By the time a teenager graduates high school, about one out of nine of his or her peers has attempted suicide. Suicide is the third leading cause of death among young people, behind car accidents and homicide, and 10% to 12% of teens ponder suicide every day.
The issue: Some pediatricians and mental health professionals believe that many teen suicides can be prevented through a five- to 10-minute questionnaire that singles out at-risk teens for follow-up diagnosis and treatment.
TeenScreen, developed at Columbia University and already deployed in some schools and doctors offices in 43 states, is the most well-known program. It asks questions about symptoms related to depression, anxiety, drug use and suicidal thoughts.
In March, the U.S. Preventive Services Task Force, a government panel that reviews evidence and develops recommendations for preventive services, effectively reversed earlier rulings and recommended screening adolescents (ages 12 to 18) for major depressive disorder in doctor's offices, provided there are resources available for follow-up and treatment.
"It's a very strong endorsement of screening," says pediatrician Thomas DeWitt of the Children's Hospital Medical Center in Cincinnati, who led the national panel.
But the recommendations have done little to quell skepticism about suicide and depression screenings.
In 2005, TeenScreen became the subject of a lawsuit after Indiana parents sued their children's school for administering the test without their consent in a case that has yet to go to trial. Some mental health experts say screening will stigmatize the 28% to 44% of students flagged for suicide risk via the questionnaire even if follow-up fails to confirm their at-risk status.
Others note that normal adolescents are often moody and that overdiagnosis of major depressive disorder, which affects just 5.6% of teens, could lead to increased use of selective serotonin reuptake inhibitors, such as Prozac, that have been linked to and increased risk of suicide.
Others say that suitable treatment is not available to many who would be identified in school- or community-based screens, where methods have not proved as effective as in primary care settings.
Even if teenagers are properly identified, they say, drug treatments benefit only one in five teen patients, and it is not clear that resources are available to provide behavioral therapy as recommended by the task force.
