraception.
Perceptions Of Young Adolescent Sexual Activity Are Greatly Exaggerated
Perceptions Of Young Adolescent Sexual Activity Are Greatly Exaggerated
Source: Guttmacher Institute
Sexual activity is and has long been rare among the youngest adolescents, according to "Sexual Initiation, Contraceptive Use and Pregnancy Among Young Adolescents," by Lawrence B. Finer and Jesse M. Philbin of the Guttmacher Institute, published online in the journal Pediatrics. Very few early adolescents (both boys and girls) have had sex (0.6% of 10-year-olds, 1.1% of 11-year-olds and 2.4% of 12-year-olds), and the incidence of pregnancy among girls aged 12 or younger is minuscule. But adolescence is a time of rapid change, and sexual activity is more common among older teens, including one-third (33%) of those aged 16, nearly half (48%) of those aged 17, and 61% and 71% of 18- and 19-year-olds, respectively.
Moreover, this pattern has prevailed for decades: A low level of sexual activity among young adolescents has long been the norm, while sexual initiation later in adolescence has been and remains a normal part of teens’ development process. At the same time, however, recent cohorts have delayed starting sex; in the current cohort of adolescents, the likelihood of sexual activity at any given age is lower than at any time in the past 25 years.
Preserving and Enhancing the Responsible Conduct of Research Involving Children and Youth: A Response to Proposed Changes in Federal Regulations
Source: Society for Research in Child Development
For the first time in twenty years the U.S. Department of Health and Human Services (DHHS, 2009) is considering changes to federal regulations governing research. The Common Rule provides the basis for government regulations and Institutional Review Boards (IRB). Proposed changes will have a significant impact on Institutional Review Board evaluation of research involving infants, children and adolescents. For example, such a revision can serve to rectify or exacerbate often observed IRB inconsistencies and over-estimation of probable harms when applying “minimal risk” or “exempt” criteria to research involving minors. Proposed revisions may also affect the feasibility of research on adolescent risk that requires waiver of parental or guardian permission to be successfully implemented. Further, recommendations for a new category of “informational risk” based on current and emerging advances in analysis and storage of bio-specimens and information technologies for archival research will have significant influence on ethical procedures required for collection and storage of longitudinal and cross-sectional data. Given the importance of any rule change to the con – duct of science related to children, the Society for Research in Child Development (SRCD) convened the SRCD Task Force on Proposed Changes to the Common Rule. The purpose of this report is to alert policymakers, scientists, and participant groups to proposed changes most relevant to research involving children and to provide recommendations for ensuring the responsible conduct of child and adolescent research in the final regulatory changes.
12th grade dropouts have higher rates of cigarette, alcohol and illicit drug use
12th grade dropouts have higher rates of cigarette, alcohol and illicit drug use
Source: Substance Abuse and Mental Health Services Administration
Youth in the 12th grade age range (ages 16 to 18} who have dropped out of school prior to graduating are more likely than their counterparts to be current users of cigarettes, alcohol, marijuana and other illicit drugs, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The report considers those who reported use in the past month to be current users. For example, dropouts in this age group are more than twice as likely to be current smokers as youth continuing with their education (56.8 percent versus 22.4 percent).
The report also shows significant differences between the levels of illicit drug use between dropouts and those remaining in school. Overall current illicit drug use among dropouts was considerably higher than for those in school (31.4 percent versus 18.2 percent). Dropouts were more likely to be current marijuana users than those in school (27.3 percent versus 15.3 percent), and more likely to be current non-medical users of prescription drugs (9.5 percent versus 5.1 percent).
Similarly, there were significant differences in the levels of alcohol use between dropouts and those in school. Dropouts had higher overall levels of current alcohol use than students (41.6 percent versus 35.3 percent) and higher rates of current binge drinking (32.3 percent versus 23.8 percent). Binge drinking is defined as drinking five or more drinks on the same occasion on at least one day in the past 30 days.
