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Depression and Suicide in Children and Adolescents: Prevention, Intervention, and Postvention.

Depression and Suicide in Children and Adolescents: Prevention, Intervention, and Postvention A recent cover story in Time magazine depicted the 240 deaths by gunshot during a single week in the United States. Nearly one-half were suicides; many were adolescents. Today, suicide by gunshot, drug overdose, carbon monoxide poisoning, wrist slashing, hanging, and a variety of "accidents" is the second leading cause of death among teenagers. Two new books by Patros and Shamoo (1989) and Poland (1989) are evidence of the growing concern among educators about suicide.

Acknowledging that the increased rate of suicides is partly a result of more accurate reporting, these authors believe that suicidal behavior has reached critical proportions among youth and that schools can and should implement prevention, intervention, and postvention programs.

Both books related suicide to depression, which has only recently been recognized by the American Psychiatrict Association as a psycho-pathological syndrome of children, as well as adults. Depression may be apparent in a student's expressions of sadness, hopelessness, and self-depreciation, withdrawal, changes in eating and sleeping patterns, and somatic complaints, or it may be masked in physical and verbal aggression and learning problems. Clearly some exceptional children are at risk.

Possible causes of depression are many. Patros and Shamoo discuss the experience of loss, genetic predisposition, and communication problems, especially with the family, as central. Poland cites a potentially lethal combination of depression, perceived crisis, substance abuse, and availability of a weapon.

It is in their discussion of educators' roles that these books are most valuable. Patros and Shamoo discuss ways educators can recognize signals of depression and suicidal behavior and assess their severity. The propose system-, building-, and classroom-level strategies for prevention; interventions for students determined to be high risk; and methods for working with students, faculty, and staff following a suicide or attempt. For many special educators, some of their prevention techniques (e.g., creating a nurturing environment, lowering academic pressures, self-esteem building, social skills training, problem-solving strategies, and reinforcement), as well as intervention strategies (e.g., a variation of the Life Space Interview, congnitive restructuring strategies, and contracts), are already familiar.

Poland sees central roles for educators in detecting and assessing severity of students' suicidal thoughts and actions, notifying parents, and securing appropriate services within and outside of school. Drawing on his own experience and review of literature and existing programs, Poland provides a blueprint for suicide intervention that could be adapted for use in any school district. He considers important, but thorny, issues like potential contagion, confidentiality, legal liability, and dealing with the news media in an informed and thoughtful manner.

Although there is considerable overlap in the content and perspectives of these books, each has some unique features. For example, Patros and Shampoo consider suicide within the larger framework of depression of children and youth, while Poland focuses more directly on suicide intervention with adolescents.

Will the approaches advocated in these books enable educators to reduce suicides among our youth? Only anecdotal evidence of their presumed effectiveness is provided. Nonevents (successful preventions and interventions), after all, are hard to document. A side effect of suicides is their devastating effect on survivors, who wish they had known or said or done something, to ease a child's despair. These two books provide information and strategies that may help improve school climates and assuage the guilt of survivors who tried to do something. In fact, these books may help save lives.
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Author:Zabel, Robert H.
Publication:Exceptional Children
Article Type:Book Review
Date:Sep 1, 1990
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