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
