Depressive symptoms are different between adults, children, and adolescents. For children and adolescents, depressive symptoms are often the opposite of symptoms usually associated with depression in adults, such as withdrawal. For children and adolescents, symptoms of underlying depression could include having a conduct disorder, being of a particularly defiant nature, or even being accident-prone.

For many children and adolescents suffering from chronic depression, the contributing factor to the depressions is often the lack of love that they feel from parents or caretakers, or the lack of emotional security. This may be attributed to parents who may be physically or emotionally abusive. In Ms. Chung's own research, she interviewed child and adolescent subjects who described the almost "deadly" messages from parents. For example, subjects were told "raising a dog would be better than raising you" or "you are better off dead." These messages result in low self-esteem, and the child or adolescent becoming emotionally needy.

In Asian cultures, parents are not demonstrative in their expressions of love. Their children may compare this to the mainstream culture and incorrectly interpret their parents' behavior to be a lack of love. However, in the Ms. Chung's research, the parents were not just less demonstrative but in fact highly dysfunctional and incapable of love. In counseling sessions, she has found it helpful to initiate open communication with the child and parent. Often, the child feels overly criticized, and they appreciate hearing the parents openly discuss positive characteristics of the child.

When working with children and adolescents who show signs of depression and suicidal thoughts, counselors and service providers should always ask the question about whether or not the individual has considered hurting oneself. At first, suicide attempts may be used to scare the parents and gain attention, but later, when emotions and reason get blurred, suicide attempts may result in successes.

There is no easy formula for treatment of depressive and suicidal personalities. It is important not to overlook the individual's conduct or change in behavior. The individual needs love, support, structure and firm guidance. It is important to work with the family as well because an individual in treatment will not always remain the therapist's patient, but he/she will remain part of a family.

Depression and suicidal ideation are not just problems for underachieving children. These problems are also prominent among high achievers who seem to be successful individuals. However, extreme pressure from family to succeed and a resulting fear of failure can result in depression and even resentment on the part of the young person. For many Asian families, the family is very central; an individual is not to bring shame to the family nor discuss personal problems outside of the family. As a result, Asian American young people may channel this depression and anger into concentration on school, where their high grades are assumed to mean that they are healthy and well-adjusted. In reality, these young people may have a narrow view of life and not develop good coping skills to deal with problematic, everyday situations.

Kenny Kwong:
Mr. Kwong discussed why depression is such a problem for Asian Americans, what the underlying needs and unique experiences of Asian American adolescents are, and what can be done to help these adolescents.

Nationally, suicide is the third leading cause of death for all individuals age 15 to 24 years old. It is particularly high for Asian Americans. The suicide rate of Asian American women ages 15 to 24 is second only to Native Americans, and above whites, blacks and Hispanics. Therefore, suicide and depression are a key concern for the Asian American community. They impair not only the functioning of individuals, but also of family and the community as a whole.

Typically, the adolescent suffering from depression does not seek out treatment. The mother or another family member calls because s/he is very upset when the child's behavior becomes extreme or out of control. The individuals suffering from depression are not the only ones facing a crisis; the entire families are in a crisis, as well as the school and other community based organizations that work with the young person.

Adolescence is a time when all individuals must struggle with life changes, but Asian American adolescents face additional risk factors that may place them more at risk. First, the individual's immigration experience has an impact on their mental health and their family relationships. New immigrants are faced with the harsh reality of prejudice and racism, whether that stems from negative or positive stereotypes. Some may even be illegal unaccompanied minors who have to work to survive and who have no family in this country to support them. Even young people who are not recent immigrants or were born here still have strong ties and responsibilities to the

Secondly, as the individual acculturates, s/he must resolve differences between family values and his/her own values influenced by the dominant culture in the U.S. For example, the individual may feel the need to assert individuality as well as meet family demands. It is also important to assess the family as well. Different family members may have different levels of acculturation that may precipitate intergenerational conflict.

Finally, another source of stress for Asian American adolescents is ethnic identity formation. Individuals may have conflicts resolving with whom s/he should identify, either the dominant or minority culture. Psychologists have outlined the process of minority identity formation that consists of periods of conformity when the individual embraces only the culture of the majority, and resistance and immersion when the individual denounces the culture of the majority and embraces that of the minority culture. Many individuals often develop a bicultural identity. It should be noted that service providers also need to come to terms with their own ethnic identity in order to understand the youth's experience.

The following are four suggestions of what the Asian American community can do to help these adolescents in need. First, there needs to be a development of sophisticated assessment skills that will examine the underlying issues that include individual and family dynamics. This will help in early detection of what may lead to serious mental health issues.

Second, it is important to develop methods to reach out to these at-risk youth and not wait until they seek treatment for serious conditions. This can be achieved by developing a network of schools, churches, youth centers, and clinics that can collaborate together to provide integrated services that can help the youth cope with the stresses they are facing.

Third, it is necessary to increase public awareness of the challenges that the youth face so that it is easier for them to share their experiences. There must be opportunities for the youth to talk about their own experiences. Finally, it is important to increase to set an advocacy agenda for mental health needs, set priorities, and work together to increase resources to support community agencies, schools, families, and youth. There is a particular need for services and bilingual professionals for newer and smaller immigrant communities.

Discussion and Comments:
It is important to note that many suicides are not reported as such, so data for Asian Americans is likely to be higher than data show. In addition, suicide attempts, which are far more numerous, are not reported.

When assessing Asian American students for depressive symptoms, counselors should look beyond the academic performance and investigate how the student relates to his/her peers. High academic performance can hide underlying mental health problems

There is a great deal of stigma around mental health problems in Asian cultures. Many parents feel that academic progress is the most important sign of well being. For their part, a young person does not want to be singled out as mentally ill. Both parents and young people may believe that talking will not help.

There is a continuing need for parenting education. Service providers should remember to acknowledge the parents' struggles with immigration and raising a child in a new country. In addition, service providers can help parents remember to grow with the children. The straightforward and strict discipline methods that they used when the child is small are not necessarily the best methods for an adolescent.

Because gay and lesbian youth in general face extremely high suicide rates, Asian American gay or lesbian youth may be at extra risk. Many will not consider coming out to their families because the cultural stigma is so strong. As a result, they may need to build a substitute family among peers until they can come out to parents.

Often a young person finds that traditional Asian philosophies and religions, such as Buddhism, do not translate well into their experience in U.S. mainstream youth culture. While they may reject their family's belief, they do not necessarily have anything to replace it for spiritual support or identity. Young people need to see their traditions reflected here so they can appreciate the strength of their heritage's cultural and spiritual values.

The fine arts and performing arts provide a way for young people to explore the Asian American experience, develop a healthy ethnic identity, and identify with others who have had similar experiences. Mentoring is also an excellent opportunity for help guide young people through difficult times. In New York City, contact organizations are the Asian American Arts Alliance, the Asian American Writers Workshop, and Asian Professional Extension (a mentoring group).
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Artsfartsyjanet writes: "I would like people to be more aware of suicide and depression in the Asian American community not only because I'm a crisis worker now but because I also can relate to people who know anyone who's committed suicide."