Adolescent Depression and Suicide

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Adolescent Depression and Suicide

• Adolescent Medicine Series
• Anthony Dekker, D.O.

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Depression and suicide are among the most serious
and prevalent causes of morbidity and mortality
affecting adolescents and young adults
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• Half of all teenagers report feeling depressed at
  some point in time
• 8 to 17 meet criteria for specific depressive
  disorder
• Depression is most significant contributor for
  suicidal ideation

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• 1993 youth risk behavior survey revealed 1/4 of
  all high school students had seriously considered
  attempting suicide in previous 12 months

• In 1994, suicide was third leading
• cause of death for 15 to 24 year old
• males and fourth leading cause of
• death for 15 to 24 year old females

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DepressionDefinition and Diagnostic Criteria

• General dissatisfaction
• Unhappiness
• Loss of interest or pleasure in usual activities
• Poor self-esteem
• Excessive guilt
• Decreased or increased appetite
• Sleep, motor, and energy changes
• Increased suicidal thinking

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Diagnostic and Statistical Manual of Mental
Disorders, 4th EditionAmerican Psychiatric
Association (DSM-IV)

• Major depressive disorder
• Dysthymic disorder
• Bipolar disorders
• Adjustment disorder with depressed mood
• Depressive disorder not otherwise specified
• Bereavement
• Major depressive disorder or bipolar disorder
  with seasonal variation

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Incidence of Major Depressive Disorder (MDD) and
Dysthymic Disorder

• 5 to 9 MDD
• 3 to 8 dysthymic disorder
• 1 bipolar disorder

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Risk Factors

• Vulnerability
• Genetic
• Environmental

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Family Risk Factors for Depression

• Low family support system
• Inept parenting, inadequate parenting, or poor
  parenting skills
• Engaged parenting style
• Family dysfunction
• Abrasive family interactions
• Marked parental conflict over childbearing

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Negative Life Events

• Increased frequency of life-time changes (living
  situations, geography, school)
• Changes in caretakers
• Physical or sexual abuse
• Siblings leaving home
• Parental divorce or remarriage
• Death of family members or close friends
• Suicide of a peer
• Violence in neighborhood

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Pre-existing Medical Conditions

• Attention deficit/hyperactivity disorder
• Learning disabilities
• Mild to moderate mental retardation
• Eating disorders
• Debilitating illness
• New onset of serious illness or disfigurement
• Asthma
• Sickle cell anemia
• Recurrent abdominal pain

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Adolescent Perceptions

• Parents seen as less caring and more controlling
• Insecure about family attachments
• Perceive self as having an inferior role in
  family rejected by family
• High level of perceived stress

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Adolescents Personality Traits

• Low self-esteem, self-worth
• Low life satisfaction
• External locus of control
• Poor problem solving or coping skills
• Feelings of rejection
• Over-reliance on others

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Adolescents Behavior

• Previous depressive episode of suicide attempt
• Drug use or abuse
• Problem behaviors in general
• Multiple sexual partners, pregnancy in females
• Academic underachievement
• Running away
• Looking outside the home for support system

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Evaluation for Depression

• Interviewing
• The HEADSSS format
• H - home
• E - education
• A - associates in activities
• D - drugs, diet
• S - sex
• S - suicide and depression
• S - savagery/victimization

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Presenting Complaints

• When symptoms began and duration
• Mood affect, attitude, and behavior
• Physical complaints
• Severity of symptoms
• Suicidal thoughts and attempts
• Family and peer relationships
• School performance
• History of similar symptoms

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Life Events

• Recent adversity or distressing events
• Recent loss
• Recent or impending change in environment
• Underlying medical condition
• Possible pregnancy
• Physical or sexual abuse

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Environmental Factors

• Family functioning
• Violence in the community

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Specific Risk Taking Behaviors

• Substance use or abuse
• Sexual behaviors
• Delinquency, truancy, or trouble with the law

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Physical Examination

• Vital signs
• Weight changes
• Acute illness
• Chronic illness
• Self-mutilation

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Laboratory Evaluation

• CBC
• Thyroid function
• Urine toxicology screen

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Intervention Strategies for Adolescents

• Patient and parent education and counseling
• General support measures
• Written contract
• Chemical abuse intervention
• Psychopharmacology

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Risk Factors, First Suicides and Attempts

• History of previous suicide attempt
• Hand gun or weapon in home
• Current suicidal ideation with specific plan
• Recent suicide attempt
• Accident-prone behavior, impulsive risk taking or
  ADDH

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Behaviors Seen Just Prior to Suicide

• Talking about suicide
• Statements of hopelessness, helplessness, and
  worthlessness
• Preoccupation with death
• Sudden elevation in mood
• Increased calling or visiting of friends and
  family
• Preoccupation with tieing up loose ends
• Giving valued things away

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Resources

• Adolescent Directory On-line
• ADOL_at_Indiana.edu
• Society for Adolescent Medicine
• www.adolescenthealth.com
• American Association of Suicidology
• www.cyberpsych.org\aas.htmyouth.html
• National Institute for Mental Health
• 1-800-421-4211