Do we miss depressive disorders and suicidal behaviours in clinical practice?

This study involved a detailed standardized initial research assessment which was carried out with 100 young people aged 12-15 years newly referred to a child and adolescent mental health service. The assessment involved the K-SADS interview with the young person and their parent, the Strengths and Difficulties Questionnaire, the Clinical Global Impression Scale, and the Children's Global Assessment Scale. Diagnoses resulting from these 'research assessments' were compared with clinical diagnoses, which were determined by case note analysis and discussion with the key clinician. Results showed that a clinical diagnosis of depressive disorder was made in only one-third of those who received a 'research assessment' diagnosis of depressive disorder, and suicidality was missed in a significant proportion of cases. Those with a diagnosis of depressive disorder had significantly more problems, more comorbidity, more suicidality and greater functional impairment than those without. It is important to keep depression and suicidality in mind when assessing young people with complex mental health difficulties. Unless specific pointers are sought, it is easy to miss these, which may mean that vulnerable young people do not benefit from potentially effective treatments.

Who attends outpatient adolescent mental health services?

OBJECTIVES: This study set out to profile the diagnoses and level of suicidal behaviour of adolescents aged 12-15 years newly referred to a Child and Adolescent Mental Health Service (CAMHS). Information on the nature and range of disorders and level of functional impairment among adolescents attending outpatient CAMHS is important for service planning and development. METHODS: A total of 100 newly referred adolescents were assessed using the KSADS-PL standardised interview. Overall level of functional impairment was measured using The Clinical Global Impressions Scale and The Children's Global Assessment Scale. RESULTS: Results showed that the majority of adolescents had more than one disorder, with almost one quarter having four or more disorders. Behavioural disorders were the most common diagnostic category, followed by anxiety disorders, and affective disorders. Although relatively uncommon, levels of functional impairment were highest in those with psychotic disorders, followed by substance abuse disorders. The most common pattern of comorbid disorders were depressive disorders plus anxiety disorders, followed by anxiety disorders plus behavioural disorders and depressive disorders plus behavioural disorders. One quarter of the young people had engaged in suicidal acts in the six months prior to attendance, while this had been the case in over one half of those with a depressive disorder. CONCLUSION: This study showed that adolescents attending CAMHS tend to have multiple disorders, high levels of suicidality, and are significantly functionally impaired. These factors need to be taken into account in the development of effective treatments.

Are Suicidal Phenomena in Children Different to Suicidal Phenomena in Adolescents? A Six-Year Review.

BACKGROUND: There has been little published about the nature and frequency of suicidal phenomena in children compared to that of adolescents. METHOD: Standardised information on all presentations with suicidal phenomena to the Children's University Hospital, Dublin from 2002 to 2008 were retrospectively analysed from a centralised database. RESULTS: During the time period of the study, 401 young people presented for assessment, of whom 21.9% (N = 88) were under 12 years of age. Children differed from adolescents in terms of gender distribution, method of self-harm, and risk factors present. CONCLUSION: Children under 12 are capable of displaying suicidal phenomena and differ considerably to adolescents in this regard.

A pilot study evaluating a support programme for parents of young people with suicidal behaviour.

BACKGROUND: Deliberate self harm (DSH) is a major public health concern and has increased among young people in Ireland. While DSH is undoubtedly the result of interacting factors, studies have identified an association between DSH and family dysfunction as well as the protective role of positive family relationships. Following a focus group meeting held to identify the needs of parents and carers of young people with DSH, a support programme (SPACE) was developed. The aims of the current study are to evaluate the effectiveness of the SPACE programme in decreasing parental psychological distress, reducing parental report of young peoples' difficulties, increasing parental satisfaction and increasing parents' ratings of their own defined challenges and goals. METHODS: Participants were recruited from a Mental Health Service within a paediatric hospital, Community Child and Adolescent Mental Health Teams and family support services. All services were located within the greater Dublin area in Ireland. Forty-six parents of children who had engaged in or expressed thoughts of self harm attended the programme and participated in the evaluation study. The programme ran once a week over an 8-week period and included topics such as information on self harm in young people, parenting adolescents, communication and parental self-care. Seventy percent (N = 32) of the original sample at Time 1 completed measures at Time 2 (directly following the programme) and 37% (N = 17) of the original sample at Time 1 completed them at Time 3 (6 months following the programme). A repeated measures design was used to identify changes in parental wellbeing after attendance at the programme as well as changes in parental reports of their children's difficulties. RESULTS: Participants had lower levels of psychological distress, increased parental satisfaction, lower ratings of their own defined challenges and higher ratings of their goals directly after the programme. These changes were maintained at 6-month follow up in the 37% of participants who could be followed up. Furthermore the young people who had engaged in or expressed thoughts of self harm had lower levels of difficulties, as reported by their parents, following the programme. CONCLUSION: These findings suggest that the SPACE programme is a promising development in supporting the parents of young people with suicidal behaviour. The programme may also reduce parental reports of their children's difficulties. Further evaluation using a randomized controlled trial is indicated.