Ganz D, Sher L
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
Minerva Pediatr. 2009 Jun;61(3):333-47.
Depression, alcohol abuse and suicidality each continue to threaten adolescent populations throughout the world. The comorbidity between these diseases has been found to be up to 73% with consistent positive correlations between adolescent drinking, depression and suicidality. Alcohol abuse, depression and suicidal behavior in adolescents have also been found to have biochemical and genetic correlates. This article explores the contributing and causative factors and directional models underlying such prevalent comorbidities. Alcohol use is shown to be both a distal and proximal cause of suicide attempts in adolescent populations. Individuals with both alcoholism and depression who attempt or complete suicide often present with significantly high levels of aggression and impulsivity. These factors may be caused or nuanced by poor or underdeveloped coping skills as well as other comorbid psychiatric conditions. Such behaviors, alone or in comorbidity, may be a consequence of childhood abuse, social pressures, low self-esteem and/or delinquency- all of which may be particularly salient among adolescent populations. Such adolescent stressors are implicated as the cause for the self-medication model. Some studies suggest that depression encourages alcohol use as self-medication and then leads to suicidality, while others imply that the initial alcohol consumption is responsible for increasing depressive and suicidal symptoms in adolescents. This article discusses the social stigma associated with alcoholism, depression and suicidality, and how that may serve to enhance these disorders in adolescent populations. Many directional models are presented based on past research and as suggestions for future research. There is a lot that can be done by clinicians, legal and educational professionals and society at large that may help to prevent and treat such problems.
抑郁症、酒精滥用和自杀倾向持续威胁着世界各地的青少年群体。这些疾病之间的共病率高达73%，青少年饮酒、抑郁和自杀倾向之间存在持续的正相关关系。青少年的酒精滥用、抑郁和自杀行为也被发现与生化和遗传因素相关。本文探讨了这些普遍存在的共病现象背后的促成因素、致病因素和定向模型。酒精使用被证明是青少年群体自杀未遂的远端和近端原因。同时患有酒精中毒和抑郁症且企图自杀或自杀成功的个体，往往表现出极高的攻击性和冲动性。这些因素可能是由于应对技能差或未发育成熟，以及其他共病的精神疾病所致或受到影响。这些行为单独出现或合并出现，可能是童年虐待、社会压力、自卑和/或犯罪行为的结果——所有这些在青少年群体中可能尤为突出。这些青少年应激源被认为是自我药疗模型的原因。一些研究表明，抑郁症促使人们饮酒进行自我药疗，进而导致自杀倾向，而另一些研究则暗示，最初饮酒会导致青少年抑郁和自杀症状加重。本文讨论了与酒精中毒、抑郁和自杀倾向相关的社会耻辱感，以及这可能如何加剧青少年群体中的这些疾病。基于过去的研究提出了许多定向模型，并作为未来研究的建议。临床医生、法律和教育专业人员以及整个社会可以做很多事情来帮助预防和治疗这些问题。
