ADOLESCENT DEPRESSION & SUICIDE

First, a few facts:  National statistics indicate that suicide is the third leading cause of death among young people between the ages of 15-24.  The U.S. Secret Service recently reported that in cases of school violence, 75% of the students involved had threatened or tried to commit suicide and more than 50% had a history of depression.  According to the Mental Health Report of the Surgeon General (1999), 6.1% of 9-17 year olds are clinically depressed.

It’s been my experience that it usually doesn’t take 1000 tests to figure out if a teenager is depressed or not.  If a student feels depressed ? then he or she most likely is depressed.  Most of the time the individual is highly aware of what’s causing the depression, for example, a difficult family situation, argument with friends, pressure to succeed in school, low grades, etc.  So, determining if someone is depressed or not is usually the easy part.

If/when the diagnosis of depression is forwarded, it is important to remember that diagnosis is always “the start,” not the finish.  Sometimes people forget this important concept.  Some say, “There!  That’s the problem ? I’m depressed.”  Then they resume their life feeling they have the answer and explanation [and rationale] for their behaviors.  But if depressed, the challenge is always, “what needs to happen and what do I need to do now to get through the problem, resolve the issue, and/or find a way to cope so that I can get back on track with my life, proceed into the future, and pursue my goals, dreams, and happiness?”

Given that adolescents experience emotions on such a deep and intense level, depression oftentimes goes hand-in-hand with the high school years.  In my opinion, “to be a teenager is, almost by definition, to be depressed.”  H. Sullivan (1953) described adolescence as a period of “Storm and Stress,” and adults sometimes forget how hard it is [was] to be a teenager.  It is also important to remember that everyone gets sad at times and sadness and depression are naturally occurring human behaviors ? nobody can be happy all of the time!  Plus, who amongst us can look at the state of our world in modern times and not get somewhat existentially depressed or confused?  Maybe a student (you?) will be sad enough about some aspect of the world that she or he will be the one who becomes highly motivated to change it in a positive manner in the future?

But on a different level, it is very important to remember that there is a big difference between depression… and clinical depression.  Individuals who are clinically depressed may feel like they are all alone in the world, there is no help, there is no way out, they are painted into a corner, or no more options are available to help them resolve their problem.  They may increasingly begin considering giving up.  Sometimes the idea of suicide enters the person’s thoughts.  It is at this moment -- when the individual feels most alone in the world -- that s/he needs to remember that there are many sources of help and support available, and even though they may not yet be aware of it, there is a way to get through the problem.

Some of the warning signs of clinical depression include, but are not limited to, feelings of sadness, emptiness, or irritability;  diminished interest or pleasure in activities;  significant weight loss or failure to gain weight for expected normal growth;  difficulties sleeping;  restlessness;  fatigue or loss of energy;  feelings of worthlessness or excessive or inappropriate guilt;  confusion, difficulty concentrating;  and/or recurrent thoughts of death or suicidal ideation.  Caution:  all of these warning signs [except the last one ? thoughts of death or suicidal ideation;  if you are experiencing thoughts of death or suicidal ideation, find help immediately] are just indicators and just because you might experience any one of them does not necessarily mean you are ? or aren’t -- clinically depressed.  There are also several different kinds and types of depression, including manic-depression (bipolor disorder), mixed episodes, hypomania, major depressive episodes, dysthymia, and others.  In every case, it is also always important to consider the frequency, duration, and intensity of the symptoms.  Does the individual experience these behaviors/moods very often, over a long period of time, and/or to a very deep/intense level?  Or was it just a bad day, a transient situation, or a relatively easily resolved problem?  There are many other considerations that psychologists, mental health counselors/therapists, psychiatrists, and doctors account for in the diagnosis of clinical depression.

It is always most important for teenagers (and people of any age) to understand:

• Depression is a treatable illness and it is important to understand whether or not you are suffering from it;
• Suicide is a preventable tragedy that sometimes occurs as a result of untreated depression;
• Students can learn to recognize the signs of depression and potential suicidality in their friends;  and
• Teens should know that they are in the best position to prevent a friend’s suicide by remembering to “ACT:  Acknowledge a friend has a serious problem, let the friend know you Care, and Tell a responsible Adult.”

SOME INDICATORS OF POTENTIAL SUICIDES:

The following listing of risk indicators and symptoms may help to determine the seriousness and level of risk of a suicide threat.  Any concerns that a student may be suicidal should be immediately reported to a school administrator, counselor, school psychologist, teacher, crisis intervention team, or other trusted adult(s).  This list used to just be shared with teachers and school staff;  it is shared here with students, because "we are all in this together."  This is one area that crosses the boundaries of age.
 

