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Overview of Psychosocial Problems in Adolescents

By Sharon Levy, MD, MPH, Assistant Professor of Pediatrics; Director, Adolescent Substance Abuse Program, Harvard Medical School; Boston Children's Hospital

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Clinicians must be aware of the high frequency of psychosocial disorders that occur during this stage of life. Screening for mental health disorders is considered a routine part of adolescent health care. Depression is common and should be screened for actively. Although suicide is a rare occurrence (5/100,000), suicidal ideation is common, with as many as 10% of adolescents reporting thoughts about suicide in their lifetime according to some studies. Anxiety often manifests during adolescence, as do mood disorders and disruptive behavioral disorders (eg, oppositional defiant disorder, conduct disorder). Individuals with thought disorders (psychosis) will often present with a "psychotic break" during adolescence. Eating disorders, especially in girls, are common. Some patients go to extraordinary lengths to hide symptoms of an eating disorder.

The clinician who has developed an open, trusting relationship with an adolescent often can identify these problems, develop a therapeutic relationship, offer practical advice and, when appropriate, encourage the adolescent to accept a referral to specialized care.