Depression and suicidal behaviour in children and adolescents

Depression is a disorder that is uncommon in pre-adolescent children, but the rates increase during adolescence, with more girls than boys affected. Aetiological factors include genetic predisposition, and early and ongoing adversities. Although milder forms of depression often remit spontaneously, mild-to-moderate depression will be helped by psychological treatments such as cognitive–behavioural therapy and interpersonal therapy. Moderate to severe depression may require antidepressants such as fluoxetine. Suicidal behaviour may be associated with a range of psychiatric disorders such as depression, and with hopelessness, despair, and/or frustration (which may be of short duration). There is often a history of recent stress factors such as family and peer relationship problems, and, for a subgroup, long-standing relationship and adjustment problems. Management requires consideration of physical intervention for the self-harm, and then identification of the risk of future self-harm, treating any underlying psychiatric disorder and ameliorating relationship and other problems.