HIGH RISK INDICATORS:

• Previous suicide attempt
 
Symptoms:
Attempt(s) at suicide known by significant others.
Family history of suicide.
• Giving away of prized possessions

Symptoms:
Distributes favorite belongings to special friends or family members as a way of saying goodbye.

Recent loss or threat of loss of friend of family member

Symptoms:
Extreme grief or trauma experienced due to tragic loss (e.g., death, suicide, divorce, separation, change in family status or residence, negative change in health status or appearance, etc.)

Specifically determined suicide method and time

Symptoms:
When questioned, expresses wish to die and indicates existing plan, available means and specific time frame for completion.

• Chronically self-destructive lifestyle

Symptoms:
Drugs, including alcohol, used excessively.
Involved in high-risk activities.
Evidences careless disregard for personal safety.
Scratches and marks body.

OTHER GENERAL INDICATORS:

• Verbalizing suicide threats

Symptoms:
Makes comments such as "I don't want to live any longer," or "You'll be better off without me," or "I could just die."
Expresses that friends and family will not miss them.
Threatens to hurt or kill self.

• Collecting information on suicide methods

Symptoms:
Makes inquiries regarding lethal weapons, pills, and other methods used by people who have committed suicide.

• Expressing hopelessness, helplessness, and anger at self or the world

Symptoms:
Expresses that no one cares.
Indicates feelings of failure and lack of self-esteem.
Has increased conflicts with family, friends, or authority figures.
Is overwhelmed with current stress factors and states, "I can't handle it."
Lacks ability to problem solve appropriately.
Feels like quitting or running away from the world.
Feels humiliated, experiences loss of face.

• Expresses death or depression themes

Symptoms:
Conversation, written expression, reading selections and art work focus on death and other morbid subjects.
Relates frightening dreams or fantasies.

• Evidences acute personality changes

Symptoms:
Withdraws from family, friends, and activities.
Becomes sexually promiscuous.
Is newly aggressive and irritable.
Has frequent crying spells, tantrums, or moodiness.
Loses interest in appearance and grooming.
Runs away from home.
Becomes depressed due to pregnancy.

• Demonstrates sudden dramatic decline or improvement in academic, athletic, or other performance activities

Symptoms:
Unable to concentrate, attend to, or complete tasks.
Chronically tardy or truant.
Fidgety, hyperactive, or hypoactive in the classroom.
Shows drastic drop or improvement in grades.

• Evidences physical symptoms of depression

Symptoms:
Appears apathetic, lethargic, bored, or extremely fatigued.
Sleeps excessively or experiences insomnia.
Suffers markedly increased or decreased appetite.
Displays tension, nervousness, or anxiety.

Even though it may not always seem like it, there exists many SOURCES FOR HELP for suicide/depression.  Here are just a few:

• Guidance Center.  If you feel you might be depressed, come to the Guidance Center and make an appointment with the school psychologist and/or your Guidance Counselor.  If you have been considering suicide or having thoughts regarding suicide, seek appropriate help immediately.  Crisis [suicide] intervention services for students are available in the Guidance Center;
• Friends, parents, family, relatives, teachers, coaches, a trusted adult, principal, other school staff, pastor/clergyman, local mental health counselor, school counselor;  family physician, Police/Sheriff and more;
• HelpLines/Crisis Lines (a few are listed below -- note, most/many are Kern County):
• Local HelpLine:  1 (800) 273-2275.
• Memorial Center:  763-4151.
• Memorial Center Emergency:  398-1800.
• Kern County Mental Health Services (24 hour crisis):  868-8000.
• Poison Control Center:  876-4766.
• 24-Hour California Youth Crisis Line:  (800) 843-5200.
• Boys Town National Hotline:  (800) 448-3000
• If in mental health crisis, call 911.
• There are others in existence.
• Immediate Crisis help is also available at Memorial Center in Bakersfield;

See the Yellow Pages or internet for additional information related to mental health/psychologists/crisis intervention.

Screening for Depression
If you feel you need to be screened for depression or just need to talk about important things, please contact your school psychologist.  There are also [free] “National Depression Screening Days."
 

"Some Indicators of Potential Suicides" from the Los Angeles Unified School District Psychological Services Crisis Intervention materials to be used as a resource for students, teachers, staff.