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