Depression and Suicide

Carrie Hatcher-Kay, PhD* 2. Cheryl A. King, PhD† 1. *Postodoctoral Fellow, Department of Psychiatry 2. †Associate Professor of Psychiatry; Chief Psychologist; Director, Child & Adolescent Depression Program, University of Michigan Medical School, Ann Arbor, MI After completing this article, readers should be able to: 1. Discuss the prevalence of depressive disorders. 2. Recognize the comorbidities of early-onset depressive disorders. 3. Explain how pediatricians and other caregivers can help youth who may be depressed. 4. Describe the first line of treatment for youth who have depressive disorders. 5. Discuss the incidence of suicidal ideation, attempted suicide, and suicide in adolescence. 6. List the risk factors for suicide by youth. Most youth occasionally experience the blues, feel sad, or become irritable. Nevertheless, it is important to consider the possibility of a depressive disorder when a depressed or irritable mood is more than temporary, occurs in conjunction with other symptoms, or interferes with daily functioning. Major depressive disorder (MDD) is manifested by a depressed or irritable mood or diminished interest or pleasure that lasts for at least 2 weeks. This is accompanied by changes in cognitive and physical functioning. Dysthymic disorder (DD) is a less severe type of depression that involves chronic symptoms and lasts for at least 1 year. These specific types of depressive disorders are the focus of this article. Depressive disorders can be identified in children of all ages, but they become increasingly prevalent during adolescence. In fact, the peak ages of depressive symptom onset in lifespan studies are 15 to 19 years and 25 to 29 years. The sharpest rise in prevalence occurs among girls during adolescence and early adulthood. Approximately 2% of school-age children and 4% to 6% of adolescents struggle with MDD at any one point in time. Lifetime prevalence rates by late adolescence range between 20% and 25%. Prior to puberty, there is about a 1:1 gender ratio for depressive disorders. After puberty, this shifts to a 2:1 ratio of females to males, which continues throughout adulthood. A combination of hormonal and social changes during puberty may …