Adolescent Depression and
Suicide
Adolescent Medicine Series
Anthony Dekker, D.O.
Depression and suicide are
among the most serious and
prevalent causes of morbidity
and mortality affecting
adolescents and young adults
Halfof 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
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
Depression:
Definition 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
Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition
American 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
Incidence of Major Depressive Disorder
(MDD) and Dysthymic Disorder
5% to 9% MDD
3% to 8% dysthymic disorder
1% bipolar disorder
Risk Factors
Vulnerability
Genetic
Environmental
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
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
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
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
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
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
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
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
Life Events
Recent adversity or distressing events
Recent loss
Recent or impending change in
environment
Underlying medical condition
Possible pregnancy
Physical or sexual abuse
Environmental Factors
Family functioning
Violence in the community
Specific Risk Taking Behaviors
Substance use or abuse
Sexual behaviors
Delinquency, truancy, or trouble with
the law
Physical Examination
Vitalsigns
Weight changes
Acute illness
Chronic illness
Self-mutilation
Laboratory Evaluation
CBC
Thyroid function
Urine toxicology screen
Intervention Strategies for
Adolescents
Patient and parent education and
counseling
General support measures
Written contract
Chemical abuse intervention
Psychopharmacology
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
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
Resources
Adolescent Directory On-line
» ADOL@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