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Depression and Suicide in Adolescence

According to Matson (1989), there exists a continuum of opinions related to the diagnosis of depression in children and adolescence. At one end appears the most conservative approach reported by Lefkowitz and Burton (1978). They believe that depression cannot be diagnosed if "depressed" behaviors are also prevalent in normal children and if such behaviors disappear over time without treatment. At the other end of the spectrum is the contention that many behaviors in children and adolescents are symptoms of "masked depression." Cytryn and McKnew (1974), Lesse (1974), and Curran (1987), as well as many other authors, discuss this concept at length. Although masked depression is no longer a popular concept and has been criticized in the literature (Bemporad, 1978), the alternative explanation for such symptoms appears to be the co-occurrence of depression with other disorders. Weller and Weller (1990) cited a number of studies of the comorbidity of depression and attention-deficit disorders, anxiety disorders, and conduct disorders in their review. In many ways, the preceding taxonomy attempts to distinguish whether symptoms manifested by adolescents constitute depression. Symptoms that adolescents manifest, however, need to be acknowledged due to their potential for dysfunction or self-destructiveness, not just because of their significance in terms of diagnostic formulation. It is for this reason that it is important to examine a variety of observed symptoms before deciding whether or not they are masking depression. As Toolan (1975) pointed out, and others have asserted (Curran, 1987), there is rarely a clear and focused picture of depression in the adolescent. Clinicians working with such populations must often spend a great deal of time assessing how the adolescent presents in a variety of contexts. Does a depressed symptom observed at home but not at school or with peers constitute justification for a diagnosis of depression? There is often a need, therefore, to assess a person's functioning in a variety of settings through the eyes of a number of observers, including the individual's own view. It is characteristic of adolescents, however, to sometimes disguise their own perceptions or color them when speaking with adults. . .





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