During a visit with a 13-year-old, the patient discusses sexual activity and depressive symptoms. What should be the first priority in care?

During a visit with a 13-year-old, the patient discusses sexual activity and depressive symptoms. What should be the first priority in care?

• A. Evaluating the patient further to determine the best contraceptive method for this patient
• B. Eliciting more details about the depression, including evaluation for suicidal thoughts or plans
• C. Managing the symptoms of allergic rhinitis at this visit and scheduling a follow-up visit to address the other issues
• D. Referring the patient to an adolescent medicine specialist

Answer: (B)

Assessing safety in the face of depressive symptoms is the immediate priority because suicide risk requires urgent attention. When a 13-year-old discloses depressive symptoms and sexual activity, you should directly screen for suicidal thoughts, intent, or a plan and evaluate the means and lethality. This quick risk assessment guides whether you need crisis intervention, safety planning, or urgent referral, which takes precedence over other concerns discussed in the visit. If no suicidality is identified, you can then address mental health more comprehensively and discuss sexual health and contraception, but only after safety has been established. Addressing allergic rhinitis or delaying care for contraception would not meet the patient’s urgent safety need, and a referral to a specialist is appropriate later in the plan, once immediate safety and basic mental health needs have been addressed.

Assessing safety in the face of depressive symptoms is the immediate priority because suicide risk requires urgent attention. When a 13-year-old discloses depressive symptoms and sexual activity, you should directly screen for suicidal thoughts, intent, or a plan and evaluate the means and lethality. This quick risk assessment guides whether you need crisis intervention, safety planning, or urgent referral, which takes precedence over other concerns discussed in the visit. If no suicidality is identified, you can then address mental health more comprehensively and discuss sexual health and contraception, but only after safety has been established. Addressing allergic rhinitis or delaying care for contraception would not meet the patient’s urgent safety need, and a referral to a specialist is appropriate later in the plan, once immediate safety and basic mental health needs have been addressed.