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Adolescent Depression and Suicide: Early Detection and Treatment the Key

Only in the past two decades has depression in adolescents been taken seriously. Depression is an illness that involves the body, mood and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Therefore it comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer (Blackman, 1995). Despite this alarming increased suicide rate, depression in this age group is greatly under diagnosed and can lead to serious difficulties in school, work, and personal adjustment, which may continue into adulthood. How prevalent are mood disorders and when should an adolescent with changes in mood be considered clinically depressed? Brown (1996), has said the reason why depression is often overlooked in adolescents is because it is a time of emotional turmoil, mood swings, gloomy thoughts, and heightened sensitivity. It is time of rebellion and experimentation. Blackman (1996), observed that the “challenge is to identify depressive symptomatology which may be superimposed on the backdrop of a more transient, but expected developmental storm.”

Therefore, the adolescent’s first line of defense is his or hers parents. It is up to those individuals who interact with the adolescent on a daily basis (parents, teachers, etc.) to be sensitive to the changes in the adolescent. Unlike adult depression, symptoms of youth depression are often masked. Instead of expressing sadness, teenagers may express boredom and irritability, or may choose to engage in risky behaviors (Oster & Montgomery, 1996). Key indicators of adolescent depression include a drastic change in eating and sleeping patterns, significant loss of interest in previous activity interests, constant boredom, disruptive behavior, peer problems, increased irritability and aggression (Brown, 1996).

What causes a teen to become depressed? For many teens, symptoms of depression are directly related to low self-esteem stemming from increased emphasis on peer popularity. For other teens, depression arises from poor family relations, which could include decreased family support and perceived rejection by parents. Oster and Montgomery (1996), stated that “when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents.” This distraction could include increased disruptive behavior, self-inflicted isolation and even verbal threats of suicide. Many times parent’s are so wrapped up with their own conflicts and busy lives that that fail to see the changes in their teens, or they simply refuse to admit their teen has a problem. In today’s society the family unit can be quite different from the stereo typical one of the 1950’s, where the father went to work and the mom was the homemaker. Today, with single parent families and families where both parents have corporate jobs, the teen may feel he or she is playing “second fiddle” in importance in the lives of their parents. Also, great stress is placed upon teens today starting in early childhood. Most enter daycare at an early age and continue into preschool. Then when public school starts they are either in the early-morning program, after-school program or just latch key kids. They are left to their own devices at an early age. Many go home to an empty house with no one to talk to about their day at school. Once the parent’s arrive home it may be time for soccer practice, baseball practice, or gymnastics class. Again no time for talking about the day’s events and with everyone going in different directions a family dinner around the kitchen table just does not happen. At one end of the spectrum, teens maybe pushed by their parent’s to excel in sports and scholastics, and at the other end there are teens that are never given direction or aspirations by their parent’s. Those pressured to excel maybe come overwhelmed by what is expected of them and can fall into using drugs and alcohol as a form of escape and may feel the only way out is that of suicide. On the other hand those teens without direction and lack of interest on the part of their parent’s, may also turn to drugs and alcohol as a means of escape. They may contemplate and even attempt suicide as a way of either drawing attention to themselves or to just end their lives because no cares about them anyway. Dr. William Beardslee of Boston, working with children and teens exhibiting depression and suicidal tendencies feels these disorders are likely based on a complex interplay of biological/genetic forces and developmental transactions between teens, family members and the outside world. Some teens manage to survive and even flourish under the most difficult circumstances, while others flounder under the same conditions. Beardslee’s research led him to several core factors in how well a teen or child will do in overcoming ongoing adversity. Primary among them were the ability to form strong relationships, an action-oriented outlook and a keen and cohesive sense of identity.

An estimated 2,000 teenagers per year commit suicide in the United States, making it the leading cause of death after accidents and homicide. Blackman (1995) stated that it is not uncommon for young people to be preoccupied with issues of mortality and contemplate the effect their death would have on close family and friends. Once it has been determined that the adolescent has the disease of the depression, what can be done about it? Blackman has suggested two main avenues to treatment: “psychotherapy and medication.” The majority of cases of depression is mild and can be dealt with through psychotherapy sessions with intense listening, advice and encouragement. For the more severe cases of depression, especially those with constant symptoms, medication may be necessary and without pharmaceutical treatment, depressive conditions could escalate and become fatal. Regardless of the type of treatment chosen, “it is important for children and teens suffering from depression to receive prompt treatment because early onset places children and teens at a greater risk for multiple episodes of depression throughout their life span.” (Brown, 1996).

