Mental Health in Adolescents

Mental health disorders are common among adolescents. Many adolescents have normal feelings of sadness and worry, and clinicians can provide reassurance to adolescents and families about the importance of navigating these feelings. However, depression and anxiety beyond normal feelings are common. Screening for these disorders is considered a routine part of adolescent health care (1, 2).

When feelings of anxiety and depression are pervasive and interfere with functioning (eg, at school, with relationships, at home), clinicians may diagnose an anxiety or depressive disorder. After assessment and diagnosis, clinicians may suggest behavioral treatment, pharmacotherapy, or both.

The COVID-19 pandemic and the global response to it, including disruptions in home and school schedules, were associated with increased rates of depression and anxiety among adolescents (3).

Suicidal ideation is also common among this patient population, and suicide was the second leading cause of death among 10- to 19-year-olds in the United States during the period from 2011 to 2020 (4). Clinicians can help mitigate suicide risk by including appropriate screening for mental health disorders, recognizing risk factors, and facilitating access to community resources.

Mood disorders and disruptive behavioral disorders (eg, oppositional defiant disorder, conduct disorder) often manifest during adolescence. These disorders are typically treated with psychotherapy for the child and advice and support for the parents and caregivers. Overdiagnosis of disruptive behavioral disorders is common because of bias (5).

Eating disorders, especially in girls, are common. Eating disorders are best managed by a specialized team that includes mental health professionals.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder and often persists into adolescence and adulthood. Research has shown poor long-term functional outcomes in children diagnosed with ADHD who are untreated or inadequately treated as compared to their peers (6). Behavioral therapy and medications can improve outcomes. Clinicians are cautioned to make the diagnosis of ADHD carefully before initiating treatment because other conditions, such as depression, anxiety, learning disabilities, and trauma, may manifest primarily with symptoms of inattention and can mimic ADHD. Because of the potential for misuse, stimulants should be prescribed only after a diagnosis of ADHD has been confirmed. Clinicians should continue to treat and monitor adolescents diagnosed with ADHD in childhood. Although substance use disorders are more common among people with ADHD, treating with stimulants does not appear to increase the risk of developing a substance use disorder and may even decrease the risk (7).

People with thought disorders (psychosis) will often present with a "psychotic break" during adolescence. Treatment includes a combination of medication, psychotherapy, and social support.

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.