Abstract
Depression is associated with increased health service use; clarifying the processes involved may offer strategies to reduce the disorder’s individual and societal burdens. This review hypothesizes roles for suicidality and deliberate self-harm to partially explain a relationship between adolescent depression and increased emergency department use. Briefly, depression is associated with suicidality and deliberate self-harm, both of which are likely common among emergency department presentations in this age group. The overlap of depression with suicidality and deliberate self-harm has implications for suicide prevention strategies that emphasize diagnosing and treating adolescent depression. First, identifying and referring depression among these emergency department presentations is promising, but limitations must be addressed. Second, interventions for adolescent depression also may affect the health conditions associated with increased emergency department use, including suicidality and deliberate self-harm. However, much more research is needed on the pathways involved before such benefits, including cost offset, can be reasonably anticipated.
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References and Recommended Reading
Lopez AD, Mathers CD, Ezzati M, et al.: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006, 367:1747–1757.
Kessler RC, Avenevoli S, Ries Merikangas K: Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry 2001, 49:1002–1014.
Simon G, Ormel J, VonKorff M, Barlow W: Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 1995, 152:352–357.
Katon W, Lin EH, Kroenke K: The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007, 29:147–155.
Katon WJ: Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003, 54:216–226.
Sewitch MJ, Blais R, Rahme E, et al.: Receiving guidelineconcordant pharmacotherapy for major depression: impact on ambulatory and inpatient health service use. Can J Psychiatry 2007, 52:191–200.
Donohue JM, Pincus HA: Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 2007, 25:7–24.
Angold A, Costello EJ, Worthman CM: Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychol Med 1998, 28:51–61.
Patten SB, Wang JL, Williams JV, et al.: Descriptive epidemiology of major depression in Canada. Can J Psychiatry 2006, 51:84–90.
Lynch FL, Clarke GN: Estimating the economic burden of depression in children and adolescents. Am J Prev Med 2006, 31:S143–S151.
Mandell DS, Guevara JP, Rostain AL, Hadley TR: Economic grand rounds: medical expenditures among children with psychiatric disorders in a Medicaid population. Psychiatr Serv 2003, 54:465–467.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 2000.
Foley DL, Goldston DB, Costello EJ, Angold A: Proximal psychiatric risk factors for suicidality in youth: the Great Smoky Mountains Study. Arch Gen Psychiatry 2006, 63:1017–1024.
Gould MS, King R, Greenwald S, et al.: Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry 1998, 37:915–923.
Garrison CA, Addy CL, McKeown RE, et al.: Nonsuicidal physically self-damaging acts in adolescents. J Child Fam Stud 1993, 2:339–352.
Spicer RS, Miller TR: Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health 2000, 90:1885–1891.
Doshi A, Boudreaux ED, Wang N, et al.: National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997–2001. Ann Emerg Med 2005, 46:369–375.
Public Health Agency of Canada: Leading causes of hospitalization. Public Health Agency of Canada website. http://www.phac-aspc.gc.ca/publicat/lcd-pcd97/hsp_mf_e.html. Accessed September 2007.
Harman JS, Scholle SH, Edlund MJ: Emergency department visits for depression in the United States. Psychiatr Serv 2004, 55:937–939.
Colman I, Yiannakoulias N, Schopflocher D, et al.: Population-based study of medically treated self-inflicted injuries. CJEM 2004, 6:313–320.
Stewart SE, Manion IG, Davidson S, Cloutier P: Suicidal children and adolescents with first emergency room presentations: predictors of six-month outcome. J Am Acad Child Adolesc Psychiatry 2001, 40:580–587.
Minino AM, Heron MP, Smith BL: Deaths: preliminary data for 2004. Natl Vital Stat Rep 2006, 54:1–49.
Centers for Disease Control and Prevention (CDC): WISQARS Years of Potential Life Lost (YPLL) Reports, 1999–2004. CDC website. http://webappa.cdc.gov/sasweb/ncipc/ypll10.html. Accessed September 2007.