New Study: Teen Driver Deaths Increase in 2012
New Study: Teen Driver Deaths Increase in 2012
Source: Governors Highway Safety Association
A report released today by the Governors Highway Safety Association (GHSA) reveals that the number of 16- and 17-year-old driver deaths in passenger vehicles increased dramatically for the first six months of 2012, based on preliminary data supplied by all 50 states and the District of Columbia. Overall, 16- and 17-year-old driver deaths increased from 202 to 240 – a 19 percent jump.
The new report – the first state-by-state look at teen driver fatalities in 2012 – was completed by Dr. Allan Williams, a researcher who formerly served as chief scientist at the Insurance Institute for Highway Safety. Dr. Williams surveyed GHSA members, who reported fatality numbers for every state and D.C. The increase in teen driver deaths coincides with a projection from the National Highway Traffic Safety Administration (NHTSA) in which all traffic deaths increased by 8 percent. It is particularly concerning that 16- and 17-year-old driver deaths appear to have increased at an even greater rate.
Deaths of 16-year-old drivers increased from 86 to 107 (a 24 percent change), while the number for 17-year-old drivers went from 116 to 133 (a 15 percent change), a cumulative increase of 19 percent. Twenty-five states reported increases, 17 had decreases, and eight states and the District of Columbia reported no change in the number of 16- and 17-year-old driver deaths.
Developmental Trends in Peer Victimization and Emotional Distress in LGB and Heterosexual Youth
Developmental Trends in Peer Victimization and Emotional Distress in LGB and Heterosexual Youth
Source: Pediatrics
OBJECTIVES: This study had 2 objectives: Our first objective was to provide the first evidence of developmental trends in victimization rates for lesbian, gay, and bisexual (LGB)- and heterosexual-identified youth, both in absolute and relative terms, and to examine differences by gender. Our second objective was to examine links between victimization, sexual identity, and later emotional distress.
METHODS: Data are from a nationally representative prospective cohort study of youth in England were collected annually between 2004 and 2010. Our final analytic dataset includes 4135 participants with data at all 7 waves; 4.5% (n = 187) identified as LGB. Analyses included hierarchical linear modeling, propensity score matching, and structural equation modeling.
RESULTS: LGB victimization rates decreased in absolute terms. However, trends in relative rates were more nuanced: Gay/bisexual-identified boys became more likely to be victimized compared with heterosexual-identified boys (wave 1: odds ratio [OR] = 1.78, P = .011; wave 7: OR = 3.95, P = .001), whereas relative rates among girls approached parity (wave 1: OR = 1.95, P = .001; wave 7: OR = 1.18, P = .689), suggesting different LGB–heterosexual relative victimization rate trends for boys and girls. Early victimization and emotional distress explained about 50% of later LGB–heterosexual emotional distress disparities for both boys and girls (each P < .015).
CONCLUSIONS: Victimization of LGB youth decreases in absolute, but not necessarily relative, terms. The findings suggest that addressing LGB victimization during adolescence is critical to reducing LGB–heterosexual emotional distress disparities but additional support may be necessary to fully eliminate these disparities.
“Looking Forward” Memos Provide Recommendations for Policy and Research
“Looking Forward” Memos Provide Recommendations for Policy and Research
Source: MDRC
At a time when limited government resources demand that the nation make the most of investments in social and education programs, policymakers increasingly need to make decisions on the basis of reliable evidence. MDRC has developed two-page memos for policymakers that suggest ways to make progress on critical issues. The first seven are below. Additional memos in the “Looking Forward” series will be released in the coming weeks.
How do we make the most of the promise of preschool, particularly as preschool programs become universal? How do we avoid the “fade out” of early positive effects as children transition to elementary school? This policy memo describes how enhancing children’s social and emotional development and their early math skills may be part of the answer.
Past and ongoing research offers direction for how to strengthen the most basic foundation for early childhood development: family relationships. This policy memo makes the case for building on this accumulating evidence to create new and innovative approaches to support children’s earliest years and the unique role of fathers.
Building Better Programs for Disconnected Youth
Almost 7 million 16- to 24-year-olds are neither working nor in school. This policy memo argues that, while the research evidence on youth programs is mixed, there are some promising findings — and a resurgence in political interest — on which to build.
