Teenage suicide occurs at an alarming rate and can be directly attributed to three main causes: depression, substance abuse, and relationships. This terrible phenomenon is rapidly increasing in the United States and only in the last decade has any serious attention been paid to the underlying causes. Suicide is the third leading cause of death for young people between the ages of 15-25, with only accidents and homicide being more common! Most teenagers express various warning signs before they attempt suicide.

Therefore, suicide is a preventable occurrence in the vast majority of cases. Depression is by far the leading cause of teenage suicide. Depression is a disease that afflicts the human psyche in such a way that the afflicted tends to act and react abnormally toward others and themselves. Therefore it comes as no surprise to discover that adolescent depression is strongly linked to teenage suicide. Adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer (Blackman, 1995).

Despite this increased suicide rate, depression in this age group is greatly underdiagnosed and leads to serious difficulties in school, work, and personal adjustment, which may often continue into adulthood. Brown (1996) has said the reason why depression is often overlooked in children and adolescents is because children are not always able to express how they feel. Sometimes the symptoms of mood disorders take on different forms in children than in adults. Adolescence is a time of emotional turmoil, mood swings, gloomy thoughts and heightened sensitivity. It is a time of rebellion and experimentation.

Blackman (1995) observed that the challenge is to identify depressive symptomatology which may be superimposed on the backdrop of a more transient, but expected, developmental storm. Therefore, diagnosis should not lie only in the physicians hands but be associated with parents, teachers and anyone who interacts with the child on a regular basis. Unlike adult depression, symptoms of youth depression are often masked. Instead of expressing sadness, teenagers may express boredom and irritability, or may choose to engage in risky behaviors (Oster & Montgomery, 1996).

Mood disorders are often accompanied by other psychological problems such as anxiety (Oster & Montgomery, 1996), eating disorders, hyperactivity, substance abuse, and suicide, all of which can hide depressive symptoms. The signs of clinical depression include marked changes in mood and associated behaviors that range from sadness, withdrawal, and decreased energy to intense feelings of hopelessness and suicidal thoughts. Depression is often described as an exaggeration of the duration and intensity of normal mood changes (Brown, 1996).

Key indicators of adolescent depression include a drastic change in eating and sleeping patterns, significant loss of interest in previous activity interests (Blackman, 1995), disruptive behavior, peer problems, increased irritability and aggression (Brown, 1996). Blackman (1995) proposed that formal psychological testing may be helpful in complicated presentations that do not lend themselves easily to diagnosis. For many teens, symptoms of depression are directly related to low self-esteem stemming from increased emphasis on peer popularity.

For other teens, depression arises from poor family relations, which could include decreased family support and perceived rejection by parents (Lasko, 1996). Oster & Montgomery (1996) stated that when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents. This distraction may include increased disruptive behavior, self-inflicted isolation, or even verbal threats of suicide. So how can we determine if someone should be diagnosed as depressed or suicidal?

Brown (1996) suggested the best way to diagnose is to screen out the vulnerable groups of children and adolescents for the risk factors of suicide and then refer them for treatment. Some of these risk factors include verbal signs of suicide within the last three months, prior attempts at suicide, indications of severe mood problems, or excessive alcohol and/or drug use. Many physicians tend to think of depression as an illness of adulthood. In fact, Brown (1996) stated that it was only in the 1980s that mood disorders in children were included in the category of diagnosed psychiatric illnesses.

In actuality, 7-14% of children will experience an episode of major depression before the age of 15. In a sampling of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide (Brown, 1996). Blackman (1995) remarked that the suicide rate for adolescents has increased more than 200% over the last decade. Brown (1996) added that an estimated 2000 teenagers a year commit suicide each year in the United States, making it the leading cause of death after accidents and homicide.

Blackman (1995) stated that it is not uncommon for young people to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Once it has been determined that the adolescent has the disease of depression, what can be done about it? Blackman (1995) has suggested two main avenues to treatment: psychotherapy and medication. The majority of the cases of adolescent depression are mild and can be dealt with through several psychotherapy sessions with intense listening, advice and encouragement.

For the more severe cases of depression, especially those with constant symptoms, medication me be necessary and without pharmaceutical treatment, depressive conditions could escalate and become fatal. Brown 91996) added that regardless of the type of treatment chosen, it is important for children suffering from mood disorders to receive prompt treatment because early onset places children at a greater risk for multiple episodes of depression and suicide throughout their life span. Until recently, the health professionals have largely ignored adolescent depression, but now several means of diagnosis and treatment exist.

Although most teenagers can successfully climb the mountain of emotional and psychological obstacles that lie in their paths, there are some who find themselves overwhelmed and full of stress (Brown, 1996). With the help of teachers, school counselors, mental health professionals, parents, and other caring adults, the severity of a teens depression can not only be accurately evaluated, but plans can be made toto improve his or her well-being and ability to fully engage life (Blackman, 1995) The second most common cause of teenage suicide is alcohol and drug use.

Although it is illegal for anyone under the age of 21 to purchase, posses, and consume alcohol, many teenagers do drink. As a result, in addition to breaking the law, these teens are particularly vulnerable to the various problems that alcohol can cause. Teens who are shy in social situations often use alcohol to loosen up and frequently end up making fools of themselves and doing things that they later regret. Still other teens seek friendship and companionship by using alcohol so they can join the in crowd.

Other teens are simply emulating their parents or trying to escape from their home environments. What many teens fail to realize are all of the negative effects drinking can have on their minds and bodies. According to the National Clearinghouse for Alcohol and Drug Information, Long-term effects of heavy alcohol use include loss of appetite, vitamin deficiencies, stomach ailments, sexual impotence, liver damage, heart and central nervous system damage, and memory loss.

Some of the common signs for teens with alcohol related problems include, an inability to control their drinking-it seems that regardless of what limits are decided on beforehand, they frequently wind up drinking too much. Two, using alcohol to escape their problems. Three, changing from their usual reserved character into the life of the party. Four, a change in personality- turning from Dr. Jeckyl into Mr. Hyde. Five, achieving a high tolerance level-able to drink everyone under the table.

Other troubling signs are blackouts, problems at work or school related to drinking and parental concerns over their drinking habits. Alcohol is a central nervous system depressant. It affects virtually every organ in the body, and chronic use can lead to numerous preventable diseases including alcoholism. According to the 1994 Monitoring the future survey, alcohol remains the number one substance used by 8th, 10th, and 12th graders. Over 50% of 12th graders report drinking alcohol within the past month. These disturbing statistics outline a problem of overwhelming proportions.

Each child who begins drinking before they reach a significant level of physical and mental maturity is increasing their chances of disease and suicide 100 fold. Support groups such as Alcoholics Anonymous and Al-Anon/Alateen have set up teen hotlines and meetings to help troubled teens with their dependence problems and to help them work out any issues which may be troubling them or to an impartial ear when listening to potential suicide victims. These programs can be a great benefit to troubled teens but it takes a community effort to steer these people in the right direction.