School-Based Interventions

What is Depression?

episode of sadness or apathy that lasts at least two consecutive weeks

interrupts daily activities 

Symptoms Emotional Symptoms

Sad mood Loss of interest in daily

activities Hopelessness Sulking Withdrawal Inability to concentrate Impulsiveness Feeling lonely Nervousness Extreme mood swings Recurring thoughts of

death or suicide.

Physical Symptoms Pain:

Headaches Back pain Tender muscles Fatigue Dizziness Sleeping too

much/little Appetite:

Unusual cravings Loss of appetite Persistent nausea Diarrhea or constipation

Red Flag Expressions

“Nobody cares about me”

“I’m bored and just want to sleep”

“I don’t care anymore”

suggestions that they want to end their life

Suicide Ideation

People who are depressed are more likely to attempt suicide.

Warning signs talking about death or suicide threatening to hurt people engaging in aggressive or risky behavior

Anyone who appears suicidal should be taken very

seriously. 

Diagnosis DSM-IV (APA, 2000)

Major Depressive Disorder

exhibit at least 5 of 9 symptoms: one must include

depressed mood or irritability

anhedonia others: daily insomnia,

extreme weight, and reoccurring thoughts of death or suicide

Duration > two weeks

Dysthymia (chronic) exhibit 2 or more

of these symptoms: poor appetite or

overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or

difficulty making decisions

feelings of hopelessness. Duration > two years

Emergence & Prevalence

2% preteens and 5% adolescents (Battle, 2002)

Childhood rates: boys = girls Puberty rates: girls 2x boys (Bayridge Anxiety / Depression

Treatment Center, 2007)

In Saskatchewan: 9.8 % rate for urban, Caucasian youth 25% rate for First Nations youth on

reserves (Lemstra, A9).

Concurrent Disorders

90% with one additional psychiatric disorders 50% experience two or more disorders

Anxiety (31-47%) Various Phobias (2.2-8.7%) Panic Disorder (2.2-2.6%) Obsessive Compulsive Disorder (2.2-7%) Posttraumatic Stress Disorder (11-19%) Various Substance Misuse Disorders (4.3-

19%), Somatoform Disorders (14-28%)

(Essau, 2008, p. 39).

Two Perspectives Medications for Depression

Antidepressants (SSRIs) change the levels of feel-good brain chemicals, serotonin. Prozac (fluoxetine) Zoloft (sertraline) Ludiomil (fluvoxamine) Paxil (paroxetine) Anafranil* (clomipramine)

selective serotonin reuptakeinhibitors (SSRIs) preferredover *tricyclic antidepressants(TCA)

Talk therapy (CBT) better cope with the

challenges of depression and life in general

help youth set realistic and positive personal goals

encourage participation in pleasant activities

learn to solve social problems

discourage negative thinking

foster assertiveness

Two Perspectives Treatment for Adolescent with Depression Study (NIMH, 2007)

Group 1 received medication only (Prozac) improvement : 60% (12 wks); 69% (18 wks)

Group 2 received medication combined with CBT (Prozac + CBT) improvement : 71% (12 wks); 85% (18 wks)

Group 3 received CBT only improvement : 44% (12 wks); 65% (18 wks) Suicidal thinking decreased in all active groups

Available at : https://trialweb.dcri.duke.edu/tads/tad/manuals/TADS_PT_Manual.pdf and

http://www.nimh.nih.gov/trials/practical/tads/questions-and-answers-about-the-nimh-treatment-for-adolescents-with-depression-study-tads.shtml

Alternative Strength-Based Perspective

Jonah Lehrer(2010), in Depression’s Upside

“capacity for intense focus” “reduced the possibility of becoming

distracted from the pressing problem” improve problem-solving “more aware and attentive” enhances “creative production” ie. Charles Darwin

Screening Measurements

Children's Depression Inventory (CDI) ages 7 to 17 ; 20-item self-report inventory

Beck Depression Inventory (BDI)adolescents; 21 m/c self-report inventory

Center for Epidemiologic Studies Depression (CES-DC) Scale www.brightfutures.org/mentalhealth/pdf/professionals/bridges/ces_dc.pdf

children & adolescents; 20-item self-report inventory(National Institute of Mental Health, n.d; Counselling Resource, 2002-11).

School-Based Interventions #1

Talk Therapy 1. Cognitive-Behavioral Therapy

focus on the ‘here and now’ focus on problem-solving strategies; goals Change maladaptive thinking patterns

2. Reality Therapy conversation-like ; open ended questions problem-solve and self-evaluate

School-Based Interventions #2 Group Counselling

teaching social skills in social and less threatening environment

openness food and drink availability relaxed, non-clinical environments part of the group

School-Based Interventions #3 Physical Activity

Walking, Running Yoga Kickboxing

More School-Based Interventions Mindfulness Meditation Breathing Exercises Gratitude Journal Light Therapy

Questions

Concerns

Worries

Beliefs