1.
Gena P. Phillips M.A., LPC, LCAS
Natalie Spencer M.Ed., LPC

2.
Ice Breaker
Let’s Get to know each other!

3.
Outline
 What is Depression
 Symptoms and Signs of Depression
 Risk Factor for Suicide
 Prevention Efforts and Effectiveness
 Family Dynamics
 Schooling
 Cultural Implications
 Questions?

4.
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?

5.
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?

6.
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.

7.
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.

8.
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)

9.
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

10.
Clinical Criteria (con’t)
Adults Children
 (4) Insomnia or hypersomnia  Similar to adults
nearly every day

11.
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)

12.
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

13.
Clinical Criteria (con’t)
Adults Children
 (7) Feeling of worthlessness  Child may present with self-
or excessive or inappropriate depreciation (e.g., “I'm
guilt (which may be stupid,” “I'm a retard”).
delusional) nearly every day Delusional guilt usually is not
(not merely self-reproach or present.
guilt about being sick)

14.
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.

15.
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

16.
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

17.
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

18.
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

19.
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

20.
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

21.
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”

22.
6 Generic Questions
to 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?

23.
Prevention Efforts and
Effectiveness
 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

24.
Prevention Efforts and
Effectiveness
 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)

25.
Prevention Efforts and
Effectiveness
 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.

26.
Prevention Efforts and
Effectiveness
 Family Based therapies have produced
positive results with children of
depressed parents
 Help children recognize symptoms
 Promote resilience

27.
Prevention Efforts and
Effectiveness
 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

28.
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

29.
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?

30.
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.

31.
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.

32.
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.

33.
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

34.
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.

35.
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

36.
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 .

37.
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.

38.
 Thank you for your time!
 Questions/Comments