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Docs Say They're Ill Prepared to Spot Mental Problems in Teens

Half don't ask their young patients about their well-being

FRIDAY, Jan. 9, 2004 (HealthDayNews) -- Many doctors aren't confident of their abilities to diagnose and treat mental illness in teens, especially when the disorders are serious, a new survey of family physicians and pediatricians finds.

Only half of the doctors said they always make a point of asking adolescent patients about their emotional well-being during exams. And three of four admitted they weren't very good at detecting drug abuse.

But doctors don't necessarily deserve blame for their shortcomings, says a teen health expert whose university helped produce the survey. Many physicians don't have the proper training to diagnose mental illness and are too rushed during check-ups, says Daniel Romer, research director of the University of Pennsylvania's Adolescent Risk Communication Institute.

"There's only so much they can do," Romer says. "If a parent doesn't say, 'My son or daughter has a problem or needs a referral,' unless they get a push, they don't have time to pursue it. They're just too busy."

The survey of 506 primary-care physicians, released this week at a conference on adolescent mental health in Rancho Mirage, Calif., is the most extensive of its kind in years, Romer says. He adds it provides new information about why teens with emotional problems -- estimates vary, but they may make up 10 percent of teens at any one time -- aren't always diagnosed.

"We know that a lot of kids aren't getting treated, but it's not always clear why," he says.

The survey, conducted between September and December 2003, found that fewer than half of doctors felt "very capable" at diagnosing major mental disorders. While 46 percent were confident of detecting depression, fewer than 20 percent thought the same way about schizophrenia and bipolar disorder.

On the other hand, 68 percent of the doctors ranked their knowledge of mental disorders as "good" or "excellent" and 78 percent said they're "very comfortable" about talking to their patients about mental disorders.

Dr. Neil S. Alex, a child psychiatrist with the Kaiser Permanente Health Plan in San Diego, says it's true physicians are pressed for time when they see adolescents -- or other patients for that matter. But he wonders if doctors in the survey might have been too hard on themselves.

"They're not as bad as they think they are," he says. Many doctors, especially experienced ones, become attuned to seemingly little changes in their patients and offer help by consulting a mental-health expert or giving a referral to a patient, he explains.

But, Alex adds, doctors don't always probe the inner lives of teens by asking them questions without their parents in the room. "They need to ask the kids what their concerns are, and to do that you need to interview the kids separately, particularly if you want to get drug and alcohol information," he says. "The same thing goes for talking about suicidal feelings. They'll talk about it, but not in their parents' presence."

When doctors do miss mental problems, he says, the illnesses are typically anxiety and depression, which may masquerade as other problems such as digestive complaints and headaches.

More information

Learn more about teen mental health from Indiana University and the American Academy of Family Physicians.

SOURCES: Daniel Romer, Ph.D., research director, Adolescent Risk Communication Institute, University of Pennsylvania, Philadelphia; Neil S. Alex, M.D., child psychiatrist, Department of Psychiatry and Addiction Medicine, Kaiser Permanente Health Plan, San Diego; Jan. 8-11, 2004, presentation, Adolescent Mental Health Initiative international summit, Rancho Mirage, Calif.
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