what college recently suffered the loss of one of their quarterbacks due to an apparent suicide?

Number 705 (Reaffirmed 2020)

Committee on Boyish Health Care

This Committee Opinion was adult past the American College of Obstetricians and Gynecologists' Committee on Adolescent Wellness Care in collaboration with committee liaison Richard R. Brookman, MD.

ABSTRACT: Mental wellness disorders in boyhood are a significant trouble, relatively mutual, and amenable to treatment or intervention. Obstetrician–gynecologists who come across boyish patients are highly probable to see adolescents and young women who have one or more than mental health disorders. Some of these disorders may interfere with a patient's ability to understand or articulate her health concerns and appropriately adhere to recommended treatment. Some disorders or their treatments will bear on the hypothalamic–pituitary–gonadal axis, causing anovulatory cycles and various menstrual disturbances. Adolescents with psychiatric disorders may be taking psychopharmacologic agents that tin cause menstrual dysfunction and galactorrhea. Adolescents with mental illness often engage in acting-out behavior or substance use, which increases their risk of unsafe sexual behavior that may result in pregnancy or sexually transmitted infections. Pregnant adolescents who take psychopharmacologic agents present a special challenge in balancing the potential risks of fetal harm with the risks of inadequate treatment. Whether providing preventive women's health care or specific obstetric or gynecologic treatment, the obstetrician–gynecologist has the opportunity to reduce morbidity and bloodshed from mental health disorders in adolescents past early identification, advisable and timely referral, and care coordination. Although mental wellness disorders should be managed by mental health care professionals or appropriately trained master care providers, the obstetrician–gynecologist can aid by managing the gynecologic adverse effects of psychiatric medications and providing constructive contraception and regular screening for sexually transmitted infections. This Commission Opinion will provide basic information most mutual boyish mental health disorders, focusing on specific implications for gynecologic and obstetric practice.

Recommendations and Conclusions

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

At least one in five youth aged 9–17 years currently has a diagnosable mental health disorder that causes some caste of harm; i in x has a disorder that causes significant harm.
The nearly mutual mental illnesses in adolescents are anxiety, mood, attention, and behavior disorders.
Suicide is the second leading cause of expiry in young people aged 15–24 years.
Obstetrician–gynecologists who run into boyish patients are highly likely to see adolescents and young women who have ane or more than mental health disorders.
Adolescents with mental illness often engage in acting-out behavior or substance use, which increase their take a chance of unsafe sexual behavior that may result in pregnancy or sexually transmitted infections (STIs).
Adolescents with psychiatric disorders may be taking psychopharmacologic agents that tin can cause menstrual dysfunction and galactorrhea.
Pregnant adolescents who accept psychopharmacologic agents present a special challenge in balancing the potential risks of fetal harm with the risks of inadequate treatment.
During preventive care visits, all adolescents should be screened for any mental health disorder in a confidential setting (if allowed by the laws of that locality).
The obstetrician–gynecologist has the opportunity to reduce morbidity and mortality associated with mental health disorders in adolescents by early identification, prompt referral, and care coordination.

Introduction

At least ane in five youth aged nine–17 years currently has a diagnosable mental health disorder that causes some degree of harm; one in x has a disorder that causes significant impairment ane 2. Only ane third of these youth receive the necessary treatment 3. I half of all serious developed psychiatric disorders outset by age xiv years, but treatment frequently does not begin for 6–23 years afterward onset 4. Anxiety and mood disorders are two to three times more prevalent in female adolescents than in male adolescents, although the reverse is true for attention deficit disorder. Obstetrician–gynecologists who see adolescent patients are highly likely to run into adolescents and immature women who have 1 or more mental health disorders Box ane. Some of these disorders may interfere with a patient'south ability to sympathise or clear her health concerns and to accordingly adhere to recommended treatment. Some disorders or their treatments will touch on the hypothalamic–pituitary–gonadal centrality, causing anovulatory cycles and diverse menstrual disturbances (such equally secondary amenorrhea or abnormal uterine bleeding). Adolescents with mental illness ofttimes engage in acting-out behavior or substance use, which increase their risk of unsafe sexual behavior that may result in pregnancy or STIs. Adolescents with psychiatric disorders may be taking psychopharmacologic agents that can cause menstrual dysfunction and galactorrhea. Pregnant adolescents who take psychopharmacologic agents present a special challenge in balancing the potential risks of fetal harm with the risks of inadequate treatment.

