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How pediatricians can turn off ‘water hose’ of adolescent mental health concerns

September 22, 2021

Editor's note:  For more coverage of the 2021 AAP National Conference & Exhibition, visit

Lifestyle changes sometimes get short shrift when it comes to managing adolescent depression. But there is good evidence behind many interventions, and they may be an important tool to manage the onslaught of mental health issues fueled by the COVID-19 pandemic, said pediatric psychologist Christina Low Kapalu, Ph.D.

“In order to manage that water hose that is coming at us of mental health concerns, I think it's important to provide these interventions to capture that mild to moderate range of depressed kids, who then may not need to go on to do psychotherapy,” said Dr. Low Kapalu, who works in the Division of Gastroenterology, Hepatology and Nutrition at Children's Mercy Kansas City.

Limited resources then will be available to those who need a higher level of care. 

Dr. Low Kapalu details several interventions during the on-demand session “Using a Lifestyle Approach to Managing Adolescent Depression” (OD0424). She focuses on approaches with the best evidence, including sleep, physical activity and socialization. Evidence also suggests good nutrition and mindfulness/relaxation training may relieve depression.

“So for example, we know there's a strong causal link between insomnia and depression,” she said. “And there's lots of studies that have shown that if you can improve sleep quality and duration and sleep habits, then you see a really good impact on depressive symptoms.”

Pediatricians may be familiar with strategies to improve sleep habits like eliminating screen time before bed, keeping phones out of the bedroom at night and maintaining consistent sleep and wake times. But when it comes to motivating teens to do those things, they may be at a loss.

Dr. Low Kapalu explains how to use six stages of change to help teens adopt healthy habits: precontemplation, contemplation, preparation, action, maintenance and relapse.

For example, a teen who is thinking about increasing physical activity is in the contemplation stage but is not ready to take action. The pediatrician could ask if the patient has thought about the benefits of regular exercise rather than saying, “I need you to exercise five days a week,” Dr. Low Kapalu explained.

“If you are going to deliver an intervention and want somebody to do something and they are not in the stage that you are meeting them at, then you're not going to have a lot of success,”
she said.

When setting goals, Dr. Low Kapalu recommends starting small to maintain motivation. For example, suggest the teen take a five-minute walk every day and follow up to discuss how it’s going.

Dr. Low Kapalu also recognizes that pediatricians often are short on time, so she explains how to help teens set goals in just a few minutes.

“I do think that this talk will help pediatricians provide a very meaningful collaborative setting with a patient in a short amount of time,” she said.

Finally, pediatricians should set the expectation that these interventions will make a difference, Dr. Low Kapalu said. “It's about selling them as effective treatments because they are, instead of delivering them as an afterthought.”

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