Outline What is Depression Symptoms and Signs of Depression Risk Factor for Suicide Prevention Efforts and Effectiveness Family Dynamics Schooling Cultural Implications Questions?
Case Study #1 Montrel is a 2nd grader. His teacher has come to you with some concerns. She tells you that Montrel’s behavior has changed in the past few weeks. She said Montrel is usually outgoing and productive in the classroom. She says that recently he complains of stomach aches everyday when they have “free time”. Instead of interacting with his peers, he sits at his desk and gazes out the window. She also said that when she asks him what is wrong, he always says “I don’t know but I don’t feel right”. She needs your guidance with this student. What do you tell her? What do you think might be going on with Montrel?
Case study #2 Jamel is in 8th grade. You are walking down the hall at school and she frantically runs into you. She is crying and she snaps at you by saying “get out of my way”. You ask her what’s going on and she says “leave me alone, you wouldn’t understand” in a very angry tone. She walks away and you follow her into the bathroom. At that time, you hear her in the stall on her cell phone saying “I don’t know what to do, I just wish I would die”. When she comes out of the bathroom, she is still crying. What do you do? What would you say to Jamel? What do you think is going on?
What is Depression?Clinical Criteria (Major Depressive Episode) Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.
Clinical Criteria (con’t)Adults Children Mood can be depressed or (1) Depressed mood most of irritable. Children with the day, nearly every day, as immature cognitive-linguistic indicated by subjective report development may not be able to describe inner mood states and (e.g., feels sad or empty) or therefore may present with observation made by others vague physical complaints, sad facial expression, or poor eye (e.g., appears tearful) contact. Irritable mood may appear as “acting out”; reckless behavior; or hostile, angry interactions. Adult-like mood disturbance may occur in older adolescents.
Clinical Criteria (con’t)Adults Children (2) Markedly diminished Loss of interest can be in peer interest or pleasure in all, or play or school activities. almost all, activities most of the day, nearly every day (as indicated by subjective account or observation made by others)
Clinical Criteria (con’t)Adults Children (3) Significant weight loss Children may fail to make when not dieting, or weight expected weight gain rather gain (e.g., a change of more than losing weight. than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day
Clinical Criteria (con’t)Adults Children (4) Insomnia or hypersomnia Similar to adults nearly every day
Clinical Criteria (con’t)Adults Children (5) Psychomotor agitation or Concomitant with mood retardation nearly every day change, hyperactive behavior (observable by others, not may be observed. merely subjective feeling of restlessness or being slowed down)
Clinical Criteria (con’t)Adults Children (6) Fatigue or loss of energy Disengagement from peer nearly every day play, school refusal, or frequent school absences may be symptoms of fatigue
Clinical Criteria (con’t)Adults Children (7) Feeling of worthlessness Child may present with self- or excessive or inappropriate depreciation (e.g., “Im guilt (which may be stupid,” “Im a retard”). delusional) nearly every day Delusional guilt usually is not (not merely self-reproach or present. guilt about being sick)
Clinical Criteria (con’t)Adults Children (8) Diminished ability to Problems with attention and think or concentrate, or concentration may be indecisiveness, nearly every apparent as behavioral day (by subjective account or difficulties or poor as observed by others) performance in school.
Clinical Criteria (con’t)Adults Children (9) Recurrent thoughts of There may be additional death (not just fear of dying), nonverbal cues for potentially recurrent suicidal ideation suicidal behavior, such as without a specific plan, or a giving away a favorite suicide attempt or a specific collection of music or stamps. plan for committing suicide
Risk Factors for Suicide Roughly 9 out of 10 adolescents who die by suicide give clues to others before their suicide attempt Recognizing risk factors early can prevent suicide and get teens the help they need Impact of some risk factors can be reduced greatly by interventions
Risk Factors for Suicide Previous suicide Substance abuse attempt or gesture Family history of Feelings of suicidal behavior hopelessness or Life stressors such as isolation interpersonal losses (relationship, social, Psychopathology legal, etc.) (depressive disorders/ Disciplinary problems mood disorders) Access to firearms Parental Physical/verbal/sexual psychopathology abuse
Risk Factors (con’t) Conduct disorders or Contagion or imitation disruptive behaviors (exposure to media Sexual orientation accounts of suicidal (homosexual, bisexual, behavior and exposure to and trans-gendered suicidal behavior in youth) friends or acquaintances) Juvenile delinquency Chronic physical illness School and/or work Living alone and/or problems runaways Aggressive-impulsive behaviors
Protective Factors Family cohesion (family with Impulse control mutual involvement, shared Problem solving/conflict interests, and emotional resolution abilities support) Social integration/opportunities Good coping skills to participate Academic achievement Sense of worth/confidence Perceived connectedness to the Stable environment school Access to and care for Good relationships with other mental/physical/substance school youth disorders Lack of access to means for Responsibilities for others/pets suicidal behavior Religiosity (a controversial topic Help-seeking behavior/advice currently) seeking
Early Warning Signs Withdrawal from friends Loss of interest in and family pleasurable activities Preoccupation with death Frequent complaints about Marked personality change physical symptoms, often and serious mood changes related to emotions, such Difficulty concentrating as stomach aches, fatigue, Difficulties in school headaches, etc. (decline in quality of work) Persistent boredom Change in eating and Loss of interest in things sleeping habits one cares about
Late Warning Signs Actually talking about suicide or Refusing help, feeling “beyond a plan help” Exhibiting impulsivity such as Not tolerating praise or rewards violent actions, rebellious Becoming suddenly cheerful behavior, or running away after a period of depression-this Complaining of being a bad may mean that the student has person or feeling “rotten inside” already made the decision to Making statements about escape all problems by ending hopelessness, helplessness, or his/her life worthlessness. Giving away favorite possessions Giving verbal hints with Making a last will and testament statements such as: “I won’t be a Saying other things like: “I’m problem for you much longer,” going to kill myself,” “I wish I “Nothing matters,” “It’s no use,” were dead,” “or “I shouldn’t have and “I won’t been born.” see you again”
6 Generic Questionsto Assess Lethality - (Wubbolding, 1996) Are you thinking about killing yourself? Have you attempted suicide in the past? Do you have a plan? Do you have the means available to you? Will you make a no-suicide agreement to stay alive? Is there anyone close to you who could prevent you from killing yourself and to whom you could speak if you feel suicidal?
