Depression and Suicide in Children and Adolescents

Michael S. Jellinek; James B. Snyder

doi:10.1542/pir.19-8-255

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Michael S. Jellinek, MD^*
James B. Snyder, MD^†

^*Chief, Child Psychiatry Service, Massachusetts General Hospital; Professor of Psychiatry and of Pediatrics, Harvard Medical School, Boston, MA.
^†Pediatric Consultation Liaison Service, Physician-in-Charge, Attention Deficit Hyperactivity Disorder Program, Division of Child and Adolescent Psychiatry, North Shore University Hospital-New York University School of Medicine, Manhasset, NY.

IMPORTANT POINTS

Vulnerability to psychiatric disorders, including depression, involves the interplay of genetic, biochemical, and psychosocial/environmental forces.
The “core” symptoms of depression are the same for children and adults, but the prevalence of certain symptoms can vary with age.
Evidence suggests that early-onset major depression is associated with especially high levels of psychiatric comorbidity, a protracted course, a poorer outcome, and a high probability of significant functional impairment.
Suicide risk factors are common to a wide range of distressed children and adolescents and are not specific to suicide.
There is no way to predict suicide among depressed children and adolescents, except in those who have made previous attempts.

Introduction

Pediatricians are confronted daily with a wide array of psychosocial issues.Whether it’s the preschooler crying and complaining of stomach aches before leaving for child care, the young adolescent skipping school, or the older teenager abusing substances, pediatricians often are put in the difficult position of having to decide if problem behaviors and emotions are“ normal variations,” developmental transitions, temperamental manifestations, or primary symptoms of a serious psychiatric disorder. Mood disturbances and depressive states often represent a diagnostic dilemma to the primary care physician.

Sadness is common and is an appropriate response to loss (eg, death of a loved one), divorce, or separation. Although the initial sadness following loss may fade over time, children often revisit their sadness in later years. Normal adaptation involves a gradual acceptance of the loss and an incorporation of this reality into the child’s life experience. Some children will reconfigure the memory of the deceased through pictures or momentos in a process called memorialization. Other children (and adults) may carry on a silent dialogue with the deceased, trying to imagine how this person would have reacted at key times during the child’s life (eg, graduations, weddings). Sadness, when provoked by …