Developmental Education: A Barrier to a Postsecondary Credential for Millions of Americans
Too many community college students arrive on campus unprepared, get placed into developmental (or remedial) courses, and never complete a credential, graduate, or transfer to a four-year institution. This policy memo calls for bolder action to learn what works to improve developmental education.
Helping Students Pay for College — and Achieve Better Outcomes
America faces a two-pronged problem in higher education: increasing costs and low completion rates. This policy memo describes how offering financial aid that rewards academic progress may help students pay for college and complete their degrees more quickly.
Subsidized Employment: A Strategy for Bad Economic Times and for the Hard-to-Employ
Subsidized employment programs provide jobs to people who cannot find employment in the regular labor market and use public funds to pay all or some of their wages. This policy memo describes how these programs may be part of the answer for the long-term unemployed in the aftermath of the Great Recession.
Building Knowledge About Successful Prisoner Reentry Strategies
The 700,000 incarcerated prisoners released each year face considerable obstacles to successfully reintegrating into their communities, and many return to prison. While state and federal agencies have mounted ambitious prisoner reentry initiatives, this policy memo explains that there is still much to learn about what works.
Assessment, Referral, and Treatment of Suicidal Adolescents
Assessment, Referral, and Treatment of Suicidal Adolescents
Source: Pediatric Annals
Suicide is the third leading cause of death among adolescents.1 Most youth who complete a suicide never came into contact with a mental health professional prior to their death by suicide. Pediatricians are ideally suited to screen high-risk adolescents for suicide because of their position as first-line providers that are most likely to encounter a previously undiagnosed case.2
However, studies suggest that screening of distressed adolescents is underutilized in the primary care setting. By one account, only 23% of providers routinely screened for suicide risk factors.3 Barriers to screening include a shortage of time and discomfort about adequately assessing suicide risk. A lack of mental health resources, including adequate numbers of child and adolescent psychiatrists across the nation, have led to the development of collaborative models of care to assist primary care providers in treating psychiatric disorders. Initial studies on these models indicate they lead to more frequent screening for mental health disorders.4
Education of medical professionals has had promising results in reducing suicide rates.5 An understanding of risk factors, protective factors, interviewing, and safety planning for a suicidal adolescent is essential for preparing general pediatric practitioners to address this important public health issue.
In 2009, there were 4,371 completed suicides in the United States in the age group 15 to 24 years, making it the third leading cause of death in this population.1 As many as 62% of patients younger than the age of 35 years who died by suicide had been in contact with a primary care provider in the year before their death; 23% of them were seen by a primary care provider in the month before their death.2 It is estimated that there are between 100 and 200 attempts for each completed suicide.6
The annual physical exam is an ideal forum in which to assess high-risk youth for suicide, but most patients report they are not being screened for emotional issues.7 Discomfort around assessing suicidal risk may have worsened after the Food and Drug Administration (FDA) issued a black box warning on antidepressant use in children and adolescents in 2004, stating, “the increased risk of suicidal thoughts and behavior (‘suicidality’) in children and adolescents being treated with antidepressant medications.”8 This advisory did not recommend against using selective serotonin reuptake inhibitors (SSRIs) in adolescents, but it did recommend close follow-up after initiating an SSRI. Following this warning, the treatment of depression in adolescents with SSRIs decreased by 16% in the following 2 years. Population-based studies have demonstrated a concurrent increase of completed suicides by 18.2% following a steady decline from the mid-1990s to 2004.9
The US Preventive Services Task Force (USPSTF) states that there is insufficient evidence to recommend routine suicide screening in primary care. However, the task force suggests that pediatricians “perform routine depression screenings for adolescents aged 12 to 18 years when appropriate services are in place to ensure accurate diagnosis, treatment and follow-up care.”10 The American Academy of Child and Adolescent Psychiatry (AACAP) and the American Academy of Pediatrics (AAP) Task Force on Mental Health jointly published an article, recommending that primary care providers (PCPs) complete routine behavioral screening for adolescents, as long as appropriate mental health follow-up services were available.11
Implementing these suggestions will require further education for pediatricians on recognizing warning signs for suicide and identifying, evaluating, and treating emotional disorders.
