When it becomes risky for teens to diagnose their mental health online

This scenario probably sounds familiar to teens who spend any amount of time online: A high schooler worried about their well-being, noticing symptoms like increasing sadnesses or withdrawal, turns to the internet and social media for answers, only to feel more lost afterward.

Perhaps their favorite influencer posted a TikTok about a new mental health diagnosis they received, and all the symptoms match what the high schooler is experiencing. The teen might assume they, too, have obsessive-compulsive disorder(opens in a new tab) or complex post-traumatic stress disorder(opens in a new tab).

Further googling may convince them this is the case. Or perhaps the influencer's next video focuses on how certain types of behavior are, in fact, a "trauma response," and the high schooler relates to the examples, exacerbating any sense that they're a broken person.

Suddenly, the teen feels like they understand themselves better, but they also likely have no real direction or support for what comes next. The self-diagnosis of conditions and behaviors may come to define them, even if they've never seen a mental health professional or received care. Rather than feeling empowered, they might instead experience hopelessness and heightened anxiousness, while also limiting their understanding of their feelings under the assumption of a specific condition.

While there are benefits to having access to mental health information on the internet, teens may be particularly vulnerable to the risks of self-diagnosis — especially when seeking answers from unreliable sources and digesting information from a vulnerable position. A new book authored by the nonprofit advocacy organization Mental Health America aims to steer teens away from that possibility.

Where to Start: A Survival Guide to Anxiety, Depression, and Other Mental Health Challenges(opens in a new tab) offers basic definitions of common conditions, in language that's accessible to younger readers. It also provides resources for seeking treatment and support.

"It's not to knock the other things that are out there on the internet, but the reality is that anybody can go online and create something that says, 'These are the things that maybe you should be looking at,' and it may not be the best information," says Dr. America Paredes, Chief Social Impact Officer for Mental Health America.

There are many reasons why adults and teens alike consult the internet and social media to answer mental health questions. Healthcare is inaccessible and unaffordable for many, and inconvenient and intimidating for even more. Mental health professionals often don't even accept insurance, and out-of-pocket treatment can cost upwards of $200 per hour, depending on where they practice.

But that assumes seeking professional care is the goal. Someone who's expecting to face stigma and judgment for experiencing mental health challenges may instead try to cope on their own, using the internet as their guide.

Indeed, this initially works well for many, especially teens who may feel shy about sharing their struggles with friends or family members. What they often get online, says Paredes, is validation of their experiences, which can be a tremendous relief if they've felt isolated and alone.

"We know youth are looking for information," she says. "When we go searching for something, on the internet, on social, you will find something that validates whatever you're feeling."

Paredes notes that this dynamic intensifies on social media, because the algorithm "provides you something that really supports whatever you're looking for." Consider how following one influencer on a certain topic, like anxiety, opens the algorithmic door to numerous other social media accounts of varying quality.

Seeking and feeling validation from social media mental health content isn't necessarily bad. After all, plenty of creators and their followers find it empowering and helpful to talk about their lived experience with mental health conditions.

Yet, being part of the audience can also stop youth from reflecting on what they should do next. They may become an observer to an influencer's mental health journey instead of beginning their own.

Similarly, when creators and influencers use phrases like "trauma response" to describe behavior a teen thought was normal, like staying busy all the time or spacing out, a teen might start to feel uncertain or worried about their well-being in cases when that might not be warranted.

While childhood trauma is actually widely prevalent, according to research(opens in a new tab), much of the social media content about "trauma responses" doesn't point youth to actionable, science-based information about how to learn more about that phenomenon. Some creators may even use that phrase to rank higher in the platform's algorithm, a possibility that may not be clear to teens.

Paredes recommends that teens pause and consider what they're seeing online before they integrate that information into their identity, which can include claiming a diagnosis without being evaluated by a mental health professional.

"It can be useful as a guiding step to finding important...information, but again you have to be very conscientious of how this language is being used and how you're interpreting it," says Paredes.

Once a teen has reflected on what they've seen, they can start thinking about potential next steps. Paredes says this may include taking one of numerous mental health screening tests developed to identify conditions like depression, anxiety, bipolar disorder, and eating disorders.

