Teens get a chair of their own
From Health cover through puberty, are preoccupied with physical changes and want to be like their peers,’’ she says.
‘‘ Anything that makes them different to their peers is not wanted . . . we may see young people struggle with management plans; they may feel it’s not worthwhile taking their medication if they don’t see results quickly; they may go into denial about their chronic illness.
‘‘ It’s not unusual for us to see teenagers and families struggle with taking on the burden of managing chronic illness. One of the most important protective factors in all this is having a family with good communication and good support.’’
Mitchell Litchfield, 24, can testify to the lack of resources and attention from which adolescent medicine has traditionally suffered. Hit with depression from the age of about 18 until he was 22, his behaviour became more disruptive and began to get him in trouble with the law.
‘‘ I used to drink heavily and drown my sorrows by going out all the time,’’ he says. ‘‘ I started to get real angry — I was getting kicked out of home. I used to fight heaps, and be violent.’’
But he quickly found that in his home town of Griffith there was little help, even though the shire has a population of nearly 25,000.
The threat of jail focused his mind on the need to get help, and by chance a family friend was a family support worker, and the first person Litchfield confided in about his anxieties, about his life direction, and about relationship difficulties.
He later began football coaching for youngsters aged 12 to 14, which he says helped get him back on track. ‘‘ It made me feel better about myself, because they (the youngsters) looked up to me, and parents would come to me and say I was doing a good job.’’
David Bennett, clinical professor in adolescent medicine at The Children’s Hospital at Westmead, says the study of teenagers’ health issues only began in any meaningful way in the US in 1951, and has spread only very slowly because of the widespread but misleading notion that adolescence is the healthiest time of life.
An entire recent issue of the International Journal of Adolescent Medicine and Health (2007;(19)3) was devoted to the health problems of adolescents in Australia. Bennett and Towns were the guest editors. ‘‘ There’s a notion that the problems of adolescence are transitional and teenagers are likely to grow out of them,’’ Bennett says. ‘‘ There’s a mindset of benign neglect. The truth is that children don’t tend to grow out of health-related problems and risky behaviours — particularly those that involve addiction and smoking and so on.
‘‘ This time of life has been described as the crucible for shaping the health of adulthood and later life.’’
An editorial in the BritishMedicalJournal earlier this year (2007;335:106-7), written by Philip Hazell, conjoint professor of child and adolescent psychiatry at the University of Sydney, found that while around 3 to 5 per cent of adolescents were affected by depression worldwide, Australian data suggested that 26 per cent of teenagers with mental disorders were treated in general or paediatric practice.
Only 9 per cent received care from specialist mental health services, even though the probability of relapse was about 40 per cent within two years and 70 per cent after five years.
In the editorial, which accompanied a study comparing the effectiveness of different treatments for depression, professor Hazell said the optimal treatment for teenagers had been ‘‘ unclear’’.
For the latest study, one group of depressed adolescents was treated with a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) alone, and another group was treated with the SSRI combined with a type of counselling called cognitive behavioural therapy. The results suggested there was no difference in outcomes between the two groups, although Hazell said the way the trial was conducted suggested that the ‘‘ implication for clinical practice is that good quality pharmacological treatment involves more than simply writing the prescription’’.
Both Towns and Bennett agree that another benefit of the new chair of adolescent medicine at Sydney University will be the opportunity to improve training for medical students and doctors in adolescent health issues.
‘‘ What an academic chair can do is highlight the importance of specialist training,’’ Bennett says. ‘‘ At the moment there’s nothing for GPs, and the Royal Australasian College of Physicians is in the process of developing a curriculum for training in adolescent medicine.’’