In adolescent major depression, when is hospitalization indicated?

• A. For mild symptoms treated in primary care
• B. For severe exacerbations or suicide attempts
• C. After one week of therapy
• D. Only if family declines therapy

Answer: (B)

Hospitalization is indicated when adolescent major depression reaches a level of risk or impairment that cannot be safely managed on an outpatient basis. The key scenario is severe symptoms with a real safety concern, such as a suicide attempt or imminent risk of self-harm. In these cases, inpatient care provides 24-hour monitoring, rapid risk assessment, and intensive treatment (medication management, psychotherapy, safety planning) in a controlled setting, which helps keep the patient safe and stabilize symptoms quickly.

Mild depressive symptoms that can be treated in primary care, or improvement after a short period of outpatient therapy, do not require hospitalization. A fixed timeline like one week of therapy isn’t a criterion for admission, and family preference alone doesn’t justify inpatient care if the patient isn’t at high risk. The emphasis is on safety and the ability to participate in treatment: if the depression is severely impairing functioning or there is active suicidality or psychosis, hospitalization is the best option.