Mental Health America's website(opens in a new tab) hosts its own collection of evidence-based screeners. In 2022, nearly 40 percent of those who completed a screener(opens in a new tab) in the U.S. were under 18. Paredes stresses that screeners do not provide a diagnosis but instead offer clarity about whether a person may be experiencing symptoms of a clinical disorder or condition.

Teens should also beware of completing online tests or quizzes provided by for-profit companies. A popular "childhood trauma test" that circulated on TikTok last year ended up being a way for a private company to capture user data and potentially share it with third parties.

Once a teen has completed a screener, Paredes recommends talking to a trusted adult about the results. While a minor will need parental permission to pursue a medical evaluation, they can still talk to a relative, coach, teacher, or another adult if they don't feel comfortable discussing the subject with their parents or caregivers.

When the screener doesn't indicate that a teen is experiencing a mental health condition, they should still consider talking about their concerns rather than dismissing them. In general, Paredes says "warmlines," or listening lines offering connection with trained peers and mental health advocates, can offer emotional support when a caller isn't in crisis. (The website warmline.org(opens in a new tab) has a directory of warmlines by state.)

Where to Start, the new book authored by Mental Health America, also contains recommendations and worksheets for further exploring mental health challenges and treatment. Paredes is hopeful that it will give teens an alternative to troubleshooting their concerns online, where there's plenty of information but often little direction.

"The decision to maybe request help, and ask for help, and then ultimately receive help in some way — not just from a professional but from other folks in your life — that's the stuff that's not really shared on social," says Paredes. "We don't see that as often, but I would love to see that."

If you're feeling suicidal or experiencing a mental health crisis, please talk to somebody. You can reach the 988 Suicide and Crisis Lifeline at 988; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488-7386. Text "START" to Crisis Text Line at 741-741. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email [email protected](opens in a new tab). If you don't like the phone, consider using the 988 Suicide and Crisis Lifeline Chat at crisischat.org(opens in a new tab). Here is a list of international resources(opens in a new tab).

Medical office buildings, a senior living facility and other central Pa. medical projects

A senior living community is planned in South Middleton Township, outside of Carlisle in Cumberland County.

In Lancaster County, WellSpan is building a 34,000-square-foot surgery center in Lancaster.

Over in York County, York College of Pennsylvania has announced it will construct a human performance and neuromuscular control laboratory with financial assistance from UPMC in Central Pa.

These are just a few of the many healthcare development projects underway in central Pa. Here’s our latest list of medical-related plans, openings, and moves in the region.

PennLive publishes a list of medical-related projects in central Pa. several times during the year. The last list was published on April 3.

Cal’s Hope

Cal’s Hope, a nonprofit working to address mental health issues and suicide prevention, has opened a new office at 502 N. Baltimore Ave.

Life care community

Weathervane Capital Partners plans to construct a 77-bed senior living community near Spring Garden Street.

UPMC/HACC Medical Assisting Certificate Program

The University of Pittsburgh Medical Center and HACC have announced a partnership to support area residents who want to pursue careers as medical assistants. Prospective students can enroll in HACC’s new two-semester Medical Assisting Certificate Program that will begin on Aug. 28.

Penn State Health Lancaster Medical Center cardiac catheterization laboratories

Two cardiac catheterization laboratories have opened at Penn State Health Lancaster Medical Center. The cardiac catheterization laboratories as well as preparatory and post-procedure rooms and storage areas take up approximately 15,000 square feet of space on the hospital’s second floor. Cardiac catheterization laboratories are equipped with imaging technology to allow cardiology specialists to perform a range of diagnostic tests as well as stent procedures to treat conditions such as blockages or irregular heartbeat.

Penn Medicine Lancaster General Health Physicians Orthopaedics

Westphal Orthopedics has joined Penn Medicine Lancaster General Health Physicians. The practice, now named Penn Medicine Lancaster General Health Physicians Orthopaedics, specializes in orthopedic care, particularly joint replacement and sports medicine surgery. The primary office is located at the LG Health Suburban Pavilion, 2106 Harrisburg Pike, Suite 116. The practice has approximately 30 employees and includes three orthopedic surgeons — doctors Thomas Westphal, Brian Brislin and Carl Becker— as well three physician assistants, an in-house physical therapy team, and administrative and clinical support staff. Information: 717-393-1900.

