Depression and Suicide in Children and Adolescents

Abstract

1. Laura M. Prager, MD* 1. *Assistant Professor, Child Psychiatry, Massachusetts General Hospital, Boston, Mass After completing this article, readers should be able to: 1. Discuss the clinical presentation and diagnostic criteria of depression. 2. Describe clinical management strategies for depression. 3. Recognize risk factors for suicide and self-destructive behaviors. 4. Understand how to assess and treat the suicidal patient. Depressive disorders in children and adolescents are common and often disabling. They can interfere with normal growth and development, academic performance, and interpersonal relationships, and they are a significant risk factor for suicide. These disorders fall on a spectrum that ranges from mild symptoms of depressed mood, which might occur in response to an acute stressor, to pervasive sad or irritable mood accompanied by problems with sleep, appetite, social isolation, and sometimes, suicidal ideas, plans, and intent. Prevalence rates for depression range from 1% to 2% of prepubertal children to 3% to 8% of adolescents. Depression in prepubertal children and bipolar disorder in any age group are equally common in both sexes. However, unipolar depressive disorders in adolescents are more common in girls than in boys (ratio of 3:1), and early onset of puberty in girls increases the risk for depression. (1) Depressed children and adolescents manifest a variety of signs and symptoms. They can be sad, irritable, or angry and may present with school or behavioral problems. They can demonstrate somatic complaints (eg, headache, stomachache, muscle weakness), decreased or increased appetite, fatigue, insomnia, hypersomnia, or disturbed sleep-wake cycles. Some children and adolescents develop psychotic features consistent with their mood symptoms, such as paranoid delusions or auditory hallucinations with self-deprecatory content. Some develop self-injurious behaviors or suicidal ideation, plan, and intent. Anxiety symptoms may be present and may predate the development of depressive symptoms. Behavioral problems ranging from oppositional defiance to frank conduct disorder may occur in conjunction with an underlying mood disorder. Depressive disorders vary in degree …