Suicide and depression in childhood and adolescence.

Suicide and depression in children and adolescents are reviewed. The true incidence of suicide in the pediatric population is not known because of under-reporting; suicide is, however, considered as a leading cause of death in this age group. Suicide in young children often reflects an immature comprehension of the state of death, combined with a wish to alter an intolerable living situation or to punish individuals significant in his environment. At age 14 the incidence of suicide increases markedly. These acts of self-destruction reflect a developmental process that follows puberty. During this period the youth experiences an impoverishment of values and controls, as well as an intensification of emotions and needs, resulting in extreme disequilibrium. In the late adolescent, as in the adult, suicide occurs commonly in response to real or imagined loss. Specific guidelines are set out for the assessment and management of the depressed and suicidal youth. Community and medical measures of a prophylactic nature are recommended in the belief that the rising incidence of suicide can be halted through an intensification of efforts on the part of the medical profession.