ion (Brown, 1996). Blackman proposed that “formal psychological testing may be helpful in complicated presentations that do not lend themselves easily to diagnosis.” 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 that could include decreased family support and perceived rejection by parents (Shamoo et al, 1993). Yapko (1997) stated that “when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents.” This “distraction” could include increased disruptive behavior, self-inflicted isolation and even verbal threats of suicide. So how can the physician determine when a patient should be diagnosed as depressed or suicidal? Brown (1996) suggested the best way to diagnose is to “screen out the vulnerable groups of children and adolescents for the risk factors of suicide and then refer them for treatment.” Some of these “risk factors” include verbal signs of suicide within the last three months, prior attempts at suicide, indication of severe mood problems, or excessive alcohol and substance abuse. Many physicians tend to think of depression as an illness of adulthood. In fact, Brown (1996) stated that “it was only in the 1980’s that mood disorders in children were included in the category of diagnosed psychiatric illnesses.” In actuality, seven to fourteen percent of children will experience an episode of major depression before the age of fifteen. An average of twenty to thirty percent of adult bipolar patients report having their first episode before the age of twenty. In a sampling of one hundred thousand adolescents, two to three thousand will have mood disorders out of which eight to ten will commit suicide (Brown, 1996). Blackman (1995)...
