Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them.
"It's a huge problem," says Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist and associate professor at Columbia University.
To address this divide, the American Academy of Pediatrics has issued updated guidelines this week that call for universal screening for depression.
"What we're endorsing is that everyone, 12 and up, be screened ... at least once a year," Zuckerbrot says. The screening, she says, could be done during a well-visit, a sports' physical or during another office visit.
Zuckerbrot helped write the guidelines, which have been in development for a while. The U.S. Preventive Services Task Force also recommends depression screening, and many pediatricians have already woven the screenings into their practices.
"Teenagers are often more honest when they're not looking somebody in the face who's asking questions," about their emotional health Zuckerbrot says. So, most pediatricians use a self-reported questionnaire that teens fill out themselves, either on an electronic device or on paper.
"It's an opportunity for the adolescent to answer questions about themselves privately," she says.
The questionnaires contain a range of questions. For instance, one version, asks: 'Over the past two weeks, how often have you been bothered by any of the following problems: feeling down, depressed or hopeless? Or, little interest or pleasure in doing things?' Teens are also asked questions such as, 'Are you having difficulty with sleep, either too much or too little?' 'Any problems with eating?'
The new recommendations also call for families with a depressed teen to develop a safety plan to restrict the young person's access to lethal means of harm. Suicide is a leading cause of death for children aged 10 to 17, and "adolescent suicide risk is strongly associated with firearm availability," according to an AAP report.
There's growing awareness in the U.S. of the need for young people to have good access to mental health care, says Dr. Doug Newton, a child psychiatrist at Kaiser Permanente in Colorado. "As a nation this has become part of the dialogue; it increasing"
"People are aware of what's happening in our schools and the importance of mental health," Newton says. Kaiser Permanente has a stigma-reduction campaign called Find Your Words.
"Stigma is a huge challenge," he says, "specifically for adolescents. Often times they're not coming in to get help because of the stigma attached."
It's not easy to talk about depression, yet the problem is fairly common. During the teenage years, there's about a 20 percent [chance] of having depression or anxiety, research suggests.
"It's highly prevalent," Newton says. The goal of the "Find Your Words" campaign is to help make depression easier for everyone to talk about.
Another challenge to diagnosis is that families often don't detect depression, or they confuse it for something else.
"Sometimes teens are acting out or misbehaving," Zuckerbrot says. They're seen as being hostile or bad. "When, instead, they're really suffering from depression."