Bridge JA, Goldstein TR, Brent DA: Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 2006, 47:372–394.
Olfson M, Shaffer D, Marcus SC, Greenberg T: Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 2003, 60:978–982.
Gould MS, Greenberg T, Velting DM, Shaffer D: Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2003, 42:386–405.
Thorpe L, Whitney DK, Kutcher SP, et al.: Clinical guidelines for the treatment of depressive disorders. VI. Special populations. Can J Psychiatry 2001, 46(Suppl 1):63S–76S.
Grunbaum JA, Kann L, Kinchen SA, et al.: Youth risk behavior surveillance—United States, 2001. MMWR Surveill Summ 2002, 51:1–62.
Hawton K, Rodham K, Evans E, Weatherall R: Deliberate self harm in adolescents: self report survey in schools in England. BMJ 2002, 325:1207–1211.
Olfson M, Gameroff MJ, Marcus SC, et al.: Emergency treatment of young people following deliberate self-harm. Arch Gen Psychiatry 2005, 62:1122–1128.
Rhodes AE, Links PS, Streiner DL, et al.: Do hospital E-codes consistently capture suicidal behaviour? Chronic Dis Can 2002, 23:139–145.
Coyle JT, Pine DS, Charney DS, et al.: Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. J Am Acad Child Adolesc Psychiatry 2003, 42:1494–1503.
Baraff LJ, Janowicz N, Asarnow JR: Survey of California emergency departments about practices for management of suicidal patients and resources available for their care. Ann Emerg Med 2006, 48:452–458.
Cheung AH, Emslie GJ, Mayes TL: The use of antidepressants to treat depression in children and adolescents. CMAJ 2006, 174:193–200.
Bridge JA, Iyengar S, Salary CB, et al.: Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 2007, 297:1683–1696.
Merry SN: Prevention and early intervention for depression in young people-a practical possibility? Curr Opin Psychiatry 2007, 20:325–329.
Centers for Disease Control and Prevention (CDC): Nonfatal self-inflicted injuries treated in hospital emergency departments—United States, 2000. MMWR Morb Mortal Wkly Rep 2002, 51:436–438.
Jacobson CM, Gould M: The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Arch Suicide Res 2007, 11:129–147.
Nock MK, Joiner TE, Jr, Gordon KH, et al.: Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 2006, 144:65–72.
Sills MR, Shetterly S, Xu S, et al.: Association between parental depression and children’s health care use. Pediatrics 2007, 119:e829–e836.
Kapur N, Cooper J, Hiroeh U, et al.: Emergency department management and outcome for self-poisoning: a cohort study. Gen Hosp Psychiatry 2004, 26:36–41.
Goodyer I, Dubicka B, Wilkinson P, et al.: Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. BMJ 2007, 335:142.
Skegg K, Nada-Raja S, Moffitt TE: Minor self-harm and psychiatric disorder: a population-based study. Suicide Life Threat Behav 2004, 34:187–196.
Beautrais AL, Joyce PR, Mulder RT: Risk factors for serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry 1996, 35:1174–1182.
Barsky AJ: Amplification, somatization, and the somatoform disorders. Psychosomatics 1992, 33:28–34.
Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL: Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 2005, 62:66–72.
Rhodes AE, Bethell J, Bondy SJ: Suicidality, depression, and mental health service use in Canada. Can J Psychiatry 2006, 51:35–41.
Costello EJ, Angold A, Burns BJ, et al.: The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry 1996, 53:1129–1136.
Mann JJ: Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003, 4:819–828.
Muehlenkamp JJ: Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry 2005, 75:324–333.
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Bethell, J., Rhodes, A.E. Adolescent depression and emergency department use: The roles of suicidality and deliberate self-harm. Curr Psychiatry Rep 10, 53–59 (2008). https://doi.org/10.1007/s11920-008-0010-9
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DOI: https://doi.org/10.1007/s11920-008-0010-9