Until recently, adolescent depression has been largely ignored. But now several means of diagnosis and treatment exist. Although most teenagers can successfully climb the mountain of emotional and psychological obstacles that lie in their paths, there are some that find themselves overwhelmed and full of stress. With the help of parents, teachers, mental health professionals and other caring adults, the severity of a teen’s depression can not only be accurately evaluated, but plans made to improve his or her well-being and ability to fully live life.

References:

Blackman, M., “You asked about…adolescent depression.” The Canadian Journal of CME [Internet]. Available: http://www.mentalhealth.com/mag1/p51-dp01.html.

Beardslee, W.R. (1998), Prevention and the clinical encounter. American Journal of Orthopsychiatry [Internet]. Available: http://www.mhsource.com/pt/p990957.hmtl.

Brown, A. (1996 Winter). Mood disorders in children and adolescents. NARSAD Research Newsletter [Internet] Available: http://www.mhsource.com/advovacy/narsad/childhood.html.

Lasko, D.S., et al. (1996), Adolescent depressed mood and parental unhappiness. Adolescence, 31 (121), 49-57.

Oster, G.D, Montgomery, S. S. (1996),. Moody or depressed: The masks of teenage depression. Self-Help & Psychology [Internet]. Available: http://www.cybertowers.com/selhelp/articles/cf/moodepre.html.


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Teenage Suicide
By Joy Cagil 

When we judge by the statistics, it is estimated that about 100,000 people kill themselves a year in the USA. Of this number only 30,000 are reported as suicides. Of these 30,000 people, 2000 are in their teenage years.

First, the most important fact of suicide: Even if a person does die by suicide, that doesn't mean he chose it. If he knew he could have his life back without so much pain, he would choose life. Suicide victims are not trying to end their life; they are trying to end the pain.

Number one cause of suicide is depression. Depression is not the same thing as the “blues”. The blues are normal feelings. Blues pass in a short time, say a couple of weeks. Depression lingers on or comes to pester a person over and over again carrying death.

Depression is a whole body disease affecting thoughts, feelings, behavior, physical health, appearance, and all areas of a person’s home, work, school and social life. Yet, depression can be treated successfully just like other illnesses such as diabetes, pneumonia, ulcers, etc. Depression is an illness that surfaces when triggered by a complex combination of genetic, psychological and environmental factors. For its treatment, therapy and very often medication are needed.

Anyone can get depression at any age. If someone is suffering from depression, he is not weak or crazy; although, he may feel like he is going crazy. He does not have a character flaw. Having depression is not his fault. When a person has depression, he cannot talk or think himself out of it.

Sometimes people who are severely depressed and contemplating suicide don't have enough energy to carry it out. As the disease begins to ease up, they may regain some of their energy, but may still have feelings of hopelessness, even though in the outside, they may seem to be calmer. At this time, they may try to kill themselves because they feel they just can't fight it anymore.

If you feel a teen is thinking of suicide, the first thing to do is to be direct. Ask them straight out if they want to kill themselves. They may answer you with a joke, but make sure that they understand you are serious and that they answer you seriously.

Emergency measures if you feel that a person is about to kill himself:

Do not leave the person alone unless you are in danger yourself. Studies show that most people will not harm themselves when they are with someone.

Listen to what the person says. What might seem trivial to you can be overwhelming to the person in pain.

Be the link to get help.

If you’re a teen yourself call your parents, their parents, another trusted adult, or better yet 911.

If you are an adult, call the parents or any other help available.

For suicide to happen three conditions are necessary:

1. Intense and excruciating psychological pain

2. Wish to die being greater and more persistent than the will to live

3. An available self-injury method

Parents, family members, and friends should not panic, but they should be on the alert when they hear certain statements, especially when they are told in clusters, bits and pieces, and a little too often. These following statements may be the indication of depression as a disease:

"I feel guilty. I feel sad. I feel like crying a lot. I feel so alone. I feel so helpless.

I don’t have fun anymore. Sometimes I feel I can’t go on living. I don’t want to go out with friends anymore. I feel “different” from everyone else.

I don’t really feel sad, just “empty”. I feel like I’m in a fog.

I don’t have any confidence in myself. I don’t like myself.

I smile, but inside, I’m miserable.

I feel scared a lot of the time, but I don’t know why.

I feel mad a lot, like I could just explode. I’m always getting into trouble. Sometimes I do things that are dangerous or that could hurt me. I use alcohol or drugs to escape or to mask feelings.

I don’t feel like talking–-I just don’t have anything to say.

I’m so restless and jittery. I just can’t sit still.

I can’t concentrate. I have a hard time remembering. I can’t think straight. My brain doesn’t seem to “work”.

I feel so disorganized, like my head is spinning.

I feel so self-conscious. I don’t want to make decisions; it’s too much work.

I’m so tired, no matter how much sleep I get. I don’t feel like taking care of my appearance or myself. My whole body feels slowed down; my speech, my walk, my movements.

