Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Depression and Suicide in Children and Adolescents
Causes
Cognitive Factors
For over two decades there has been considerable interest in
the relationship between a particular “mindset” or approach to perceiving
external events and a predisposition to depression. The mindset in question is
known as a pessimistic“attribution bias” (Abramson et al., 1978; Beck, 1987;
Hops et al., 1990). A person with this mindset is one who readily assumes
personal blame for negative events (“All the problems in the family are my
fault”), who expects that one negative experience is part of a pattern of many
other negative events (“Everything I do is wrong”), and who believes that a
currently negative situation will endure permanently (“Nothing I do is going to
make anything better”). Such pessimistic individuals take a characteristically
negative view of positive events (i.e., that they are a result of someone else’s
effort, that they are isolated events, and that they are unlikely to recur).
Individuals with this mindset react more passively, helplessly, and
ineffectively to negative events than those without a pessimistic mindset
(Seligman, 1975).
There is uncertainty over whether this mindset precedes depression (and
represents a permanent style of thinking as part of an individual’s
personality), is a manifestation of depression that is only present when the
patient is depressed, and/or is a consequence or“scar” of a previous, perhaps
unnoticed, depressive episode (Lewinsohn et al., 1981). This pessimistic mode of
thinking does not occur in children under age 5, which could be one of the
reasons why depression and suicide are rare in early childhood (Rholes et al.,
1980; Rotenberg, 1982).
There is evidence that children and adolescents who previously have been
depressed may learn, during their depression, to interpret events in this
fashion. This may make them prone to react similarly to negative events
experienced after recovery, which could be one of the reasons why previously
depressed children and adolescents are at continuing risk for depression (Nolen-Hoeksema
et al., 1993).
Perceptions of hopelessness, negative views about one’s own competence, poor
self- esteem, a sense of responsibility for negative events, and the
immutability of these distorted attributions may contribute to the hopelessness
that has been repeatedly found to be associated with suicidality (Overholser et
al., 1995).
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