Prevention Efforts andEffectiveness Many studies focus on the treatment of depression in both children and adults, however few focus on its prevention In a recent study the Journal of American Medical Association (JAMA, 2009) examined the effectiveness of prevention interventions in adolescents with depressed parents Study concluded that Cognitive Behavioral Therapy (CBT)- is effective in reducing the risk of depressive symptoms in adolescents with depressed parents
Prevention Efforts andEffectiveness Study consisted of 316 adolescents aged 13-17 who had at least one parent or caregiver with a current or past diagnosis of depressive disorder The participants also had a history of current or past depressive symptoms. Participants randomly assigned to groups to receive either sessions of group CBT or their current treatment. Participants participated in 8 weekly CBT sessions followed by 6 monthly session ( learn coping and cognitive restructuring and problem solving skills)
Prevention Efforts andEffectiveness Study measured the rate of occurrence of depressive episodes that lasted 2 weeks. At conclusion of study and follow up period incidence of depressive episodes in the intervention group as 21.4% versus 32.7% in the control group. Intervention group reported improvement in depression symptoms more often then control group.
Prevention Efforts andEffectiveness Family Based therapies have produced positive results with children of depressed parents Help children recognize symptoms Promote resilience
Prevention Efforts andEffectiveness Wake County School Prevention Effort: Signs of Suicide Video and SOS information was presented to 9th graders in Health/PE class Students filled out a form if they ever considered suicide or felt depressed, sad, or unhappy Counselors would review forms and met with students before the end of school
Family Dynamics Family conflict can trigger or worsen depression symptoms Parents should open lines of communication to encourage children/teens to talk Families often place attention and energy on depressed child and neglect own health and other family members Important to keep whole family strong and healthy
Family Dynamics Resistant Parents- Pro-active vs. Re-active The Mentally Ill Parent Making Recommendations- Parents can resist help Shame and Fear Emotionally and Physically Attached- What do you do?
Family Dynamics Families should maintain balance by: Reaching out for help- Support groups, friends, etc Be open with family- Don’t cover up situation. Invite other children and teens to ask questions Avoid the blame game- Not the time to point fingers, but offer support.
Schooling Depression in children and teens can have negative effects on schooling. In schools (rather than home or community) students’ problems with academics, peers or other issues are more likely to be evident. At schools, students have the greatest access to multiple helpers, such as teachers, counselors, nurses, and classmates who have the potential to intervene.
Schooling Depressed teens often skip school Decline in academics- Important for teachers to receive training to know reasons why school performance drops Students who feel connected to schools ( believe teachers care about them, feel part of the school) are less likely to engage in suicidal behaviors.
Cultural Implications Cultural differences can be reflected in differences in preferred styles of coping with day-to day problems. Evidence indicates there is a persistent disparity in the health status of racial and ethnic minority populations as compared to the overall health status of the US population
Cultural Implications People in the lowest socio- economic positions are 2-3 times more likely than those in the highest positions to experience mental disorders Racism and discrimination are highly stressful and can adversely affect health and mental health.
Cultural Implications In 2003 11% of African American male students in grade 9-12 seriously considered suicide In 2002 the suicide rate among African American females was the lowest of all racial/gender groups- 1.6 per 100,000 Among males ages 15-24 American Indians and Alaskan Native have the highest suicide death rate of 27.9 per 1000, 000 population • US Department of Health and Human Services
Cultural Implications Multiple studies suggest that children and adolescents of Hispanic origin experience more mental health problems than their non- Hispanic counterparts Asian Americans do not access mental health treatments as much as other racial /ethnic groups. This is perhaps due to a strong stigma related to mental illness. Emotional problems are viewed as shameful and distressing .
Cultural Implications Gay and lesbian teens suffer from depression as well. Gay and lesbian teens may experience depression if they are rejected by family or society for being gay or are victims of harassment.
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