Occasionally, my heart will pound very hard; I can’t catch my breath; I feel tingly; my vision seems strange; and I feel like I might pass out. This passes in seconds, but I’m afraid it will happen again. (This statement points to panic attacks.)

I’m frustrated with everything and everybody. I feel my life has no direction.

I have trouble falling asleep or wake up in the middle of the night and can’t get back to sleep.

I don’t feel like eating anymore. I feel I could eat all the time. I’ve gained or lost a significant amount of weight.

I have headaches, stomachaches, backaches, and/or pain in my arms and legs. I feel dizzy a lot.

My vision seems blurred or slow at times. Nothing I do makes me feel better."

Signs of Trouble:

Abrupt changes in personality

Giving away possessions

Previous suicide attempt

Use of drugs and/or alcohol

Change in eating pattern - significant weight loss or gain

Change in sleeping pattern – insomnia or oversleeping

Unwillingness or inability to communicate

Extreme or extended boredom

Being careless and accident prone

Unusual sadness, discouragement or loneliness.

Talk of wanting to die – the words mostly used are: ending it all, end, finish, stop

Neglect of academic work and/or personal appearance

Family disruptions - divorce, trauma, losing loved one

Running away from home or truancy from school

Rebelliousness - reckless behavior

Withdrawal from people/activities they love

Confusion - inability to concentrate

Chronic pain, panic or anxiety

Perfectionism or restlessness

Life Events That Could Trigger Suicide:

Major loss...of a loved one

Other major losses like a home, car, pet, prized possession

A trauma, or loss of a relationship

Divorce in the family

Problems with school or the law

Breakup of a romance

Unexpected pregnancy

A stressful family life (Having abusive parents, parents who are depressed or are substance abusers, or a family history of suicide)

Loss of security or fear of authority, peers, group or gang members

Stress due to new situations; college or relocating to a new community

Failing in school or failing to pass an important test

A serious illness or injury to oneself

Seriously injuring another person or causing another person's death, maybe in a car accident

------------------

The following are the guidelines given by the Yellow Ribbon organization.

To Help a Suicidal Teenager:

Deal with your own feelings first. The idea of young people wanting to kill themselves is difficult for adults to grasp. The first reaction is often shock or denial. Trust your feelings when you think someone may be suicidal. A second reaction might be efforts to argue, minimize, to discount the young person's feelings of despair. Remember that most young people who contemplate or attempt suicide are not intent on dying. Rather, at the moment, the pain of living is more unbearable than the fear of dying.

1. Listen, don't lecture. What the young person really needs in this crisis period is someone who will listen to what is being said. Try to understand from the teenager's viewpoint.

2. Accept what is said and treat it seriously. Do not judge. Do not offer platitudes.

3. Ask directly if the individual is thinking of suicide. If the teenager has not been thinking of suicide, he or she will tell you. If the young person has been thinking of it, your asking allows the opportunity to bring it out in the open. Isolation and the feeling that there is no one to talk to compounds suicidal thinking. You will not cause someone to commit suicide by asking them if they are suicidal.

4. Talk openly and freely and try to determine whether the person has a plan for suicide. The more detailed the plan, the greater the risk.

5. Try to focus on the problem. Point out that depression causes people to see only the negatives in their lives and to be temporarily unable to see the positives. Elicit from the person's past and present positive aspects which are being ignored.

6. Help the young person to increase his/her perception of alternatives to suicide. Look at what the young person hopes to accomplish by suicide and generate alternative ways to reaching the same goals. Help determine what needs to be done or changed.

7. Help the person recall how they used to cope. Get the person to talk about a past problem and how it was resolved. What coping skills did he or she use?

8. Evaluate the resources available and help identify the resources needed to improve things. The individual may have both inner psychological resources and outer resources in the community that can be strengthened. If they are absent the problem is much more serious. Your continuing observation and support are vital.

9. Do not be misled by the teenager's comments that he/she is past the emotional crisis. The person might feel initial relief after talking of suicide, but the same thinking could recur later.

10. Act respectfully. Do arrange with the person to be back in contact within a few hours. Offer yourself as a caring and concerned listener until professional assistance has been obtained.

11. Do not avoid asking for assistance and consultation. Call upon whomever is needed, depending upon the severity of the case. Do not try to handle everything alone. Go to the child's guidance counselor, principal, parents, minister, etc. Seek out referrals from hotlines, etc. Convey an attitude of firmness and composure so that the person will feel that something appropriate and realistic is being done.

 

Joy Cagil is an author on http://www.Writing.Com/. Her background is in foreign languages and linguistics. Her portfolio can be found at http://www2.writing.com/main/view_item/user_id/joycag/

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