nclude decreased family support and perceived rejection by parents (Lasko et al., 1996). Oster & Montgomery (1996) 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, 7-14% of children will experience an episode of major depression before the age of 15. An average of 20-30% of adult bipolar patients report having their first episode before the age of 20. In a sampling of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide (Brown, 1996). Blackman (1995) remarked that the suicide rate for adolescents has increased more than 200% over the last decade. Brown (1996) added that an estimated 2,000 teenagers per year commit suicide in the United States, making it the leading cause of death after accidents and homicide. Blackman (1995) stated that it is not uncommon for young people to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Moreover, adolescents are particularly at risk for ...
