SUMMARY:
     Only in the past two decades, have depression and suicide been taken seriously. Depression is an illness that involves the body, mood and thoughts. Depression affects the way a person eats and sleeps, feels about themselves, and the way they think of the things around them. It comes as 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). Teen suicide has more than tripled since the 1960’s (Santrock, 2003). Despite this alarming increased suicide rate, depression in this age group is largely 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 thought the reason why depression is often overlooked in adolescents is that it is a time of emotional turmoil, mood swings, gloomy thoughts, and heightened sensitivity. Adolescence is often a 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.” (p. 52)
An adolescent’s first line of defense is his or hers parents. Peers can be an essential part of detecting changes and differences in youth. Most of a teens waking hours are spent at school or with friends. It is up to those individuals who interact with the adolescent on a daily basis (parents, teachers, peers) 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, 1996). The most common form of depression for females are drastic changes in eating patterns. 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). Often times a teen shows multiple efforts to gain attention towards their depression by attempting suicide. These efforts should be taken very seriously even if there was no physical injury because of the attempt. In high school, a boy I will call John had attempted suicide several times and showed many signs of depression throughout high school. Because of the lack of treatment, the depression continued into adulthood. John committed suicide during his college years. Through the early detection and treatment method John could have been helped and his life would have been spared.
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 what they believe to be rejection from their parents (Lewis, 1996). Oster and Montgomery (1996) stated “when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents” (p 2). This distraction includes increased disruptive behavior, self-inflicted isolation and even verbal threats of suicide. Many times parents wrapped up with their own conflicts and busy lives 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 stereotypical 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 may be working full time, the teen may feel they are playing “second fiddle” in importance. Great stress placed upon teens today starting in early childhood contribute to strain and depression. Most enter daycare at an early age and continue into preschool. When public school starts, they are in the early-morning program, after-school program or just latch key kids. Children left to their own devices at an early age develop sensations of loneliness. Many go home to an empty house with no one to talk to about their day at school. Once the parents arrive home, it may be time for soccer practice, baseball practice, or gymnastics class. In my own circumstances, my mother worked two jobs and was never home often times making me feel as if she was not interested in me. She would often miss cheerleading competitions that I held important and her absence would be devastating. Many times parents are too tired to spend time with their children, also leaving the child feeling neglected. At one end of the spectrum, teens are pushed by parents to excel in sports and academics. At the other end, there are teens never given direction or aspirations by their parents. 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. Those teens without direction and lack of interest on the part of their parent’s also increase likeliness of drugs and alcohol activity as a means of escape. (Lasko 1996) 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. A fellow student in my high school attempted suicide by overdosing on dangerous drugs. She would have died if her friend had not found her and sought out treatment.
Dr. William Beardslee of Boston, working with children and teens exhibiting depression and suicidal tendencies feels these disorders are based on a complex interplay of biological/genetic forces and developmental transactions between teens, family members and the outside world (Beardslee, 1998). 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 organized sense of identity (1998).
Santrock (2003) addresses gender differences as it relates to suicide and depression. Females tend to emotionally compound and dwell on issues making them twice as likely for depression symptoms. Puberty and physical changes happen at an earlier age for females and therefore increases the likelihood of depression symptoms to be noticed earlier in age. Females have more problems with discrimination and sexism, causing more stress, and therefore increasing their likelihood of depression. Males are more likely to complete suicide whereas females are more likely to try to reach out with a flawed attempt more often.
     An estimated 2,000 teenagers per year commit suicide in the United States, making it the third leading cause of death (Santrock, 2003). Blackman (1995) stated that it is common 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, many things can be done about it. Blackman has suggested two main concepts in treatment: psychotherapy and medication. The majority of cases of depression are mild and cured 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, p 283)
Until recently, adolescent depression largely ignored. Now, several means of diagnosis and treatment exist. Lewis (1996) wrote a research article involving programs that involved peers as helpers in dealing with depression and suicide. The research, conducted through a survey method, concluded that schools with a peer helping program have much success through the implementation of the program. However, the downfall of the success is that the programs usually are started because of a tragic event and end once that event has passed over time. The truly successful programs are those that have a program at all times available to children even though there is not a heightened alertness to the issue of depression and suicide. 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. Those children must find somewhere to deal with those emotions.

