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Teenage Depression and Suicide
HSci 436 – Health
Concerns of the
Adolescent
Mood Disorders
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Most frequently diagnosed mood disorders
among adolescents include:
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major depressive disorder,
dysthymic disorder,
bipolar disorder
All are serious since the may potentially
increase the risk of suicide
Statistics
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Suicide increases steadily through the teens and is
the third leading cause of death at that age (CDC,
1999; Hoyert et al., 1999)
Over 90 percent of children and adolescents who
commit suicide have a mental disorder
20% to 50% of children with depression have a
family history
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Children with depressed parents are 3 times more likely to
experience depression (Birmaher et al., 1996a, 1996b)
Depression is more prevalent in females
Major Depressive Disorder
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Characterized by three or more depressive episodes lasting from 7 to 9
months, each.
10 to 15% of Adolescents experience MDD at any given time (Smucker et
al., 1986)
Children experiencing depressive episodes often exhibit:
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Sadness
Loss of interest in activities that used to please them
Self-criticism and perception that others criticize them
Feelings of being unloved, pessimistic, and hopeless about the future
Rumination
Thoughts that that life is not worth living, and thoughts of suicide may be
present.
Irritability sometimes leading to aggressive behavior.
Indecisiveness, problems concentrating,
Fatigue, Neglecting of appearance and hygiene;
Normal sleep patterns that are disturbed (DSM-IV).
General aches and pains, headaches, stomach aches are more common in
children than adults.
Dysthymic Disorder
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Fewer outward symptoms than major depressive
disorder
More of a chronic condition than major depressive
disorder.
Onset is during childhood and adolescence.
Adolescent is generally depressed on most days
with an average duration of four years(Kovacs et al.,
1997a).
70% of children of dysthymic disorder eventually
experience major depressive disorder (Double
depression).
Dysthymic Disorder
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Prevalence
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Estimated at about 3%
Tends to be equal in boys and girls before puberty
After age 15 it is twice as likely in girls and
women (Weissman & Klerman, 1977; McGee et
al., 1990; Linehan et al., 1993)
Reactive Depression
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Also called Adjustment Disorder with Depressed
Mood.
Most common form of depression in adolescents
Depressive feelings are generally attributed to a
specific catalyst such as a loss, rejection, failure, etc.
Depression generally lasts a relatively short period of
time ranging from a few hours to 2 weeks.
Chacterized by feelings of sadness, lethargy, and
preoccupation.
Mood generally changes when a new, pleasnt, or
interesting event is presented.
Depression Treatment
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Psychosocial Intervention
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The APA has found certain forms of cognitive-behavioral
therapy to be probably effective in treating depression.
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“Coping with depression” consists of: social skills training,
assertiveness training, relaxation training and imagery, and
cognitive restructuring
Pharmacological Treatment
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Although tricyclic antidepressants tend to be effective with
adults, their efficacy has not been shown with children.
Selective serotonin reuptake inhibitors (SSRI) appear to be
somewhat effective in treating children.
Bipolar Disorder
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Moods of depression alternate with manic moods.
Onset is often during adolescence.
Depressive mood is often the first manifestation,
followed by a manic phase up to months or years
later.
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Cycles may tend to shorten over time.
Depressive mood is generally similar in symptoms
and characteristics to major depressive disorder.
Bipolar Disorder – Manic phase
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Adolescents often experience:
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Feelings of being Energetic and Special
Loss of sleep although no fatigue
Tendency to talk frequently, rapidly, and loudly
Sensation of thoughts racing
Difficulty focusing
Delusional perceptions of own abilities
Reckless or risky behavior
Sexual preoccupations leading to promiscuous behavior.
Bipolar Treatment
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Pharmacolagical
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Difficult to treat since both depression and mania
must be treated.
Lithium has typically been the treatment of choice.
Suicide
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Since the 1960’s, the rate among 15-19 year-old
males has tripled while remaining stable among
females.
The rate has declined among males in general since
the 1980’s but continued to increase among AfricanAmerican males.
Access to firearms has been suggested as a reason
for the increase, BUT…
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Rates have also increased in countries with strict bans on
firearms.
Suicide Risk Factors
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Tend to be similar for both genders but with different weighting
Female Risk Factors:
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Male Risk Factors:
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Major depression (up to 12x risk)
Previous suicide attempt (up to 3x risk)
Previous suicide attempt (up to 30x risk)
Major depression (up to 12x risk)
Disruptive behavior (2x risk)
Substance abuse (up to 2x risk)
Low communication levels with parents may be a risk factor for
both sexes
Suicide Risk Factors
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Often proceeded by stressful life event
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Some studies suggest that real or fictional media
accounts of suicide may motivate more vulnerable
teens to act on suicidal urges (Velting & Gould,
1997)
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Failed relationship with boyfriend or girlfriend
Getting into trouble at school or with law enforcement
Reports of a celebrity suicide may make it seem like a
reasonable, accepted, or even heroic action
Suicide Clusters
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Probably resulting from imitation (Davidson, 1989)
Suicide Treatment
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Treatment must deal with intense feelings of
distress and hopelessness
Cognitive-behavioral therapy may be
effective, compared to family therapy and
other forms of psychotherapy
Treatment focuses on quantifying and
ranking sources of stress and then
developing problem-solving approaches to
deal with stress.
References
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Centers for Disease Control and Prevention.
(1998). Youth risk behavior surveillance—United
States, 1997. CDC Surveillance Summaries,
August 14, 1998. MMWR, 47 (No. SS-3).
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Centers for Disease Control and Prevention.
(1999). Suicide deaths and rates per 100,000
[On-line]. Available: http://www.cdc.gov/ncipc/
data/us9794/suic.htm