In the February 9, 2018 issue of The Chronicle of Higher Education, 20 students gave voice to what has become a rising concern on college campuses across the country. Although the focus of the article was on students with anxiety, statistics on increasing numbers of children and adolescents with anxiety and other mental illness are alarming. According to data from The American Freshman 2016 National Norms study (Wyllie & Lipka, 2018), more than 4 in 10 freshman say they feel overwhelmed by all they have to do, compared with fewer than 2 in 10 freshmen in 1985. Wyllie and Lipka further note more than 1 in 4 students report symptoms of anxiety according to the Healthy Minds Study of 2016-2017. Anxiety has significantly affected academic performance and led to a doubling of hospital admissions of suicidal adolescents in the last decade (Wyllie & Lipka). These data should be alarming to college leaders and to all pediatric providers. According to the American College Health Association 2017 National College Health Assessment, anxiety disorders in college students have surpassed depression as the most common reason to seek mental health services on college campuses (Denizet-Lewis, 2017). Pediatric providers have recently become increasingly concerned about the prevalence of depressive disorders in children and adolescents.

Clark, Jansen, and Cloy (2012) reported on the state of the science of the treatment of childhood and adolescent depression. At the time of their publication, prevalence of depression was estimated to be 2.8% in children younger than 13 years and 5.6% in adolescents 13 to 18 years of age. Clark et al. present a compelling case for the life-long effects of childhood depressive disorders including, but not limited to, poor academic performance, substance abuse, early pregnancy, and a multitude of social, economic, employment, and family disruptions that occur well into adulthood. Although the prevalence is high, childhood and adolescent depression frequently goes undiagnosed and undertreated. Clark et al. present many useful tables detailing criteria for major depressive episodes in children and adolescents, the differential diagnoses of depression, and recommendations for practice.

In a New York Times Magazine article, Paul (2010) raised the question "can preschoolers be depressed?" The answer was a definitive yes with caution expressed over the potential to pathologize behaviors typical of various developmental stages. A review of the history of child psychiatry revealed greater willingness and recognition that depression can and does occur in young children.

Research has shown a significant link between early childhood adversity and toxic stress with later learning, behavioral, physical, and mental well-being. Using an eco-bio-developmental framework, Shonkoff et al. (2012) make a compelling case for viewing many adult disorders as developmental in origin. They describe adverse childhood experiences as including persistent health disparities associated with poverty, discrimination, or maltreatment. Pediatric providers should become "front-line guardians of health child development and strategically positioned community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and life-long health" (Shonkoff et al. p. e232.).

These data about the prevalence of depression and other mental health issues should be a clarion call to action and advocacy for all pediatric nurses. Early identification and promoting timely access to appropriate therapy can make a difference in supporting optimal child and adolescent mental health.

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