INTERVIEWS:
     Unfortunately, due to the graphic topic of suicide and depression, it was not possible to conduct any adolescent interviews. In trying to ask youth regarding their feelings about suicide and depression, parents were not willing to allow me to talk to their children or schools found it inappropriate. “Sadly, the reluctance to discuss the issue also contributes to the problem” was what one telephone hotline, identified as Nancy told me via a short telephone interview at the National Hopeline Network (1-800-SUICIDE). The interview was very brief due to needing to keep phone lines open, but she was able to discuss briefly that the problem of adolescents not feeling that they have someone to talk to because they will get in trouble is a common thing that she hears from callers. She feels that if suicide and depression were not taboo to talk about in schools then children may feel that they have an outlet to talk to someone. Nancy also referred me to their website at www.suicidecrisiscenter.com for more information.
     For additional professional interviews I was also met with resistance. Three professionals I called said they were not comfortable having a telephone interview. When I offered to make an appointment at their convenience it became clear that they expected to be paid for the sessions. One of the counselors asked me about my insurance and told me, “whatever you want to talk about in a session is up to you and you can use the 55 min any way you would like.” I had decided to go in and try and speak with someone as a walk in and not phone first. The receptionist told me that “all of the therapists have appointments all day long and you can leave your name and number and I will have someone call you.” I did leave my name and number and no one ever phoned me.
Frustrating as this was, I decided to talk to some teachers about their feelings about adolescents and suicide risks. They deal with children in the risk age group every day and are poised to see the early warning signs of depression or suicide signs. Dave Pratt, a science teacher at Deer Valley High School has one student, Emily*, that is a “cutter”. Emily cuts her arms and legs daily and has been diagnosed a manic depressive. I asked him if there was anything that was told to him about her and he told me that the school told him that her parents and the school psychologist are aware and if he noticed her bleeding to send her to the school nurse. He admitted his frustration as well at the schools for not taking more initiative to help students “who are obviously in need of help, let alone those who don’t know how to cry out for it.” Other teachers that I tried to speak with at the high school age were reluctant to speak with me.
As difficult as it was for me, a concerned adult, to get information or someone to talk about a delicate topic of suicide….. I can only imagine how a 15 year old wondering why they should live when they fell like dying must feel! Throughout my research process and the many obstacles I faced I felt angry and resented the fact that handing someone a pamphlet does not always quench their thirst for information. How can a child feel comfortable talking to someone when no one will even talk to me about it? Nancy, at the suicide hotline, also had told me that many children are one time callers and that “is just all they need is someone to talk to them and calm down the immediate feelings”. I am not sure how she knows that “this is all they need” but if that is so, then why not open the doors for more communication at a more personal level? I am now under the firm belief that the hotlines are so very important to today’s youth and am in support of them fully!
Obviously, detection and treatment need to begin with the earliest element of warning signs. This can only be possible through the collaboration of willing adults. With the help of parents, teachers, schools, mental health professionals and other caring adults, the severity of a teen’s depression can be accurately evaluated. Plans made to improve his or her well-being and ability to live life to the fullest. Giving the attention to the symptoms and signs of depression can save a child’s life. Early detection and treatment is the key to preventing adolescent depression and suicide.



References Section:

Blackman, M., “You asked about…adolescent depression.” The Canadian Journal of CME [Internet]. Retrieved April 4 2004, from http://www.mentalhealth.com/mag1/p51-dp01.html.

Beardslee, W.R. (1998), Prevention and the clinical encounter. American Journal of Orthopsychiatry [Internet]. Retrieved April 5 2004, from http://www.mhsource.com.

Brown, A. (1996 Winter). Mood disorders in children and adolescents. NARSAD Research Newsletter [Internet]. Retrieved April 1 2004. from 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.

Lewis, Max W. & Lewis, Arleen C., (1996). Peer Helping Programs: Helper role, Supervisor training and Suicidal Behavior. Journal of Counseling & Development. 74 (3). 307-315.

Oster, G.D, Montgomery, S. S. (1996),. Moody or depressed: The masks of teenage depression. Self-Help & Psychology [Internet]. Retrieved April 1 2004, from http://www.cybertowers.com/selhelp/articles/cf/moodepre.html.

Santrock, John W. (2003). Adolescence 9th Edition. Depression and Suicide (pp. 95 464-467). McGraw-Hill Companies.