WellSpan Health surgery center

WellSpan held a groundbreaking ceremony for a 34,000-square-foot surgery center to be constructed in the CityGate Corporate Center at 35 Erick Road. The two-story building that will house the surgery center is expected to open in the summer of 2024. The center will also be the home to numerous WellSpan specialty practices.

WellSpan Health outpatient endoscopy center

WellSpan has announced that construction is underway on an outpatient endoscopy center, which is expected to open in the spring of 2024 at 4150 Barrett Blvd.

WellSpan Health EMS

Northeastern Area EMS and WellSpan EMS have announced a new service agreement. Equipment and other assets of Northeastern Area EMS transitioned ownership to WellSpan EMS. Nine employees from Northeastern Area EMS are now employees at WellSpan. The employees will continue to work out of the facility at 10 Devco Drive.

York College of Pennsylvania human performance and neuromuscular control laboratory

York College of Pennsylvania has announced it will construct a human performance and neuromuscular control laboratory thanks UPMC in Central Pa. The Human Performance and Neuromuscular Control Laboratory will be part of the Dr. Donald E. And Lois J. Myers School of Nursing and Health Professions. The school said the lab will provide students with a hands-on learning experience.

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©2023 Advance Local Media LLC. Visit pennlive.com. Distributed by Tribune Content Agency, LLC.

As fewer MDs practice rural primary care, a different type of doctor helps take up the slack

For 35 years, this town's residents have brought all manner of illnesses, aches, and worries to Kevin de Regnier's storefront clinic on the courthouse square — and he loves them for it.

De Regnier is an osteopathic physician who chose to run a family practice in a small community. Many of his patients have been with him for years. Many have chronic health problems, such as diabetes, high blood pressure, or mental health struggles, which he helps manage before they become critical.

"I just decided I'd rather prevent fires than put them out," he said between appointments on a recent afternoon.

Broad swaths of rural America don't have enough primary care physicians, partly because many medical doctors prefer to work in highly paid specialty positions in cities. In many small towns, osteopathic doctors like de Regnier are helping fill the gap.

Osteopathic physicians, commonly known as DOs, go to separate medical schools from medical doctors, known as MDs. Their courses include lessons on how to physically manipulate the body to ease discomfort. But their training is otherwise comparable, leaders in both wings of the profession say.

Both types of doctors are licensed to practice the full range of medicine, and many patients would find little difference between them aside from the initials listed after their names.

DOs are still a minority among U.S. physicians, but their ranks are surging. From 1990 to 2022, their numbers more than quadrupled, from fewer than 25,000 to over 110,000, according to the Federation of State Medical Boards. In that same period, the number of MDs rose 91%, from about 490,000 to 934,000.

Over half of DOs work in primary care, which includes family medicine, internal medicine, and pediatrics. By contrast, more than two-thirds of MDs work in other medical specialties.

The number of osteopathic medical schools in the U.S. has more than doubled since 2000, to 40, and many of the new ones are in relatively rural states, including Idaho, Oklahoma, and Arkansas. School leaders say their locations and teaching methods help explain why many graduates wind up filling primary care jobs in smaller towns.

De Regnier noted that many MD schools are housed in large universities and connected to academic medical centers. Their students often are taught by highly specialized physicians, he said. Students at osteopathic schools tend to do their initial training at community hospitals, where they often shadow general practice doctors.

U.S. News & World Report ranks medical schools based on the percentage of graduates working in rural areas. Osteopathic schools hold three of the top four spots on the 2023 edition of that list.

William Carey University's osteopathic school, in Hattiesburg, Mississippi, is No. 1 in that ranking. The program, which began in 2010, was intentionally sited in a region that needed more medical professionals, said Dean Italo Subbarao.

After finishing classwork, most William Carey medical students train in hospitals in Mississippi or Louisiana, Subbarao said. "Students become part of the fabric of that community," he said. "They see the power and the value of a what a primary care doc in a smaller setting can have."

Leaders from both sides of the profession say tension between DOs and MDs has eased. In the past, many osteopathic physicians felt their MD counterparts looked down on them. They were denied privileges in some hospitals, so they often founded their own facilities. But their training is now widely considered comparable, and students from both kinds of medical schools compete for slots in the same residency training programs.

