For an isolated young person, depression can start with feelings of despair and disaffection. It may progress to swallowing copious amounts of drink and drugs to numb the black mood. The final tragic step is to end it all with a rope or an overdose. And afterwards, everyone, including the parents, might still be wondering why.
A young person with depression, or who has a family history of depression, is in general more vulnerable to "being knocked about by life - by losses, breakups, academic failures, financial difficulties", says Dr Patrick McKeon, a consultant psychiatrist and chairman of AWARE (the national support group for people with depression). Depressed young men who have recently suffered a loss - either a bereavement or the break-up of a sexual relationship - are particularly at risk.
The number of suicides in the State rose from 71 in 1945 to 383 in 1995, notes Dr McKeon. Most of these suicides were young men between the ages of 15 and 24.
"Suicide is now the most common cause of death in young men in Ireland: between 1990 and 1996 there has been a fourfold increase in the suicide rate in this age group", says Dr McKeon, whose research survey, Suicide In Young People: A Global Perspec- tive is published today. Plans are afoot to establish a commission representative of youth bodies in Ireland to study this report and make recommendations.
Under-reporting of suicide is a ignificant problem and many of those who attempt suicide will try again.
In a European context, the general increase in suicide among young people is "associated with certain demographic features such as higher divorce rates, high unemployment, high homicide rates, reductions of population under the age of 15, an increase in the percentage of the population over 65, more women in the workforce and in third-level education, and an increase in the consumption of alcohol and drugs", says Dr McKeon.
But a recent Dutch study of 14 to 20-year-olds suggests that "depression, hopelessness and low self-esteem" are "better predictors of suicide attempts than socio-demographic features".
The link with depression is "very strong": "90 per cent of those who commit suicide have some sort of psychiatric disorder. Fifty per cent of suicides have a depressive illness, and 10 to 15 per cent have alcohol and drug abuse problems," says Dr McKeon.
The most risky times of the year are May and October, when people with depression (which is at its worst in winter) experience "a lift": "When the depression is lifting they can feel intense irritation and anger which they then often turn against themselves." This does not only apply to people with clinical depression, which is "simply a depression bad enough to need medication". Ten per cent of the 15 to 24-year-old age group suffer from clinical depression, and a further 10 per cent have "significant emotional distress" which Dr McKeon defines as "not bad enough to be diagnosed as clinical depression, but puts them at risk".
He suggests an inherited form of "biochemical brain abnormality" - most likely low levels of the neuro-transmitter, serotonin - which may be directly linked to depressives with "suicidal behaviour".
Although they are more likely to suffer from depression than men, women are less likely to take their own life. The suicide rate for women has remained stable for many years.
"Women will tell you that they would not commit suicide because of their children or because of their parents," explains Dr McKeon. "Their sense of family commitment prevents them. Men don't have that sort of linkage into life."
To curb the high incidence of suicide among depressed young men, treatment needs to be much improved. "Two out of four get no help. Only one out of four gets appropriate help." The options include psychotherapy or medication, or a combination of both.
According to a study by the Suicide Research Foundation in Cork, only 18 per cent of young men aged 15 to 24 years who committed suicide had received psychological treatment in the year before their death, though almost three-quarters of this group were regarded as being mentally ill.
"Our ability to reliably identify those who are likely to kill themselves is not great," says Dr McKeon. "Depression - in homes, schools, factories, businesses and universities - must be recognised as a problem. Primary care facilities appear to be inadequate to cope with the one in 20 people in the general population and the one in 10 people in the GP's surgery who have clinical depression."
AWARE runs a Beat The Blues programme in secondary schools throughout the State, and is starting two new groups for young people, due to meet in Trinity, and in Dundalk RTC, this autumn. There is clearly a need for more effective counselling services in schools and at third level. Rosie McAdam, who is carrying out research at UCD into suicide, notes there are only two part-time professional counsellors employed by the college to cater for 17,000 students.
"Counselling services for students are vastly underfunded," notes Coleman Byrne, president of USI. "Most colleges have an average of one professionally trained counsellor per campus. We'd like to have funding for more, as well as the resources to provide more peer counselling through the students' union. Generally when someone is depressed, the last thing they want to do is go to a professional counsellor. They are more likely to talk to someone from their peer group.
"Once young people don't withdraw altogether, we won't lose them," he concludes.
Today AWARE launches DAWN (Depression Awareness Week Nationwide) with lectures cusing on young people and depres- sion. Tel: 01-8308449.