Adolescent Mental Health
Approximately 50% of mental health issues manifest by age 14.
This section covers prevalence, screening tools, key clinical presentations, and confidentiality guidance for practitioners working with young people.
Screening & Validated Instruments
Approximately 50% of mental health issues manifest by age 14. It is recommended to perform annual screening utilising validated instruments.
Depression Screening
Patient Health Questionnaire — Adolescent version. Validated instrument for annual depression screening in adolescents.
Anxiety Screening
Generalised Anxiety Disorder 7-item scale. Recommended for annual anxiety screening alongside depression assessment.
Substance Use
Validated for individuals aged 9–21. Screen alongside mental health at every visit — co-occurrence is common.
Suicide Risk
Columbia Suicide Severity Rating Scale. Evaluate intent, means, plan, and protective factors at every clinical visit.
Recognising & Managing Key Conditions
Depression & Anxiety
Depression in adolescents may be characterised by irritability instead of typical sadness. Anxiety disorders are the most frequently diagnosed conditions. Initial treatment: psychotherapy (CBT). Pharmacotherapy (SSRIs) indicated for moderate-to-severe or treatment-resistant cases. Start low dose and closely monitor in the first month.
Eating Disorders
Highest incidence between ages 14 and 18. Anorexia nervosa has the highest mortality rate of all psychiatric illnesses. Monitor: bradycardia, electrolyte imbalances (low potassium and phosphate), bone density loss, and amenorrhea. A collaborative, multidisciplinary team approach is essential.
Suicide & Self-Harm
Suicide is a primary cause of death among young people. Evaluate intent, means, plan, and protective factors at every clinical visit. Always ask about suicide directly — doing so does not increase risk. A safety plan should be created jointly with the patient and their family.
Psychosis & Emerging Illness
Early intervention is critical for first episode psychosis. Look for prodromal indicators: social withdrawal, declining academic performance, and perceptual disturbances. Cannabis use substantially increases risk of psychosis in genetically vulnerable youth.
Suicide AssessmentPractitioners should always ask about suicide directly, as doing so does not increase the risk. A safety plan should be created jointly with the patient and their family. Use the Columbia Suicide Severity Rating Scale at every visit.
Legal & Ethical Framework
In most legal systems, adolescents are permitted to consent to their own mental health treatment. Confidentiality should be reviewed during each visit using the HEADS-ED framework.
Confidentiality Protocol
- Confidentiality should be reviewed at every visit using the HEADS-ED framework
- Confidentiality should only be broken if there is an immediate and serious risk of harm to the patient or others
- The rationale for any breach must be documented thoroughly
- In most legal systems, adolescents may consent to their own mental health treatment
HEADSSS 3.0 Framework
Integrate psychosocial assessment at every adolescent consultation, including mental health, home, education, activities, drugs, sexuality, and suicide/safety screening.
- ↗Full HEADSSS 3.0 interview guide
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