Michael Dill, director of workforce studies at the Association of American Medical Colleges, said it makes sense that osteopathic school graduates are more likely to go into family practice, internal medicine, or pediatrics. "The very nature of osteopathic training emphasizes primary care. That's kind of their thing," said Dill, whose group represents MD medical schools.

Dill said he would be confident in the care provided by both types of doctors. "I would be equally willing to see either as my own primary care physician," he said.

Data from the University of Iowa shows osteopathic physicians have been filling rural roles previously filled by medical doctors. The university's Office of Statewide Clinical Education Programs tracks the state's health care workforce, and its staff analyzed the data for KFF Health News.

The analysis found that, from 2008 to 2022, the number of Iowa MDs based outside the state's 11 most urban counties dropped more than 19%. Over the same period, the number of DOs based outside those urban areas increased by 29%. Because of the shift, DOs now make up more than a third of rural Iowa physicians, and that proportion is expected to grow.

In Madison County, the picturesque rural area where de Regnier practices, the University of Iowa database lists seven physicians practicing family medicine or pediatrics. All are DOs.

De Regnier, 65, speculated that the local dominance of the osteopathic profession is partly due to the proximity of his alma mater, Des Moines University, which runs an osteopathic training center 35 miles northeast of Winterset.

Des Moines University has one of the country's oldest osteopathic medical schools. It graduates about 210 DO students a year, compared with about 150 MD students who graduate annually from the University of Iowa, home to the state's only other medical school.

Many patients probably pay no attention to whether a physician is an MD or a DO, but some seek the osteopathic type, said de Regnier, who is a past president of the American College of Osteopathic Family Physicians. Patients might like the physical manipulation DOs can use to ease aches in their limbs or back. And they might sense the profession's focus on patients' overall health, he said.

On a recent afternoon, de Regnier worked his way through a slate of patients, most of whom had seen him before.

One of them was Ben Turner, a 76-year-old pastor from the nearby town of Lorimor. Turner had come in for a check of his diabetes. He sat on the exam table with his shoes off and his eyes closed.

De Regnier took out a flexible plastic probe and instructed Turner to say when he felt it touch his feet. Then the doctor began to gently place the probe on the patient's skin.

"Yup," Turner said as the probe glanced against each toe. "Yup," he said as de Regnier brushed the probe against his soles and moved to the other foot. "Yeah. Yeah. Yup. Yeah."

The doctor offered good news: Turner had no signs of nerve damage in his feet, which is a common complication of diabetes. A blood sample showed he had a good A1C level, a measure of the disease. He had no heaviness in his chest, shortness of breath, or wheezing. Medication appeared to be staving off problems.

Chris Bourne, 55, of Winterset, stopped in to consult de Regnier about his mental health. Bourne has been seeing de Regnier for about five years.

Bourne takes pills for anxiety. With input from the doctor, he had reduced the dose. The anxious feelings crept back in, and he had trouble sleeping, he told de Regnier, sounding disappointed.

De Regnier noted the dose he prescribed to Bourne is relatively low, but he had approved of the attempt to reduce it. "I'm glad you tried," he said. "Don't beat yourself up."

In an interview later, Bourne said that until he moved to Winterset five years ago, he'd never gone to an osteopathic physician — and didn't know what one was. He's come to appreciate the patience de Regnier shows in determining what might be causing a patient's problem.

"When he sits down on that stool, he's yours," Bourne said.

Another patient that day was Lloyd Proctor Jr., 54, who was suffering from previously undiagnosed diabetes. His legs were swollen, and he felt run-down. Tests showed his blood sugar was more than four times the normal level.

"The pancreas isn't happy right now, because it's working too hard trying to take care of that blood sugar," the doctor told him.

De Regnier diagnosed him with diabetes and prescribed medication and insulin, saying he would adjust the order if necessary to minimize Proctor's costs after insurance. He brought out a syringe and showed Proctor how to give himself insulin injections. Proctor listened to advice on how to measure blood sugar.

"And maybe I should quit grabbing Mountain Dew every time I'm thirsty," the patient said, ruefully.

De Regnier smiled. "I was just getting to that," he said.

The appointment was one of the doctor's longest of the day. At the end, he reassured Proctor that they could get his diabetes under control together.

"I know that's a lot of info. If you get home and think, 'What'd he say?' — don't hesitate to pick up the phone and give me a call," de Regnier said. "I'm happy to visit anytime."

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.