Diagnosis and assessment of depression and suicidality using the NIMH Diagnostic Interview Schedule for Children (DISC-2.3).

The diagnostic Interview Schedule for Children (DISC-2.3) was studied in a sample of 265 adolescent inpatients to determine type and concurrent validity of depressive symptoms and depressive disorder diagnoses for different DISC-2.3 informants (parent, adolescent, both). The Children's Depression Rating Scale--Revised, Reynolds Adolescent Depression Scale (RADS), Suicide Ideation Questionnaire--Junior, Spectrum of Suicide Behavior Scale, and clinical consensus diagnoses were used to assess concurrent validity. Results indicated that (1) parents, compared to adolescents, reported a higher prevalence of all depressive symptoms with the exception of weight change; (2) DISC-2.3 depressive and suicidality symptoms were related positively to independent validating criteria for all informant conditions, suggesting good concurrent validity; (3) the DISC-2.3 both informant condition correctly identified the most depressive disorders; and (4) the parent, but not the adolescent, DISC-2.3 Informant condition contributed to the prediction of clinical consensus diagnoses of depression after taking into account RADS scores.

Predictors of comorbid alcohol and substance abuse in depressed adolescents.

OBJECTIVE: To identify clinical profiles discriminating depressed adolescents on the basis of comorbid alcohol/substance use disorders and to determine whether or not profiles with high predictive power are gender-specific. METHOD: One hundred three adolescent inpatients with major depression (65 girls, 38 boys) participated in a comprehensive diagnostic evaluation. Independent assessments of depression, suicidality, and psychosocial adjustment were conducted using well-validated instruments. RESULTS: Gender-specific clinical profiles were identified that predicted alcohol/substance abuse in depressed adolescents with high levels of sensitivity (90%). The significant discriminant function for depressed girls included the following predictors: longer depressive episodes, more conduct problems and psychosocial impairment, and more active involvement in relationships with boys. The significant discriminant function for depressed boys included conduct disorder, older age, and schoolwork problems. These profiles correctly identified most depressed adolescents with comorbid alcohol/substance abuse. CONCLUSIONS: Given that alcohol abuse and depression are associated with highly impaired social functioning and increased risk of self-harm, sensitivity in case identification is critical. Clinicians should conduct comprehensive assessments of alcohol/substance abuse in depressed adolescents with the identified clinical profiles.

Suicide contagion among adolescents during acute psychiatric hospitalization.

OBJECTIVE: The study investigated whether exposure to other suicidal adolescents led to suicide contagion among patients hospitalized on an acute adolescent psychiatry unit. It also examined whether some adolescents express more suicidality during hospitalization than before admission. METHODS: Fifty-seven adolescents with a range of diagnoses admitted to a university-based psychiatric inpatient unit were assessed for suicidality at hospital admission and discharge using the Spectrum of Suicide Behavior scale and the Suicidal Ideation Questionnaire-Jr. Suicidal intent or behavior was the primary reason for admission of 58 percent of the patients. RESULTS: Despite many patients' severe suicide risk at hospital admission, 94 percent expressed no active suicidal intent and engaged in no behavior that could be considered suicidal during hospitalization. Four patients engaged in possibly suicidal, self-cutting behaviors; however, these incidents did not cluster in time. Fourteen patients (26 percent) expressed a significant increase in suicidal ideation during hospitalization, but the increase was not associated with study measures of exposure to other suicidal adolescents. CONCLUSIONS: Contagion of suicidal behaviors may not be a frequent or significant problem on acute adolescent inpatient units, although the phenomenon of increased suicidal ideation among some inpatients warrants further study.