Behavioral Health » Military Leaders » Child/Adolescent » Depression

Frequently Asked Questions Depression & Suicidal Behavior in Young People

Q: What is Depression?

A: While the term "depression" can be used to refer to a sad mood, clinical depression is more than just feeling blue or down. Children who are clinically depressed feel down, sad, or hopeless all the time, for weeks on end. According to the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), in order to meet criteria for Major Depressive Episode, an individual must experience five or more of the following symptoms during the same two-week period:

  • Depressed or irritable mood most of the day, nearly every day
  • Disinterest in things once enjoyed
  • Fatigue or loss of energy
  • Difficulty sleeping, or sleeping too much
  • Significant weight loss or gain, change in appetite, or failure to make expected weight gains
  • Difficulty thinking, including inability to concentrate while reading or even watching television
  • Being observably agitated or slowed down
  • Feeling worthless or overly guilty
  • Talks about death or suicide

If you think your child or teen might be depressed check out the Depression Screening Quiz.

Q: What is the difference between depression and bereavement?

A: If your child or adolescent is experiencing depressive symptoms related to the loss of a parent, grandparent, friend, or pet, he or she is suffering from bereavement, not clinical depression. According to the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), bereavement is classified as a stressor that may require clinical attention, but it is not a mental disorder. More about bereavement

With depression, these feelings arise without a loss, or if a loss is experienced by the child, the depressive symptoms last much longer than normal grief.

Q: Is depression a mental disorder?

A: There are several different Depressive Disorders, which are considered mental disorders:

  • Major Depressive Disorder is characterized by one or more Major Depressive Episodes that last at least two weeks and include depressed or irritable mood or loss of interest, accompanied by at least four additional symptoms of depression. More
  • Dysthymic Disorder is a more chronic, but low-grade (less intense) type of depression. It is characterized by depressed or irritable mood day after day, for at least one year. More

Children and teens may also exhibit symptoms of depression that do not meet criteria for a mental disorder. A mental health or medical provider can help determine if your child or adolescent has a Depressive or Adjustment Disorder, and if so what level of care is needed.

Q: What if my child or adolescent is down and blue, but not clinically depressed?

A: If your child or adolescent does not meet criteria for a Depressive Disorder, depressive symptoms may still negatively impact his, her, or your family’s life. Young people can sometimes have difficulties with their mood in response to stressful events, such as changing schools, parents getting divorced or remarried, deployment, facing disappointment, etc. Feeling down and blue from time to time is normal. It is important to communicate this to young people, and support them through difficult times. Self-care information posted on this site may be helpful for young people to help them cope with the normal ups and downs of life. If you have any doubt about whether or not your child or adolescent is clinically depressed, consult with your pediatrician or a mental health provider.

Q: Is depression and/or suicidal behavior common in young people?

A: About five percent of children and adolescents in the general population suffer from depression at any given point in time.1 Approximately four percent of adolescents get seriously depressed each year.2 Major Depressive Disorder and Dysthymic Disorder are common disorders occurring in approximately two percent of children and four to eight percent of adolescents.3 Depressive disorders tend to affect boys and girls equally before they reach puberty. After age 15, depression is twice as common for females, than males.4 Depression is a significant risk factor for suicide in young people. Suicidal thoughts and attempts are more common in adolescents than children, particularly young children. Survey data from 1999 indicates that 19.3% of high school students had seriously considered attempting suicide, 14.5% had made plans to attempt suicide, and 8.3% made a suicide attempt during the year preceding the survey.5 More

Q: Why do young people consider attempting suicide?

A: People consider suicide when they are hopeless and cannot see other options for solving problems. Young people feel stress, confusion, self-doubt, and pressure to succeed. Adolescence, in particular, is time where young people undergo many changes. In addition to normative developmental changes, sometimes children and teens undergo other stressors, such as parents divorcing or remarrying, or moving to a new community or school.6 Sometimes when young people are extremely distressed they believe that suicide is their only way out. People who contemplate suicide aren’t "crazy". They often feel terribly isolated; because of their distress, and may not be able to think of anyone they can turn to, furthering this isolation.1 Suicidal behavior is often related to psychiatric disorders, such as depression, substance abuse, or borderline personality disorder.7 Risk factors include: 5

  • Previous suicide attempt(s)
  • History of mental disorders, particularly depression
  • History of alcohol and substance abuse
  • Family history of suicide
  • Exposure to the suicidal behavior of others
  • Barriers to accessing mental health treatment
  • Recent stress or loss (relational or social)
  • Easy access to lethal methods

Q: How can I tell if a young person is contemplating suicide?

A: Sometimes young people will provide clues or warning signs that they need help, but sometimes they don’t supply any warning signs. Some warnings include:2 More about warning signs

  • Withdrawing from friends and family
  • Depression
  • Talking, writing or giving verbal hints ("I’m useless," "I won’t be around much longer")
  • Purposefully putting personal affairs in order (e.g., giving or throwing away favorite possessions, clean his or her room, etc.)
  • Change in eating and sleeping habits
  • Rebellious behavior, running away, problems at school
  • Drug and alcohol use
  • Unusual neglect of personal appearance
  • Significant personality change
  • Loss of interest in and withdrawal from pleasurable activities

If someone you know is exhibiting these signs it is important to ask the individual if they are considering suicide. If they are feeling suicidal, it can come as a great relief to the individual to discover that someone has some insight into how they are feeling.7

Q: What should you do if a young person tells you they are thinking about suicide?

