The adolescent who attempts suicide has most often exhibited symptoms of depression over a prolonged period of time. However, recognizing the depressed adolescent who is at risk of suicide is often difficult. As noted above, mood swings with depressive elements are common among normal adolescents and are not indicative of psychopathology. The clinical manifestations of depression in the adult, including apathy, sleep disturbances, decreased appetite, and bowel irregularity may or may not be present, Particularly in younger teenagers, depression may manifest itself with non-adult symptomatology. A variety of other troubling behaviors, termed depressive equivalents, serve as indicators of possible underlying depression in the adolescent. These depressive equivalents would include somatic Complaints, acting out, running away, boredom, and difficulty in concentrating.
Nearly half of the adolescents who attempt suicide have made a physician contact in the weeks, which preceded their attempt. They present for care with a variety of functional complaints which include headaches, abdominal pain, muscle aches, dizziness, and nausea, as well as the more traditional depressive symptoms of decreased appetite, weight loss, constipation and insomnia. It is estimated that some 30 % of adolescents who seek medical attention are suffering from some degree of depression, and certainly all those teenagers who are diagnosed as having functional or psychosomatic complaints need to be questioned for suicidal ideology.
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Acting – out behaviors, including temper tantrums, delinquency, truancy, and promiscuity, are always signs of a young person in difficulty and frequently are clues to underlying depression. Such behavior often defends the adolescent against coming to grips with feelings of being unloved and inadequate, action is substituted for thinking and self-image is inflated through the bravery, cleverness, and independence necessary to accomplish antisocial and defiant acts. As these behaviors often serve to alienate and further separate the teenager from persons and agencies that can be of support they tend to increase rather that alleviate underlying depression.
Running away, often categorized as an acting-out behavior, requires special emphasis. Approximately half of the adolescents who attempt suicide give a history of having run away from home. Such behavior not only signals that the young person is in difficulty but also indicates that the adolescent is feeling a home situation which he or she regards as hostile and non-supportive. Furthermore, there are few safe and supportive places for the teenager to run to. They often fun away to environments, which are more threatening, more hostile, and less supportive, and where exploitation and abuse are likely eventualities. The depressed adolescents who flee their home environments represent social and behavioral emergencies.
The depressed teenager is often bored and restless. Such teenagers may alternate rapidly between intense interest in a particular project and total abandonment of the activity. Great enthusiasm for a hobby or a sport may signal a craving for diversion as an escape from intolerable boredom. In the depressed teenager such relief is short-lived, and inactivity and loss of interest quickly return. The adolescent with repetitive alternating enthusiasm and need be suspect.
Difficulty in concentrating is of importance as it may be the sole complaint for which the depressed adolescent seeks help. These teenagers report that no matter how long and how hard they try to apply themselves to their studies, they are unable to absorb information and complete tests. Upwards of 70% of depressed teenagers will complain of both poor concentration and diminished school performance, other causes could be chronic or disabling ailments, poverty, family disintegration, revenge, shame, etc.