Common Mental Health Disorders*

Feet Disorders

Generalized Anxiety Disorder (GAD): Excessive feet and worry (apprehensive expectation) about a number of events or activities. The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or upshot of the anticipated event. The individual finds it hard to control the worry and to keep worrisome thoughts from interfering with attention to tasks at manus. Somatic symptoms frequently are associated.

Social Anxiety Disorder: Marked and persistent fear of one or more social or performance situations, provoking symptoms of anxiety and causing extreme distress or abstention of the situation.

Panic Disorder: Recurrent unexpected panic attacks.

Panic Attack: An abrupt surge of intense fearfulness or intense discomfort that reaches a peak inside minutes and during which time four or more of thirteen physical and cognitive symptoms occur (palpitations, pounding heart, or accelerated middle rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling light-headed, unsteady, giddy, or faint; chills or heat sensations; paresthesias [numbness or tingling sensations]; derealization [feelings of unreality] or depersonalization [being detached from oneself]; fear of losing control or "going crazy"; fear of dying).

Obsessive–Compulsive Disorder (OCD): Although the specific content of obsessions and compulsions varies amid individuals, certain symptom dimensions are common in OCD, including those of cleaning (contamination obsessions and cleaning compulsions); symmetry (symmetry obsessions and repeating, ordering, and counting compulsions); forbidden or taboo thoughts (eg, aggressive, sexual, and religious obsessions and related compulsions); and harm (eg, fears of damage to oneself or others and related checking compulsions).

Posttraumatic Stress Disorder (PTSD): The evolution of characteristic symptoms (including fright-based re-experiencing, emotional and behavioral symptoms, anhedonic or dysphoric mood states, negative cognitions, arousal and reactive-externalizing symptoms, dissociative symptoms, or combinations of these symptom patterns) after exposure to actual or threatened death, serious injury, or sexual violence.

Mood Disorders

Aligning Disorder With Depressed Mood: The development of emotional or behavioral symptoms in response to an identifiable stressor(s) that occur within 3 months of the onset of the stressor(s) in which depression mood, tearfulness, or feelings of hopelessness are predominant.

Major Depressive Disorder (MDD): A period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may exist irritable rather than sad.

Bipolar Disorder: A singled-out period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased action or energy, lasting at least 4 consecutive days and present most of the day, about every day, or that requires hospitalization.

Premenstrual Dysphoric Disorder: The cyclic recurrence of severe, sometimes disabling, changes in affect—such as mood lability, irritability, dysphoria, and anxiety—that occur in the luteal phase of a woman's menstrual cycle and subside around, or shortly after, the onset of menstruation. These symptoms may exist accompanied by the common physical and behavioral symptoms of premenstrual syndrome.

Attention Arrears Hyperactivity Disorder

Symptoms of inattention and hyperactivity or impulsivity present for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Disruptive Behavior Disorders

Conduct Disorder: Repetitive and persistent pattern of behavior that violates the basic rights of others or the age-appropriate societal norms, including aggression to people and animals, devastation of holding, deceitfulness or theft, or serious violation of rules (such every bit running away, truancy, curfew violations.)

Oppositional–Defiant Disorder: Pattern of negativistic, hostile, and defiant behavior that includes iv or more than of the following—often losing temper, often arguing with adults, oftentimes refusing to follow rules, oftentimes annoying others, often blaming others, often angry or resentful, frequently spiteful or vindictive.

Data from American Psychiatric Clan. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): APA; 2013.

*For consummate diagnostic information, consult the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The most common mental illnesses in adolescents are anxiety, mood, attending, and beliefs disorders. The criteria to brand each specific diagnosis are outlined and discussed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) 5 and summarized in Box i. This Commission Stance provides basic information about common boyish mental health disorders, focusing on specific implications for gynecologic and obstetric practice. The emphasis is on recognition and referral, rather than specifics of treatment for each disorder. Although substance abuse disorders and eating disorders are included in the spectrum of mental affliction and may coexist with other disorders, acceptable give-and-take is beyond the scope of this document. The American College of Obstetricians and Gynecologists has addressed these issues in other documents half-dozen 7 8 ix. Additional information on eating disorders is bachelor from the American University of Pediatrics x.

