The end of September is the end of National Suicide Prevention Month, a statement that feels wrong somehow, as though preventing suicide is constrained to this short, 30-day period of school beginnings and football games and changing leaves.
It was a bitterly cold February day when one of my daughters attempted suicide. It came as a shock, the classic signs of depression completely missing from my otherwise bubbly 14-year-old. I also got a crash course in the brutal truth about mental health access: it can be nearly impossible to get the help so desperately needed.
To be released from the emergency room, she was required to have mental health help in place, either by way of placement in a hospital or outpatient treatment scheduled with a psychiatrist. There was no inpatient bed available for her in our entire state. And there was no psychiatrist who could take a new adolescent patient. It was a catch-22.
In a board meeting with the editorial board of Pediatrics in Review last year, one challenge became incredibly clear: there are not enough pediatric specialists (psychiatry, endocrinology, dermatology—you name the specialty, it was mentioned), and general pediatricians are often taking on the burden of having to be the specialist; a task they often feel ill-prepared to do.
The most common comment in the evaluation questions after the CME quizzes, in response to whether the reader will apply any of the content of the article, is that they would refer the patient to a specialist. The most common comment I hear from parents is that their child is referred out to a specialist . . . and they can’t find one that is available.
The September issue of Pediatrics in Review is dedicated to the topic of depression and mental health, and it does what Pediatrics in Review does best: arms general pediatricians with the knowledge and tools to address the challenging and sometimes overwhelming task of being the specialist in the room when children and adolescents cannot immediately find help elsewhere. Depression Part 1: Evaluation contains excellent tables on diagnosing major depressive episodes, disorders related to depression, and nonpsychiatric causes of depression as well as evaluation and screening tools (10.1542/pir.2022-005688). Depression Part 2: Treatment provides guidance on psychosocial, psychological, and pharmacologic therapies, as well as outside resources for the pediatrician (10.1542/pir.2024-006479).
It’s been ten years since that February day, and thanks to the people who were able to “fill in the gaps” when specialists were overwhelmed, my daughter is now thriving. Whether you find yourself in the position of diagnosing and referring or being the makeshift specialist for patients for whom there is no other option, Pediatrics in Review will help you fill the gaps.
