WASHINGTON, DC—Military providers are concerned about how the stress of war may be affecting the mental health of teenagers of military parents. Colonel Kris Peterson, the Army Surgeon General’s Consultant for Child and Adolescent Psychiatry and Chief of Psychiatry at Madigan Army Medical Center, says studies on military children show that they are experiencing increased anxiety and depression.

For teenagers, the Army data show that there is “significant increased utilization of both outpatient mental health and inpatient services,” over the last eight years, according to Dr Peterson. The data indicate that inpatient mental health days have almost doubled for teenagers ages 15 to 17 from 2003 to 2008. “You look at the demands on military families…with multiple deployments of parents—both moms and dads. You look at both children and teenagers, and my expectation would be that there would be a significant impact,” he said.

Reaching Teens

A clinically depressed teen differs from a moody teen. While a moody teenager may experience a wide range of emotions, depression symptoms include feeling sad, a loss of energy, and decreased interest in activities for a period of 2 weeks or more.

Young people who suffer from depression may have a hard time dealing with their daily activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Untreated clinical depression can lead to school failure, alcohol or other drug use, and even suicide. According to SAMHSA’s National Mental Health Information Center, nationally, 10% to 15% of children and adolescents have some symptoms of depression at any given point in time.

Teenagers who are experiencing the impact of deployments and who have become depressed may be reluctant to seek help. “With teenagers, I think you begin moving into a realm where they are looking at themselves and how they fit in the world. I think that becomes one of the difficulties in dealing with mental health with teenagers—how autonomous they are. They are working through that breaking away phase, and at the same time, they still need their parents,” said Dr Peterson.

In addition, in some areas, finding mental health services for young people is challenging due to a shortage of mental health care providers.

The need for specific programs to support the mental health needs for military youth is a relatively new phenomenon. Doctor Peterson noted that prior to the current conflicts, military families often consisted of young active duty soldiers and their spouses, and fewer children. “From ’91 to the present, we have really grown the Army in a positive way, in which the Army is one of volunteers, and they have a lot of kids. It was not until 2003 that we arrived at a point where we were stressing them out over and over again with deployments,” he said.

Center to Help Teens

One Army effort to tackle the issue of mental health for young people is through the Military Child and Adolescent Center of Excellence, which is a center that was established last year at Madigan. The center is still under development, and was about 20% staffed as of last month, but is seeking to expand.

The center is working to build systems of care to address the mental health needs of military children by providing technical assistance to professionals who serve military youth, and by building capacity for care of youth within the military health care system. Earlier this year, the center held its second annual Military Child and Adolescent Summit, where military and civilian experts presented research and highlighted the challenges facing young people.

The center is applying a multidisciplinary approach to its work. Personnel who serve youth from a variety of disciplines are working to find programs that will address the needs of young people and are charting the way forward in developing initiatives supporting child and adolescent behavioral health. A multidisciplinary approach is especially important, given a national shortage of mental health care providers. “We realize that with the shortages we have in the subspecialty arena, we need to utilize and synergize with our primary care colleagues in family medicine and pediatrics to extend them and ourselves in the realm of behavioral health,” said Dr Peterson.

US Preventive Services Task Force Recommendations

Earlier this year, the US Preventive Services Task Force issued a recommendation to screen adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment, and follow-up care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression. The recommendations and the accompanying summary of evidence appeared in the April issue of Pediatrics.

The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting, and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age.

Clinical depression lowers the quality of life among children and adolescents. Depression can cause difficulties in school and family and social relationships. Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24, and the sixth-leading cause of death among those ages 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood. Nearly 6% of adolescents 13 to 18 years of age are clinically depressed, and it is more common among girls than boys.

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