Feet Disorders

Feet disorders are the almost common mental wellness disorders in adolescents. At any given time, one in viii adolescents meets clinical criteria for an anxiety disorder 11. Anxiety disorders include generalized feet disorder, social anxiety disorder, and panic disorder Box 1. Feet disorders are clinically significant when they interfere with of import areas of functioning, such as school, piece of work, or relationships with family unit and peers. They oftentimes occur in conjunction with depressive disorders or attention-deficit/hyperactivity disorder (ADHD) and are associated with an increased risk of suicide. Meet Box 2 for risk factors of anxiety disorders.

Risk Factors for Anxiety or Mood Disorders

History of depression or other mental health disorder
Parental history of feet or mood disorder or other mental wellness disorder
Increased bookish or social demands
Stressful family environments (eg, poverty, harsh subject field, minimal support)
Early or significant losses (parental expiry, divorce, termination of a human relationship)
Chronic affliction
History of beingness bullied, including cyberbullying
History of neglect or physical, mental, or sexual abuse
History of alcohol or other substance apply
History of carry disorder, malversation, or other antisocial behaviors

Physical symptoms are common for many feet disorders. The gynecologist may be consulted for severe dysmenorrhea or chronic pelvic pain. Other symptoms include chest pains, palpitations, shortness of jiff, dizziness, syncope, nausea, vomiting, recurrent abdominal hurting, every bit well as disturbances in sleep patterns, ambition, and energy levels.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) now are classified separately from anxiety disorders in DSM-V. Although closely related to anxiety disorders, OCD was felt to be circuitous enough to merit its own department and PTSD may manifest with symptoms that resemble mood disorders, or anxiety disorders, or both. Patients with OCD may present with vulvovaginitis from excessive attention to perineal hygiene or may accept excessive concerns near the frequency, length, or amount of bleeding during their menstrual periods. Patients with PTSD may have an excessive fear of gynecologic examination, particularly if they accept a history of sexual attack or sexual abuse, and frequently will crave additional time, reassurance, and anticipatory education.

Mood Disorders and Depression

At any given fourth dimension, 1 in 20 adolescents meets clinical criteria for a mood disorder and up to 1 in four children volition feel a mood disorder by their late adolescence 12. Mood disorders include aligning disorder with depressed mood, major depressive disorder, bipolar disorder, and premenstrual dysphoric disorder Box 1. Depression is more common in female adolescents than in male adolescents.

Adolescents with mood disorders show fewer vegetative symptoms (eg, fatigue and depression energy) and more irritability than adults with mood disorders, oft self-medicate with alcohol and other substances, and are at increased adventure of suicidal behavior. Approximately 2 thirds of adolescents with a mood disorder accept one or more than mental disorders, including anxiety disorders, comport disorders, and ADHD. See Box ii for risk factors for mood disorders.

Depressed mood may interfere with motivation for effective measures to forestall pregnancy and STIs. Unprotected sex activity with multiple partners is common during manic episodes. Low may inhibit motivation to take medications as directed, including oral contraceptives, or continue scheduled appointments. Weight changes associated with low or some psycho-pharmacologic agents may exist attributed by patients or families to hormonal contraceptives, which may affect adherence to the hormonal contraceptive or the psychiatric medication.

Adolescents who report symptoms of depression that adversely touch school, piece of work, or interpersonal relationships, simply experience these symptoms only during the seven–10 days preceding each menstrual period may have premenstrual dysphoric disorder 6. They should be evaluated for co-occurring mood or anxiety disorders.

Attention-Deficit/Hyperactivity Disorder

Approximately one in 20 adolescents meets clinical criteria for ADHD 13. Adolescents with ADHD tend to be easily distracted, inattentive, and emotionally immature. They ofttimes have behavioral and educational problems. Adolescents with ADHD have an increased tendency for gamble-taking behavior, including risky sexual beliefs. They may require boosted time spent on patient education with clearly presented instructions (eg, utilize of contraceptives). Procrastination may lead to delays in filling or renewing prescriptions. Their impulsivity and lack of focus may exist a bulwark to consequent and correct use of contraceptive pills, patches, rings, or condoms.

Disruptive Behavior Disorders

Disruptive behavior disorders include oppositional–defiant disorder and conduct disorder. Females with comport disorder oftentimes run away from home and are at increased risk of sexual exploitation or trafficking as well as engaging in high-risk sexual behavior. Confusing behavior disorders oftentimes coexist with substance use disorder and mood and anxiety disorders. Patients with disruptive behavior disorders may be argumentative and resistant to advice from any adults, including health care professionals.

