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Mental Vital Signs

By Scott Hamilton, MD
May 26, 2022
Hamilton Blog Headshot Updated 12.21.21

This week’s guest columnists are Drs. Mai Vu and Jeremy White, family practice residents at Ochsner University Hospital & Clinics

Our quiet night in the Pediatric ER was interrupted by shouts from the triage bay. “I can’t breathe! Help me!” My brain ran through the possibilities: Bad allergic reaction? Chicken bone in the throat? Then, the nurse rolled by with a 13-year-old girl who actually didn’t look that bad. Sure, tears were rolling down her cheeks and she was heaving sobs, but her oxygen level was normal. Her parents confirmed that she had a history of anxiety and was having a panic attack. Despite attempts to de-escalate her, the patient insisted she was dying. Unfortunately, there’s no vital sign to provide early warning of one’s declining mental state.

May is Mental Health Awareness Month. It needs its own month because many find it a difficult topic to discuss with children and teens. Parents may not comprehend the severity of their child’s anxiety or depression and fail to notice the little signs like more moodiness or jumpiness at any downturn in their day. Maybe their teenager has lost interest in previous activities he loved, like sports or movies. Each of these signs can often and easily be explained away as normal “hormonal” changes for teens.

Some parents can’t take the next step to ask, “How are you feeling?” or “Are you depressed?” An even harder question to pose: “Do you want to die?” Parents who do ask these questions may often be rebuffed by an irritated shrug, an eye roll or a quick exit from the room. Teenagers can be difficult – challenging parents to see the subtle signs, put two-and-two together and get the problem out into the open. Thus, mental health gets its own month, encouraging parents to take a closer look at their child’s pain and maybe even save their lives.

One afternoon, parents brought their 14-year-old son to the clinic to discuss changes they noticed in him. He first stopped wanting to go to school and began sleeping more, which is normal behavior for teenage boys. However, they got more concerned as his appetite decreased, his grades declined and his school was calling with disciplinary issues. Despite the signs, his parents were still shocked at the obvious diagnosis: depression.

There are clear correlations between the rise in kids' depression, anxiety and suicide and recent changes in their social environments. A 2017 study found that pediatric suicide rates had increased by 150%, and self-harm among girls ages 10-14 had tripled. The study also found that spending more than three hours per day on social media put kids at a higher risk for mental health problems. Sadly, the addiction to phones and social media is, like any addiction, hard to break. Child and teen social isolation and electronic dependence only furthered during the pandemic.

Where do we go from here? Limiting screen time and social media access seems intuitive, but can be difficult. Parents of younger children can start with prevention. Instead of using phones and tablets as babysitters, opt for traditional social interactions like regular conversations with your children at the dinner table and bedtime. Save the devices for when they’re around 12 years old. When they become teenagers, don’t let go of the important times to talk, or revive them if they have lapsed. We lamented above that there’s no vital sign for mental health, like oxygen levels or blood pressure, but actually, there is - communication with your children, free of distractions.