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
Treatment
Suicide
Psychotherapeutic Treatments
Suicidal children and adolescents report feelings of intense emotional distress
involving depression, anger, anxiety, hopelessness, and worthlessness and an
inability to change problematic, frustrating circumstances or to find a solution
to their problems (Kienhorst et al., 1995; Ohring et al., 1996). They feel so
distraught that they often respond impulsively to their despair.
Psychotherapeutic techniques aim to decrease such intolerable feelings and
thoughts and to reorient the cognitive and emotional perspectives of the
suicidal child or adolescent (Kernberg, 1994; Spirito, 1997).
Cognitive-behavioral therapy (CBT) may be a useful intervention, considering
that suicidal children and adolescents often experience negative cognitions
about themselves, their environment, and their futures. Recent research suggests
that CBT may be more effective than systemic behavior family therapy or
individual nondirective supportive therapy in reducing depressive symptoms
associated with suicidal ideation (Brent et al., 1997). Such treatment can focus
on re-attribution of precipitating issues for suicidal behavior and enable the
suicidal child or adolescent to rank stresses and to consider avenues of
problem-solving (Rotheram-Borus et al., 1994; Brent et al., 1997; Spirito,
1997).
Interpersonal conflicts are important stresses related to the risk imparted by
poor social adjustment of potentially suicidal children and adolescents.
Treatment of interpersonal strife may significantly reduce suicidal risk. Recent
research into the efficacy of interpersonal psychotherapy of depressed
adolescents suggests beneficial effects (Kaslow & Thompson, 1998); it is a
treatment that may be modified to address the risk factor issues related to
interpersonal loss, conflicts, and need for restitution often reported by
children and adolescents with suicidal tendencies.
A significant class of risk factors for suicide involves family discord, which
is characterized by poor communication, disagreements, and lack of cohesive
values and goals and of common activities (de Long, 1992; Miller et al., 1992;
Wagner, 1997). Suicidal children and adolescents often feel that they are
isolated within the family, exhibit problems in independence, and view
themselves as expendable to the family, a perception that is a motivating force
for self-annihilation (Sabbath, 1969; Pfeffer, 1986; Miller et al., 1992).
Family intervention with suicidal children and adolescents is an important
method to decrease such problems and to enhance effective family problem-solving
and conflict resolution, so that blame is not directed toward the suicidal child
or adolescent. Cognitive-behavioral approaches with suicidal children and
adolescents and their families aim to reframe their understanding of family
problems, alter the family style of maladaptive problem-solving techniques, and
encourage positive family interactions (Rotheram-Borus et al., 1994).
Time-limited home-based intervention to reduce suicidal ideation in children and
adolescents and to improve family functioning has been reported to have limited
efficacy for children and adolescents without major depressive disorder
(Harrington et al., 1998). Psychoeducational approaches to reduce the extent of
expressed anger may be helpful in lowering risk for suicidal behavior in
children and adolescents (Fristad et al., 1996).
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