Deadline Personality Disorder

Deadline personality disorder affects 1–3% of adolescents and young adults, mostly females fourteen. Although typically not diagnosed before age 18 years, onset typically takes place during adolescence. Borderline personality disorder is characterized by frequent bouts of anger, depression, and anxiety, lasting only hours, ofttimes alternating. Attitudes toward others shift chop-chop from idealization (seen every bit "all good") to devaluation (seen as "all bad"). Patients with deadline personality disorder are highly sensitive to rejection and fear abandonment, which causes them to demand frequent attention. Impulsive behavior includes binge-eating, high-hazard sexual behavior, nonsuicidal self-injury, and suicide attempts. These patients ofttimes report a history of abuse, neglect, or separation in childhood and 40–lxx% report a history of sexual abuse 15.

Somatization Disorders

Somatic symptoms, common in children and adolescents, are reported by females more than than males, specially afterward puberty 16. The gynecologist may exist consulted for chronic pelvic pain, severe dysmenorrhea, vulvovaginal pain or itching, ovarian cysts, or painful intercourse. A patient may request repeated STI testing despite low-risk behavior and previous negative exam results. In the farthermost, a patient may be convinced she is pregnant, have amenorrhea, intestinal enlargement, and other pregnancy symptoms without confirmatory evidence for pregnancy (pseudocyesis) 17.

Body dysmorphic disorder, an obsessive preoccupation that some aspect of i's body is flawed and must be hidden or corrected, usually begins during adolescence. It is often associated with OCD or social anxiety disorder.

The direction of somatization disorders can be difficult and frustrating. The obstetrician–gynecologist should acknowledge the reality of the physical symptoms while emphasizing the normal findings on concrete examination and avoiding excessive diagnostic testing. Unless the symptom is gynecologic, the patient should be referred to her principal intendance provider for comprehensive care and close follow-up. Gynecologic symptoms should be managed with advisable treatments (eg, nonsteroidal antiinflammatory drugs or hormonal contraceptives for dysmenorrhea).

Suicidal Thoughts

Suicide is the 2nd leading cause of expiry in young people aged 15–24 years, with a rate of 13.ix deaths by suicide in this population per mean solar day; the rate of suicide attempts is 100–200 times higher than that of completions 18. Obstetrician–gynecologists should be peculiarly alert to the possibility of depression and possible suicidal ideation in meaning and parenting adolescents and those with symptoms of anxiety disorder or mood disorder. Adolescents at adventure include those who exhibit declining schoolhouse grades, chronic sadness, family dysfunction, problems with sexual orientation, gender identity, physical or sexual abuse, booze or drug misuse, have a family history of suicide, or have made a previous suicide attempt.

Adolescents contemplating suicide rarely offer that information every bit a presenting symptom. Nevertheless, they often feel relieved when the subject is broached. Questions should be asked in a direct, nonthreatening, nonjudgmental manner. The obstetrician–gynecologist may begin with, "Sometimes adolescents dealing with similar issues or issues become very downward and start to question life itself. Does this happen to you lot?" A positive answer should exist followed with questions such as:

"Accept you ever idea about suicide or harming yourself?"
"Are you thinking about suicide now?"
"Practise you accept a plan for suicide?" (If the patient answers affirmatively, ask for details of the programme and whether she has always attempted suicide in the past.)

The hazard of suicide is highest when the patient tin describe a programme for time, location, and means of suicide and has like shooting fish in a barrel admission to the means, peculiarly medications or firearms xix. When any risk of suicide try or serious self-harm is identified or admitted, the adolescent should be referred to a mental health crisis agency or emergency department for cess by a mental wellness care professional person. The obstetrician–gynecologist should notify those who need to monitor, protect, and ensure the safety of the patient, fifty-fifty if this means breaching confidentiality. This may include providing information to parents or guardians about securing weapons or lethal drugs that may exist available to the patient.

Nonsuicidal Self-Injury

Nonsuicidal self-injury (eg, "cutting") is intentional self-inflicted harm to the surface of one's body with the expectation that the injury volition lead to only minor or moderate physical damage. This typically is washed to obtain relief from negative feelings or cerebral states v. The estimated lifetime prevalence of nonsuicidal self-injury among high school students is 12–23%, with rates higher in females than males. Nonsuicidal self-injury often is associated with feet disorders, mood disorders, personality disorders, eating disorders, and especially with a history of sexual abuse or chronic neglect and maltreatment in childhood. Nonsuicidal self-injury should be suspected in patients with frequent accidents or questionable explanations, or unexplained wounds or scars noted during examination, or both. The obstetrician–gynecologist may be more likely than other health care providers to see the patient undressed. If the obstetrician–gynecologist notes scars or cuts on the breasts, belly, arms, or legs, he or she should ask about nonsuicidal self-injury and refer the patient to advisable mental health cess and management 6. Screening for depression and suicide also should include screening for nonsuicidal cocky-injury.

