Depression and Suicide in Children and Adolescents

Abstract

Despite national recommendations, screening for adolescent depression is generally uncommon and is typically characterized by regional and racial/ethnic disparities. This variability in practice may leave some adolescents disproportionately vulnerable to untreated depression. Further education about depression in general and specifically regarding screening may help address such disparities. Objectives After completing this article, readers should be able to: 1. Describe the diagnostic criteria and initial assessment of depression. 2. Outline screening and management strategies for depression. 3. Discuss risk factors for and presentations of suicidal thoughts and behaviors. 4. Determine the acute management and secondary prevention of suicidality. AUTHOR DISCLOSURE Drs Maslow and Dunlap have disclosed no financial relationships relevant to this article. Dr Chung has disclosed that he serves on an advisory board for Pfizer. This commentary does contain a discussion of an unapproved/ investigative use of a commercial product/ device.

Physical Fighting among School-Attending Adolescents in El Salvador: An Examination of the 2013 Global School-Based Health Survey

“…In addition, other research provides additional evidence that bullying is associated with psychological conditions such as depression [40]. Depression itself is a risk factor for suicide among this population [41]. This implies that being bullied is not only implicated in physical fighting behavior but also potentially suicidal behavior.…”

Relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among school students: a school-based study in Zhejiang Province, China

“…A meta-analysis including 320,375 students included in 40 studies conducted in China found that the prevalence of suicidal ideation among high school students was 18.0% (95%CI: 16.6–19.5) [11]. The epidemiology of suicidal ideation and attempt involves a large number of risk factors, including socio-demographic factors (e.g., gender, family income and family structure) [12, 13], behavioural factors (cigarette use, alcohol use, illicit drug use, inadequate physical activity and ever having sexual intercourse) [14–16], mental health (e.g., sadness, loneliness and depression) [15, 17, 18], poor physical health [19, 20] and poor academic performance [21].…”

Family and School Contexts as Predictors of Suicidal Behavior among Adolescents: The Role of Depression and Anxiety

“…Nevertheless, considering the results from the mediation analyses, this relationship seems not to be direct; rather, it is fully mediated by depression. The link between depression and suicide during adolescence has been extensively explored in previous research [23,41] and is characterized by various psychological, biological, and social mechanisms [42]. Indeed, as there is evidence that depression is a main determinant of suicidal behavior, the worrisome increase in rates of depression among adolescents worldwide [43] aggravates the severe public health concern about suicide.…”

“…While some studies have found a direct association between family functioning and suicidal behavior in adolescents even after controlling for mental health problems [10,21], others studies have identified several factors that are mediators or moderators of this relationship, in particular, negative effects [6,22]. In this regard, adolescent suicide has been closely related to mental health problems, particularly high rates and severity of symptoms of depression [23] and anxiety [24]. On the other hand, although some studies have identified depression and anxiety as mediators in the association between family function and suicidal behavior, to our knowledge, no studies have compared the mediating effects of depression and anxiety on this association.…”