Teenage Depression and Suicide

1. Teenage Depression and Suicide HSci 436 – Health Concerns of the Adolescent

2. Mood Disorders • Most frequently diagnosed mood disorders among adolescents include: • major depressive disorder, • dysthymic disorder, • bipolar disorder • All are serious since the may potentially increase the risk of suicide

3. Statistics • 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 • Children with depressed parents are 3 times more likely to experience depression (Birmaher et al., 1996a, 1996b) • Depression is more prevalent in females

4. Major Depressive Disorder • 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: • 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.

5. Dysthymic Disorder • 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).

6. Dysthymic Disorder • Prevalence • 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)

7. Reactive Depression • 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.

8. Depression Treatment • Psychosocial Intervention • The APA has found certain forms of cognitive-behavioral therapy to be probably effective in treating depression. • “Coping with depression” consists of: social skills training, assertiveness training, relaxation training and imagery, and cognitive restructuring • Pharmacological Treatment • 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.

9. Bipolar Disorder • 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. • Cycles may tend to shorten over time. • Depressive mood is generally similar in symptoms and characteristics to major depressive disorder.

10. Bipolar Disorder – Manic phase • Adolescents often experience: • 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.

11. Bipolar Treatment • Pharmacolagical • Difficult to treat since both depression and mania must be treated. • Lithium has typically been the treatment of choice.

12. Suicide • 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 African-American males. • Access to firearms has been suggested as a reason for the increase, BUT… • Rates have also increased in countries with strict bans on firearms.

13. Suicide Risk Factors • Tend to be similar for both genders but with different weighting • Female Risk Factors: • Major depression (up to 12x risk) • Previous suicide attempt (up to 3x risk) • Male Risk Factors: • 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

14. Suicide Risk Factors • Often proceeded by stressful life event • Failed relationship with boyfriend or girlfriend • Getting into trouble at school or with law enforcement • Some studies suggest that real or fictional media accounts of suicide may motivate more vulnerable teens to act on suicidal urges (Velting & Gould, 1997) • Reports of a celebrity suicide may make it seem like a reasonable, accepted, or even heroic action • Suicide Clusters • Probably resulting from imitation (Davidson, 1989)

15. Suicide Treatment • 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.

16. References • 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). • 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