Perusing the literature reviewed in this chapter, it is clear that there are a number of fundamental epidemiologic questions for which as yet we have no empirical answers. The basic questions focus on issues of incidence, prevalence, natural history, and etiologic factors in regard to depression and suicidal behaviors and how ethnicity plays out in this regard.
1. The available data on prevalence are quite limited. For example, there are almost no data on the prevalence of clinical depression among diverse ethnic minorities, different socioeconomic strata, and rural compared with urban populations. The same is true for the spectrum of suicidal behaviors.
2. From the perspective of prevention and treatment as well as epidemiology, understanding the natural history of child and adolescent disorders is critical, yet there are essentially no data on incidence, duration, and recurrence of clinical depression and suicidal behaviors in minority populations.
3. Comorbidity is increasingly recognized as a key phenomenological feature of psychiatric disorders among children and adults (Bird, Gould, & Staghessa, 1993; Brady & Kendall, 1992), yet there are basically no community-based epidemiologic data on the prevalence, incidence, and natural history of comorbid disorders with depression and suicidal behaviors in minority adolescents.
4. A key to understanding disorders is understanding the role of developmental factors (Costello & Angold, 1993), but at present there are few data on the role of development in the manifestation of psychiatric problems, because there are few data from epidemiologic studies examining the relation between developmental milestones of stages and psychiatric syndromes such as depression and suicide.
5. Ultimately, the goal of psychiatric epidemiology is to explain the etiology of mental disorders. A necessary requisite is data from prospective, longitudinal studies assessing the roles of multiple risk factors drawn from both psychosocial and biological domains in specific disorders and the specificity of effects of these factors. Few such data are available on depression or suicidal behaviors among minority youths.
6. In addition to examination of the role of risk factors in etiology, there also is a need for community-based epidemiologic studies aimed at understanding the factors affecting duration and recurrence of child disorders, in particular, depression and suicidal behaviors.
7. To date, the role of biological factors has been little studied and is poorly understood vis-à-vis child and adolescent disorders. Fuller knowledge of the etiology of such disorders will require inclusion of biological and genetic variables in our conceptual models (Cohen et al., 1995; Roger, 1995; Uchino, Cacioppo, & Kiecolt-Glaser, 1996).
8. We need more research on the role of ethnicity in depression and suicidal behaviors, but future research should focus on an expanded conceptualization of the ethnic experience. Reliance on ethnic status as the sole measure of the ethnic experience has yielded limited explanatory power (see Trimble, 199091; Roberts & Chen, 1995). Ethnicity is a complex biopsychosocial construct that is only partially operationalized by demographic categories of race or ethnic status. Trimble (1990-91) has argued that ethnicity can (should) be examined using measures that assess three domains: natal, behavioral, and subjective. There have been few epidemiological studies that have incorporated such a strategy, examining the question of what is is about ethnicity that increases or decreases risk for psychiatric disorder.
I submit that these research issues constitute central research challenges that need to be met successfully if we are to better understand depression and suicidal behaviors among adolescents. By this, I mean all adolescents, including those from the diverse cultural streams that constitute American society.
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