Obstetric and Gynecologic Implications of Psychopharmacologic Agents

In 2015, 28% of youths anile 12–17 years reported using prescription psychotherapeutic drugs (use or misuse) and vi% reported misuse of psychotherapeutics 20. Misuse was defined every bit apply without a prescription; use in greater amounts, more than often, or longer than the respondent was told to accept them; or apply in whatever other way a doctor did not direct the respondent to utilize them. Amid young adults aged eighteen–25 years, 44% used and 15% misused prescription psychotherapeutic drugs 20. Apply of psychopharmacologic agents in adolescents depends on accurate diagnosis and typically is an offshoot to nonpharmacological handling. The all-time role for the obstetrician–gynecologist is to address the obstetric and gynecologic implications of these agents. Table 1 includes details about psychopharmacologic medications frequently prescribed for adolescents. Obstetrician–gynecologists should recognize the complexity of prescribing for an adolescent and young adult population, and that they differ from the adult population. The complexity of prescribing for adolescents is well-reviewed elsewhere 21 22. An boyish should exist managed by a health care provider with experience and training treating adolescents with mental wellness disorders. Additionally, narcotics should not exist prescribed for underlying pain or dysmenorrhea. Obstetrician–gynecologists should be familiar with local and state rules regarding the medical use of controlled substances, including stimulants and sedatives.

Mental Health Disorders in Adolescents

Obstetrician–gynecologists should know that some medications tin touch menstruation and that selective serotonin reuptake inhibitors (SSRIs) may be associated with sexual dysfunction Table one. Antiepileptic drugs used for bipolar disorder may affect circulating levels of oral contraceptives and as well can touch the efficacy of the medication being prescribed (eg, lamotrigine and valproic acid) 23. Additional data on the safety and efficacy of specific contraceptive methods for those with certain characteristics or medical conditions is provided past the Centers for Disease Control and Prevention'southward Medical Eligibility Criteria for Contraceptive Use, available online at www.cdc.gov/reproductivehealth/contraception/usmec.htm 23.

As noted by the Centers for Disease Control and Prevention's Medical Eligibility Criteria for Contraceptive Use, a woman beingness treated with teratogenic drugs is at increased risk of poor pregnancy outcomes and, as such, long-interim, highly effective contraceptive methods (eg, implant, intrauterine devices) may be her all-time contraceptive pick 23. During pregnancy, shut collaboration betwixt the obstetrician and the prescribing psychiatrist is essential to provide adequate handling to residual the benefits with potential maternal and fetal harms 24. The U.Southward. Food and Drug Administration is phasing out the use of production letter categories—A, B, C, D, and X—to classify the risks of using prescription drugs during pregnancy. These categories are being replaced with 3 detailed subsections that describe risks inside the existent-world context of caring for meaning women who may need medication. For more information, see world wide web.fda.gov/ForConsumers/ConsumerUpdates/ucm423773.htm.

More than one tertiary of those who are prescribed antidepressant and antianxiety medications discontinue use within the first 3 months of drug initiation; another 25% terminate use betwixt 3 months and 6 months because of unacceptable agin furnishings, about ordinarily continued drowsiness, decreased sexual libido, and anxiety 25. The obstetrician–gynecologist, when reviewing current medications, may be the commencement wellness intendance provider to learn that a patient is no longer taking her medication and, therefore, has the opportunity to refer the patient back to her mental health intendance professional. Additionally, some data report higher rates of contraceptive nonuse, misuse, and discontinuation among women with symptoms of mental health disorders (eg, depression and anxiety) compared with asymptomatic women 26. Proactive counseling about long-interim, highly constructive contraceptive methods may exist benign in this population.

