Janet Grossman

Preliminary Studies of the Reliability and Validity of the Children's Depression Rating Scale

The Childrens Depression Rating Scale, revised version (CDRS-R), is a reliable, clinician-rated scale which differentiates the depressed from the nondepressed child. The sum score of the CDRS-R appears to provide a better estimate of depressive symptomatology than does clinical impression. The relationship of the sum of the CDRS-R with global clinical ratings of depression indicates that the scale measures the severity of depression which is its primary purpose. The scale is not affected by the age of the child in our clinical sample, and the content of the items grouped as mood, somatic, subjective, and behavior all show good correlations with depression. The CDRS-R has been shown to be useful in a variety of settings, suggesting it is useful in both primary and secondary depressions.

Suicide and Violence Prevention: Parent Education in the Emergency Department

OBJECTIVE To determine prospectively whether parental receipt of injury prevention education is associated with new action limiting access to lethal means and if so, what action was taken for which means. METHOD Prospective follow-up of 103 adults whose children made an emergency department visit for mental health assessment or treatment. Record review assessed whether hospital staff provided injury prevention education. Logistic regression was used to determine the likelihood of new caretaker action limiting access to the following potentially lethal means: firearms, alcohol, prescription medications, and over-the-counter medications. RESULTS Significant associations were found between exposure to injury prevention education and action to limit access (adjusted odds ratio = 3.6, 95% confidence interval = 1.1-12.1, p = .04). Five of 8 adults whose households contained firearms took new action to limit access after injury prevention education, whereas none of the 7 firearm-owning families who did not receive injury prevention education took new action to limit firearm access. Similar patterns were seen for other means. Adults more often chose to lock up rather than dispose of lethal means. CONCLUSIONS Injury prevention education should be provided to parents during child/adolescent emergency department mental health-related visits. Potential for violence prevention is real because parents do take new action to limit access to lethal means when means restriction education is provided.

Hypomania in a Four-Year-Old

This case report of a 4-year-old boy has a particularly clear clinical history and pattern of hypomania. Besides hyperactivity and emotional lability, which has previously been described in the offspring of a bipolar parent, the boy displayed pathologically prolonged states of emotional arousal to minimal stimulus, as well as euphoria, overtalkativeness, irritability, episodic states of frenzied activity, and minor depressive feelings. Because the clinical picture was so clear, the identification of possible hypomanic behavior in other young children may be aided.

Psychotic and Depressed Children: A New Entity

Both cross-sectional and longitudinal assessments of 6 children ages 6–12 years who clinically present as both psychotic and depressed are described. Diagnostic assessments included standardized assessments for diagnosis, ratings of severity of depression, family history and the dexamethasone suppression test. Three children are described clinically. Review of all diagnostic data for 6 children suggests that a diagnosis of major depressive disorder with psychotic features and/or with schizoaffective disorder may be appropriate for certain prepubertal children.

Youth suicide-related visits in an emergency department serving rural counties: Implications for means restriction

A large proportion of suicide attempts result in injuries requiring medical attention, but little is known about youth presenting to rural emergency departments (EDs) for suicide-related behavior. We conducted a chart review of youth receiving mental health (MH) evaluations during 1994 in an ED serving rural counties. Forty percent of the these visits were for suicide-related events. These youth were more likely to be older, female and white than youth receiving MH evaluations for reasons not related to suicide. No differences were found on recent substance use, non-suicidal aggression, or MH service contact when comparing suicidal to non-suicidal youth. Youth receiving MH evaluations were homogenous with respect to suicide risk factors. Chart reviews provided no evidence that means restriction education was provided. We discuss broader implications of these findings for the role of means restriction in EDs.

Police collection of firearms to prevent suicide: correlates of recent turn‐in experience

Although household firearm removal is a recommended strategy for preventing deaths among suicidal youth, appropriate mechanisms for household firearm disposal have not been identified. We surveyed members of an association of police chiefs about experience, polices and attitudes with respect to the collection of firearms turned in to prevent adolescent suicide. Over one‐third of the respondents reported recent firearm turn‐ins to prevent suicide. Three‐quarters of the respondents reported the existence of departmental policy to handle suicide‐related turn‐ins. The existence of departmental policy with respect to firearm surrender was significantly associated with recent suicide‐related turn‐in experience. Attitudes were associated with the existence of a policy and, for departments without a policy, intentions to implement a policy. Inspection of comments provided by informants suggested that attitudes were associated with knowledge about the role of firearms in completed suicide. Although further longitudinal research is needed to evaluate whether policies are a precursor to experience, our data support the viability of this causal hypothesis. A high base rate of existing involvement of police jurisdictions in suicide prevention suggests that prevention efforts focused on expanding police involvement may prove successful. We discuss the development of a written firearm turn‐in policy in one police department and append this policy as an example.