Diagnosis and treatment of childhood depression and self-destructive behavior

This paper presents the results of a survey of Washington, DC, area physicians who confront the diagnosis and treatment of childhood depression and potential suicide. Questions addressed included the prevalence of childhood depression and self-destructive behavior, beliefs about such phenomena, criteria used in the diagnosis of depression, and treatment preferences for both childhood depression and self-destructive behavior. Nearly half of respondent physicians reported knowing of suicide attempts among patients under 14 years old; almost two thirds currently had a patient in treatment for depression with a mental health professional. Physicians subscribed to a number of traditional but false beliefs about young children's capacity for intentional self-destruction and the incidence of such acts being disguised as "accidents." Wide variation was observed in the symptoms physicians used to diagnose depression. In general, physicians attended most to overt behavior and family history, followed by psychological problems. Physicians need to be alert to the diagnostic significance of "masked" symptoms of depression, such as somatic complaints and acting-out, antisocial behaviors.