The Full general Role of the Obstetrician–Gynecologist

Obstetrician–gynecologists should ask about any mental illness diagnoses and treatments, especially medications and family history, and coordinate care with the patient'south mental health intendance providers. Obstetrician–gynecologists who intendance for minors should be enlightened of federal and state laws that affect confidentiality, state statutes on the rights of minors to consent to health care services, and the regulations that utilize to their practice. During preventive care visits, all adolescents should exist screened for any mental health disorder in a confidential setting (if allowed by the laws of that locality) past asking questions such as those listed in Box 3. The Patient Health Questionnaire (PHQ-9), validated for employ with adolescents, is a useful screening tool Box 4. This can be self-completed by the patient or administered past the obstetrician–gynecologist or role staff. The final question screens for suicidal thinking. Many institutions use the PHQ-2, the first two questions, as the initial screen.

Useful Questions for Screening for Mental Health Disorders

Practise you worry a lot or feel overly stressed out? How practice y'all cope with stress?
Practice you feel bored, sad, or irritable most of the fourth dimension? How do you cope with this?
Do you have any difficulty with sleeping or appetite?
Exercise you notice yourself continuing to call up about past unpleasant experiences?
Practise you ever feel so upset that you wished y'all were not alive or wanted to die?

Information from Hagan JF, Shaw JS, Duncan PM, editors. Vivid Futures: guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village (IL): American Academy of Pediatrics; 2008.

Patient Health Questionnaire-9: Screening Instrument for Depression

Instructions: How oft take you been bothered by each of the following symptoms during the past two weeks? For each symptom put an "X" in the box beneath the answer that best describes how yous have been feeling.

	Not at All	Several Days	More Than Half the Days	Nearly Every Solar day
	(0)	(one)	(2)	(3)
Piffling interest or pleasure in doing things*
Feeling down, depressed, irritable, or hopeless*
Trouble falling asleep, staying comatose, or sleeping besides much
Feeling tired or having piffling energy
Poor appetite or overeating
Feeling bad about yourself—or that yous are a failure, or have permit yourself or your family downwardly
Trouble concentrating on things, such as reading the newspaper or watching goggle box
Moving or speaking so slowly that other people could have noticed? Or the contrary—being so fidgety or restless that yous take been moving around a lot more than usual
Thoughts that you would exist better off dead, or of hurting yourself in some fashion

Total score	Depression severity
0 to 4	Minimal
5 to 9	Mild
10 to 14	Moderate
fifteen to xix	Moderately severe
20 to 27	Astringent

Adapted from patient health questionnaire (PHQ) screeners. http://www.phqscreeners.com. Retrieved February ii, 2017.

*The kickoff two questions comprise the Patient Health Questionnaire (PHQ)-two. If the PHQ-ii is positive for depression, the PHQ-ix should be administered.

Positive responses to screening questions should be investigated further and the patient should be referred to a mental health care specialist or agency for further evaluation and handling. A list of appropriate wellness care providers and resources should be made bachelor and can include child and adolescent psychiatrists, adolescent-friendly psychologists or other psychotherapists, adolescent medicine specialists, and behavioral pediatricians. Adolescents, especially minors, may do good from having a parent or guardian every bit role of the process of accessing mental health services. Where it is not possible to involve a parent, an alternative adult relative, family friend, or advisor may be an option. Short-term follow-up (with a visit or telephone telephone call) can decide if recommendations have been followed, provide an opportunity for the obstetrician–gynecologist to offering assist with any barriers to the referral, and provide support to the patient and her family.

Conclusion

Mental health disorders in adolescence are a significant trouble, relatively common, and amenable to treatment or intervention. Whether providing preventive women'due south health care or specific obstetric or gynecologic handling, the obstetrician–gynecologist has the opportunity to reduce morbidity and mortality associated with mental health disorders in adolescents by early on identification, prompt referral, and care coordination. An agreement of the obstetric and gynecologic implications of mental health disorders and their handling is disquisitional. Although mental health disorders should be managed by mental health care professionals or appropriately trained primary care providers, the obstetrician–gynecologist can assist by managing the gynecologic adverse effects of psychiatric medications and by providing effective contraception and regular screening for STIs.

For More than Information

The American College of Obstetricians and Gynecologists has identified additional resources on topics related to this document that may be helpful for ob-gyns, other health care providers, and patients. Yous may view these resources at www.acog.org/More than-Info/AdolescentMentalHealth.

These resources are for information only and are not meant to exist comprehensive. Referral to these resources does non imply the American Higher of Obstetricians and Gynecologists' endorsement of the organization, the organization's website, or the content of the resources. The resources may change without notice.

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Source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/mental-health-disorders-in-adolescents