Adolescent depression and emergency department use: the roles of suicidality and deliberate self-harm.

Depression is associated with increased health service use; clarifying the processes involved may offer strategies to reduce the disorder's individual and societal burdens. This review hypothesizes roles for suicidality and deliberate self-harm to partially explain a relationship between adolescent depression and increased emergency department use. Briefly, depression is associated with suicidality and deliberate self-harm, both of which are likely common among emergency department presentations in this age group. The overlap of depression with suicidality and deliberate self-harm has implications for suicide prevention strategies that emphasize diagnosing and treating adolescent depression. First, identifying and referring depression among these emergency department presentations is promising, but limitations must be addressed. Second, interventions for adolescent depression also may affect the health conditions associated with increased emergency department use, including suicidality and deliberate self-harm. However, much more research is needed on the pathways involved before such benefits, including cost offset, can be reasonably anticipated.