Studies of the affective state in bereaved children.

The process of bereavement in children ranges from the absence of grief to symptoms of anxiety and conduct disturbances. Some psychoanalytic opinion holds that the absence of grief, associated with lack of cognitive maturity, leads to the development of psychopathology later in life. Other writers describe a mourning response, taking the form of ambivalence, anxiety, and care giving, which may protect against subsequent depression. This paper describes the affective response in 16 children ages four to 17 years, two to three years following the death of a parent, in order to further characterize developmental aspects of the emotional repertoire of bereavement. Only children aged 12 and over were depressed according to the Poznansky Children's Depression Rating Scale and criteria in the DSM-III. Conduct disturbances were observed in the younger children and some of the older children and were correlated with depression in the group as a whole. This suggests that the expression of depressive affect depends on maturation and that the young child may register grief only through anxiety and negativism. Examples of this spectrum of responses are offered in two case vignettes.

Suicide notes in adolescence.

Suicide rates for adolescents have shown a substantial increase over the past 30 years, but there is little information regarding the clinical status of adolescents who end their lives. In the adult literature, one avenue to understanding the psychologic condition immediately prior to the self-destructive act has been the study of suicide notes, and the present study constitutes the first systematic investigation of notes left by children or adolescents. Records of death were examined in the Office of the Coroner, City of Montreal, and all suicides between ages 10 and 20 were identified for the years 1978 to 1982. Seventeen individuals who left notes were identified, comprising 10% of the population of suicides. Suicides who left notes did not differ from the total group in age and sex distribution but were more likely to choose shooting as a method. The content of the notes was studied in terms of 11 variables which had proven characteristic of suicide notes in the adult literature, and the results were compared to those reported for adults. In general, our results support a psychoanalytic perspective which understands suicide as resulting from an ambivalent attachment to an object, loss of the object, internalization, and the direction of aggression against the self. Cases appeared to fall into two clusters. Older adolescents were more concrete, left specific instructions, did not address the note, did not give a reason for the act, and tended to choose intoxication as a method.(ABSTRACT TRUNCATED AT 250 WORDS)

An epidemiologic study of adolescent suicide.

This study investigated suicides by persons aged ten to nineteen during the years 1978 to 1982 in the City of Montreal. Records of death in the Office of the Coroner, City of Montreal, were examined and suicides designated according to standard criteria. Age, sex, method of suicide, and month of death were noted. Mean incidence of suicide for the entire sample was 5.92 per 100,000 population. The mean figure for males was 9.52 and for females 2.32, with the incidence greater among males in each of the five years. Incidence of suicide in the fifteen to nineteen year old group was approximately ten times that in the ten to fourteen year old group, a difference which was constant across sex and across the five year period. Among boys, hanging was the most frequent method of suicide, with firearms second, and jumping from a height or in front of a vehicle third. Among girls, drug intoxication was most common, with firearms and jumping ranking second and third respectively. No monthly periodicity was found. The epidemiology of adolescent suicide in Montreal appears to be similar to that reported in other locations.