School-based Treatments for Students with Depression

1. School-based Treatments for Students with Depression POTHEINI VAIOULI & THERESA OCHOA INDIANA UNIVERSITY

2. Definition & Criteria of Mood Disorders Depressed or expansive mood Decreased energy Loss of interest or pleasure in almost all activities Changes in appetite, weight, sleeping patterns Irritability, poor concentration, or difficulty making decisions Feelings of worthlessness & thoughts of death or suicide Dysthymic Disorder: chronic condition of unhappiness but does not reach clinical levels Major Depressive Disorder: feelings of unhappiness inconsistent with one’s circumstances

3. NIMH Statistics on Depression & Suicide 20.9 million Americans 18 years or older suffer from a mood disorder in any given year Untreated, depression can lead to suicide In 2006, 33,330 suicides were reported occurring in the US 90% of those who killed themselves had a diagnosable disorder like depression

4. Childhood & Adolescent Mood Disorders Prevalence for adolescent depressive disorder vary from 1.6 to 8.9 % 24% of young people will have suffered one clinically significant depressive episode by the age of 18 years (Merry et al, 2004) 2% of children under 12 are diagnosed with depression compared to 4-8% in adolescents (Asarnow, Scott, & Mintz, 2002) Younger children tend to be diagnosed with dysthymic disorder

5. Range of Treatments for Depression • Cutting Edge • Deep brain stimulation (DBS) • Transcranial magnetic stimulation (TMS) • Controversial • Electroconvulsive Therapy (ECT) • Most Common • Pharmacological & Psychosocial

6. Treatment for Depression in Youngsters Depression is reliably identifiable in children and adolescents (Lucci 2010) • Only 1% of children and adolescent diagnosed with depression were reported to receive treatment (Weisz, McCarty 2006). • Students with EBD and LD are at high risk for experiencing depressive symptoms (Maag 2002)

7. Outcomes for Students with Depression Depression is persistent and leads to negative social and academic outcomes such as: • Social withdrawal • Diminished self esteem • Poor physical health • Decline in academic performance • Increased risk for dropping out of school • Suicide ideations (Maag, 2002, Ferguson et al., 2002, Frojd et al., 2007)

8. Research Question and Method What treatments are available for children and adolescents with depression? Literature search ERIC, JSTOR, EBSCO Descriptors • Depression, emotional and behavioral disorder (EBD), childhood and adolescent depression, evidence based practices, mental health settings, school treatments, pharmacological interventions and behavioral, interventions • Combinations and variations of the above descriptors along with the disorder’s acronyms in the field of special education

9. Literature Search Results… Initial results yielded 1453 articles Search parameters • peer-reviewed publications in English published since 2000 to the present • children & adolescents • no comorbidity with other disabilities • no substance abuse • inclusion of a DSM-IV diagnosis criteria • settings: mental health clinics & schools 25 studies were retained • research on treatment effectiveness • for children & adolescents with depression • carried in clinics or/and schools

10. Literature Search Results Continued • 19 of 25 were implemented in outpatient health clinics and may have included pharmacological treatments, psychosocial treatments or a combination of the two • 6 of 25 carried in schools or school based clinics and included psychosocial treatments

11. Psychosocial Interventions Cognitive Behavior Therapy • Focus on cognition & behavior • Emphasis on teaching new behaviors & check reality • Training on self-instruction, problem solving, cognitive restructuring of reality • Strategies used: modeling, role playing, positive reinforcement • Aim: self-management to facilitate the emotional & social growth of students with depression (Maag & Swarer, 2005)

12. Psychosocial Interventions Interpersonal psychotherapy • Interpersonal conflicts or transitions perpetuate depression • Focus on an empathetic, less directive therapeutic relationship • Emphasis on authority concerns, loss or death, peer pressure, self image • Aim: reduce depressive symptoms & improve social functioning of the participants (Rufollo & Fischer,2009)

13. Treatments for adolescent depression in school settings

14. Kovacs, Sherrill, George, Pollock, Tumuluru, and Vincent, 2006

15. Birmaher, Brent, Kolko, Baugher, Bridge, Holders, Iyengar, and Ulloa, 2000

16. Kataoka, Stein, Jaycox, Wong, Escuerdo, Tu, Zaragosa, and Fink, 2003

17. Mufson, Dorta, Wickramarante, Nomura, Olfson, and Weissman, 2004

18. Merry, McDowell, Wild, Bir, and Cunliffe, 2003

19. Rufollo & Fischer, 2009

20. Summary of Types of Interventions Of the 6 studies included • 3 offered Cognitive Behavioral Support(~50%) • 1 offered Cognitive Behavioral Support & Family Therapy & Systemic Therapy (~17%) • 1 offered Contextual Emotional-Regulation Therapy (~17%) • 1 offered Interpersonal Psychotherapy (~17%)

21. Summary of Intervention Settings Of the 6 studies included • 1 was carried in an elementary school setting (~17%) • 3 were carried in middle school settings (~51%) • 2 were carried in both middle school & high school settings (~35%)

22. Summary of Treatment Effectiveness • 4 of 6 studies (67%) report significant effect sizes (Kataoka et al, ; Kovacs et al, 2006; Mufson et al., 2004; Rufollo & Fischer, 2009) • 2 of 6 studies (33 %) report medium/moderate effect sizes(Merry et al., 2003; Birmaher et al., 2000)

23. Discussion

24. Conclusions • Psychotherapy interventions seem to be the treatment of choice for delivering school based interventions to students with depression. • Psychosocial interventions may need to be modified to complement and coordinate with the school schedule. • Psychologists, social workers and special educators may be the most appropriate for delivering timely and appropriate school based interventions for students with depression.

25. Suggestions for Future Research • Emphasis on school settings for initial access to treating child and adolescent depression • Training of special educators on psychotherapy interventions so that they can design and implement interventions for students with depression • Collaboration between social workers, special educators & school psychologists can promote prevention and early intervention for children and adolescents with depression

26. Questions & Comments