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 physician’s 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 1980’s 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