A: If a young person tells you they are thinking about suicide, you should take their distress seriously, listen without judgment, and help them get to a professional for evaluation and treatment. If a young person is in imminent danger of harming himself or herself, do not leave them alone. You may need to take emergency steps to get help, such as calling 9-1-1. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide, including medications or sharp objects.8

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Find a local crisis center.

If you are experiencing a behavioral health crisis, please call TriWest at 1-866-284-3743.

Q: What treatments are helpful for Depression?

A: According to Division 53 of the American Psychological Association several specific forms of short-term psychotherapy have been shown to be beneficial in the treatment of depression in children and teens. Cognitive behavioral therapy (CBT) is likely to help both children and teenagers. For depressed teenagers, interpersonal therapy (IPT) is a well-established treatment. IPT helps teens understand and address problems in their relationships with family members and friends that contribute to depression. More

Some medications (specifically, selective serotonin reuptake inhibitors, or SSRIs) may help relieve youth depressive symptoms, especially for teens. However, little is known about their long-term effects or effectiveness for younger children. More

According to the Academy of Child and Adolescent Psychiatry, the use of antidepressants seems indicated with children and adolescents who have such severe symptoms that psychotherapy is not effective, who have tried psychotherapy and it has not worked, or who have long-lasting or a recurrent (keeps coming back) form of depression. If your provider determines that medications are necessary to treat your child’s or adolescent’s depression, SSRIs are the initial antidepressants of choice.3 The American Academy of Child and Adolescent Psychiatry recommends that psychiatric medications should not be used alone, and should only be one part of a comprehensive treatment plan. More

It is important to consider potential side-effects compared to the benefits of medications. Not all medications work the same for everyone; therefore it is important that you consult with your pediatrician or a child psychiatrist to determine which medication (if any) is best for your child.

Questions to Ask your child’s provider about psychiatric medications.

The United States Federal Drug Administration (FDA) directed manufacturers of antidepressants to revise their labeling to include a "black box" warning to alert health-care providers to an increased risk of suicidality in children and teens. More

The Medication Guide About Using Antidepressants in Children and Teenagers provides more information about this warning, and helps parents make an informed decision about the use of antidepressants with their child or adolescent. The American Psychiatric Association and American Academy of Child and Adolescent Psychiatry produced The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families. This guide provides a different perspective on the FDA’s "black box" warning, useful information about depression and suicide, and guidelines to help patients and families make informed decisions about obtaining the most appropriate care for a child with depression.

Q: What treatments are helpful for suicidal behavior/attempts?

A: Psychotherapy or medications might be helpful for helping a suicidal child or adolescent solve problems that are causing them to feel suicidal. A trained professional can assess the situation and make treatment recommendations.

Q: How do I locate specialists or support groups for depression?

A: You can contact any of the following organizations, which have referral capabilities:

Q: How do I get immediate help for a child or adolescent who is feeling suicidal?

A: The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Find a local crisis center.

You may also call the TriWest behavioral health crisis line at 1-866-284-3743.

Q: Does my child or adolescent have to see a specialist in order to get help for depression?

A: Your PCM may be able to prescribe medications for your child or adolescent’s depressive symptoms. You can discuss your concerns with your PCM during your general medical appointment. Caregivers and young people can learn a number of tools on their own for coping with depression. Check out the self-help tools offered by this site. If your PCM believes it is necessary to seek specialty care, they will be able to assist you to that next level of care. Sometimes family, friends, or clergy can be the best sources of support when facing a challenging behavioral change.

Q: Will TriWest pay for depression treatment?

A: When a primary behavioral health problem is a diagnosed mental disorder, e.g., depression or an anxiety disorder, treatment in support of the diagnosed mental disorder may be covered. TRICARE beneficiaries are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility. More

References:

1American Academy of Child and Adolescent Psychiatry (2004). The depressed child. Fact Sheets for Families, 4 (10/92). Accessed 5/10/06.

2National Institutes of Mental Health (2001). Let’s talk about depression. NIMH Fact Sheet, No. 01-4162. Accessed 5/10/06.

3American Academy of Child and Adolescent Psychiatry (1998). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10suppl).

4U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. Accessed 5/10/06

5Centers for Disease Control and Prevention. (2000). Youth risk behavior surveillance -- United States, 1999. In: CDC Surveillance Summaries, June 9, 2000. MMWR 2000;49(No. SS-5), p. 10.

6American Academy of Child and Adolescent Psychiatry (2004). Teen Suicide. Fact Sheets for Families, 10. Accessed 5/10/06.

7Stoney, G. (2001). Suicide FAQ. Healthyplace.com accessed 5/10/06.

8National Institute of Mental Health (1999). Frequently Asked Questions About Suicide. Accessed 5/10/06.