Lowering the Risk of Suicide in Depressed Children and Adolescents

In an article in Current Psychiatry, ”How to lower suicide risk in depressed children and adolescents”, researchers Shailesh Jain (MD, MPH, ABDA), Rakesh Jain (MD, MPH), and Jamal Islam (MD, MS) discuss how to determine whether a child is at risk as well as treatment options depending on the severity of their symptoms.  Depression often goes undiagnosed in children and adolescents and is just as often undertreated. It is a challenge to detect it and treat it in young children, especially with due consideration that depression may occur as a result of genetic predisposition or dysfunctional parenting.

The average duration of depression in children and adolescents is about seven to eight months. Symptoms often vary with age. In children of pre-school age, depressive symptoms may manifest as somatic and behavioral problems. Children are often sad or irritable. Older children exhibit sadness and lose interest in social activities. Adolescents feel an array of symptoms such as feeling mentally and physically fatigued, loneliness, anger, uncertainty, and many others. Patients with subsyndromal depressive symptoms—where relapse and recurrence are common, may suffer depressive episodes even into adulthood. Factors to watch out for in these cases include “severity of depressive episodes, concurrent psychotic symptoms, suicidal thoughts, history of recurrent depressive episodes, threshold of residual symptoms, recent stressful life vents, adverse family environ, and family history of depression”.

The best way to determine the appropriate method of treatment for children is through proper assessment techniques. Informal interviews like the Child and Adolescent Psychiatric Assessment, the Kiddie Schedule for Affective Disorder and Schizophrenia, and the Diagnostic Interview for Children and Adolescents are often helpful in understanding and assessing the problem. Therapists often assess children to see if they have any “emotional difficulties, lack of developmental progress, levels of distress, impairment in functioning”, and whether or not they are danger to themselves or others around them.

Treatment options vary depending on the severity of the patient’s symptoms. Patients who have mild cases of depression often use psychotherapy, usually in the form of cognitive-behavioral therapy (CBT) to treat their problems. However, patients with more moderate to severe forms of depression will use antidepressants or a combination of both antidepressants and psychotherapy, a treatment often used for older adolescents who have treatment-resistant depression. Common antidepressants include brands like Citalopram, Celexa, Fluoxetine, Prozac, Sertraline, Zoloft, Venlafaxine, and Effexor. In much more serious cases where high risks of suicide are involved, hospitalization may be required for the patient.

There are four recommendations for lowering the risk of suicide in vulnerable children, as explained by the researchers. The first is to create a “safety plan” which entails directing the patient’s behavior in a certain situation. For example if a patient is feeling depressed or has suicidal thoughts, they should do something or contact someone to address the problem. Another recommendation is creating a “hope box” where a patient collects mementos and other things that give them reasons to want to live and give them hope. This should be accessible at all times so the patient can use it any time they feel they are in a state of despair or facing a mental crisis. A third suggestion is counteracting alienation. Patients may feel isolated or as if they are bothering others, so they should be encouraged to participate in more social activities, no matter how small they may be. For many children, the feeling of being alone may drive their suicidal behavior. Lastly, management of “overarousal” is another effective strategy. Overarousal is often manifested as an agitation of some kind. By addressing and reducing the agitation, patients would be less driven to a state where they feel depressed. On such example of agitation is insomnia, and effective ways of treating it include better sleep hygiene, stimulus control techniques, and sleep restriction.  

In addition to the four recommendations provided by researchers, a good support system of peers and family, high self-esteem and self-confidence from acceptance through social interactions and “body image satisfaction”, and a sense of “religious and existential well-being" where patients feel they have meaning and some kind of purpose in life are often attributed to children who have low rates of depression. 

Source:

Jain, S., Jain, R., Islam, J. (2012). How to lower suicide risk in depressed children and adolescents. Current Psychiatry, 11(5), 21-31

Written By: Salma Khan