Depression and Suicide in teenagers

'Fact Sheets' of The Centre for Adolescent Health, Royal Children's Hospital, Melbourne

Depression

Depression is more than the typical mood swings of adolescents. Real depresession is not 'normal' in adolescents, mood swings are.

Probably about 5% of the general adolescent population suffers from depression. Adolescents under stress, who have experienced loss, or who have learning or behavioural disorders are more likely to suffer depression.

The behaviour of depressed adolescents is different from that of depressed adults. Typical characteristics are:

• persistent sadness
   
• an inability to enjoy things that previously brought enjoyment
   
• increased restlessness or irritability
   
• frequent health complaints such as headaches or stomach aches
   
• frequent absence from school or not succeeding at schoolwork
   
• poor concentration, boredom
   
• noticeable changes in eating or sleeping patterns.

Adolescents who are depressed may say that they wish they were dead, or have little interest in things around them. They may abuse drugs and alcohol as a means of escape.

Recognising Depression

Early diagnosis and treatment are very important in cases of depression. Parents should ask a medical professional to refer them to an adolescent psychiatrist. Most depression can be treated. But treatment needs to deal with all causes and aspects of the depression, not just the symptoms. Depression is usually treated in two stages. The acute treatment stage aims to reduce the symptoms until the young person feels more at ease and stable, with the aim of stopping the symptoms from recurring. Counselling, psychotherapy, family therapy and a number of other approaches can all be beneficial. The aim is to make the family and adolescent aware of what is happening and to help the adolescent feel better about themselves and their life.

Antidepressant medication is not normally used with adolescents except in some severe cases.

The following is a checklist or rating scale for depression. On this rating scale, 2 = very true, 1 = true and 0 equals not true. The number most appropriate to each statement should be circled.

0 1 2 Confused, seems to be ‘in a daze'

0 1 2 Cries a lot

0 1 2 Deliberately harms self or attempts suicide

0 1 2 Fears going to school

0 1 2 Fears he / she has to be prefect

0 1 2 Feels worthless

0 1 2 Likes to be alone

0 1 2 Has nightmares

0 1 2 Over anxious or fearful

0 1 2 Feelings of great guilt

0 1 2 Overtired

0 1 2 Headaches and / or stomach - aches

0 1 2 Oversleeping or trouble sleeping

0 1 2 Timid or shy

0 1 2 Sad or depressed

0 1 2 Withdrawn, doesn't get involved with others

0 1 2 Underactive, slow, lethargic

0 1 2 Talks about killing self

If, on the rating scale, if the numbers add up to 20 or more, it is likely that the adolescent is suffering from depression.

Suicide

The suicide rate for teenagers in Australia has increased dramatically in recent years. In some states of Australia, suicide is the leading cause of death for 15-24 year olds.

In many ways, there are more stresses on contemporary adolescents than previously. Competition and exam pressures, looking for a job, general uncertainty, confusion and self-doubt, and changes in family structure such as blended families and divorce can all create uncertainty and lack of self esteem.

In some adolescents this will result in depression and even suicide. In young people, suicide is often a conscious desire to end pain, it may seem to be the 'answer' - the 'way out' of a problem.

Many of the symptoms that can lead to suicide are similar to those of depression. Adolescent psychiatrists recommend that if one or more of the following signs are present, a parent should talk things through with their son or daughter and, if necessary, seek professional help.

Danger Symptoms

• Changes in eating and sleeping habits
   
• Withdrawal from friends, family and regular activities
   
• Violence, rebelliousness or running away
   
• Drug and alcohol abuse
   
• Unusual neglect of personal appearance
   
• Marked personality change
   
• Boredom, difficulty concentrating, decline in standard of schoolwork
   
• Frequent 'health' complaints such as stomach aches, headaches, fatigue
   
• Loss of interest in recreational activities
   
• Inability to tolerate praise or rewards.

Verbal and Open Danger Signs

A young person who is thinking about suicide may: complain of feeling 'rotten' inside, make statements such as 'I won't be a problem much longer', 'Nothing matters', 'I won't see you again'.

A young person may give away favourite possessions, put their things in order, throw away previously important belongings. If an adolescent says 'I want to kill myself', or 'I'm going to commit suicide', the remark should always be taken seriously. Talking it out with the adolescent, even if it seems a difficult thing to do, is the best approach. The adolescent will then understand that the adult cares about them. Preferably refer the problem to a doctor or adolescent psychiatrist.

Possible signs of suicidal tendencies should always be taken seriously.

Teenage Suicide Study

A recent study found a lack of awareness of the signs leading to teenage suicide. The study found that knowledge of how to work with teenagers with suicidal tendencies was not strong, especially amongst potentially influential professionals such as doctors and teachers.

Suicide is the second highest cause of death amongst 15-24 year olds in Australia. The study also found that 50% of suicidal adolescents would have visited a doctor in the month prior to their suicide.

The authors of the study were clinical psychologist Dr David Smith and psychologist Ms Kylie Scoullar. Ms Scoullar said that a major concern was that 40% of teachers and doctors said that they would not take a suicide threat seriously. Eleven percent of teachers said that if they were confronted with a suicidal student, they would not take direct action. However, teenagers who have said they were going to kill themselves have been found to be in a high risk bracket.

Pre-suicidal tendencies were found to include giving away valued possessions, substance abuse and poor handling of parental conflict. Both authors highlighted the need for better training in this area for both doctors and teachers.

Reference

The information for this article was taken from the 'Fact Sheets' of The Centre for Adolescent Health, Royal Children's Hospital, Melbourne.