A 17-year-old girl is brought to the office by her mother for a routine well-child visit. They have no concerns. The patient is in the tenth grade, and her grades are Bs and Cs. She participates in year-round soccer and has a well-varied diet. Menarche was at age 12, and menses are regular. The patient has been sexually active with 1 partner for the past 2 years, and she uses condoms consistently. She does not use alcohol, tobacco, or illicit drugs. Previous laboratory testing includes negative HIV, gonorrhea, and chlamydia results 6 months ago. Last year, due to reported fatigue, she had a complete blood count performed with normal results. This patient should be screened for which of the following conditions at this visit?
Routine adolescent screening | |
Category | Screening method* |
Mental health |
|
Sexual health |
|
Substance use |
|
Dyslipidemia |
|
Safety |
|
*Annually, unless otherwise indicated. | |
Adolescent well visits provide important opportunities to assess physical health and emotional well-being. Suicide is a leading cause of death in this age group, with depression as the greatest risk factor. Therefore, early recognition and treatment of depression are critical for suicide prevention.
Most adolescents experience transient mood symptoms due to dramatic social changes and increasing autonomy and responsibility; clinical depression occurs in about 10%. Risk factors include a family history of psychiatric disease, psychosocial stressors (eg, bullying), gender dysphoria, and certain comorbid conditions (eg, anxiety, substance use). Classic symptoms include depressed mood, loss of interest in activities, change in weight and sleep, and poor concentration. Adolescent-specific manifestations can include irritability, failure to gain an expected amount of weight, and academic decline. Many adolescents also have somatic symptoms such as abdominal pain and headache.
However, depression often goes unnoticed in adolescents because symptoms are often attributed to normal teenage stress. Therefore, all adolescents age ≥12 should undergo an annual depression screening with a validated screening questionnaire. If screening is not performed or if depression is untreated, symptoms may worsen and become life-threatening (Choice F).
(Choice A) Rating scales, such as the Vanderbilt Assessment Scales, can be used to screen for attention deficit hyperactivity disorder (ADHD) in patients with impaired functioning due to hyperactivity or inattention. However, this family has no concerns, and routine ADHD screening is not recommended.
(Choice B) Routine screening for cervical dysplasia and human papillomavirus (HPV) via Pap test is recommended in women age ≥21. In patients age <21, rates of cervical cancer are extremely low, and HPV and cervical dysplasia typically regress spontaneously.
(Choice C) Sexually active girls and women should receive annual chlamydia and gonorrhea screening until age 25. This patient was recently tested and has had no new partners or symptoms, findings making repeat testing unnecessary at this time.
(Choice E) Screening for iron deficiency anemia is performed at age 1 and can be considered once in adolescent girls due to blood loss from menses. This patient has normal menses with a normal hemoglobin last year, making repeat testing unnecessary.
Educational objective:
Early recognition and treatment of depression can prevent suicide, a major cause of death in adolescents. Therefore, all adolescents age ≥12 should be screened annually for depression.