POTHEINI VAIOULI

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School-based Treatments for Students with
Depression

• POTHEINI VAIOULI THERESA OCHOA
• INDIANA UNIVERSITY

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Definition Criteria of Mood Disorders
Major Depressive Disorder feelings of
unhappiness inconsistent with ones circumstances

• Dysthymic Disorder chronic condition of
  unhappiness but does not reach clinical levels

• 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

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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

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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

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Range of Treatments for Depression

• Cutting Edge
• Deep brain stimulation (DBS)
• Transcranial magnetic stimulation (TMS)
• Controversial
• Electroconvulsive Therapy (ECT)
• Most Common
• Pharmacological Psychosocial

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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)

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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)

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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 disorders acronyms in
  the field of special education

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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

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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

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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)

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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)

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Treatments for adolescent depression in school
settings
Study n Age Treatment Duration of Design Effect
Elementary school
Kovacs et al. (2006) 20 7-12 CERT 12-16 weeks Plt.001
Middle Schools High Schools
Birmaher et al., (2000) 107 13-18 CBT, FT, ST 12-16 weeks P.001
Kataoka et al. (2003) 198 10-15 CBT 18-24 weeks Plt0.01
Mufson, Dorta, Wickmarante,Nomura, Olfson,Weismman (2004) 63 12-18 IPT/TAU 12-16 weeks P0.72
Merry, Mc Dowell, Wild, Bir, Cunlifer (2003) 399 13-15 CBT, 12-16 weeks P lt 0.01
Rufollo Fischer (2009) 60 11-18 CBT 12-16 weeks P lt 0.01
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Kovacs, Sherrill, George, Pollock, Tumuluru, and
Vincent, 2006
n 20
Age 7-12
Intervention Contextual Emotional Regulation Therapy
Duration 12-16 weeks
Setting Elementary school
Delivery of intervention Members of the research team
Measure/Instrument K-SADS (children, parents) FDS-Y (clinicians) CDI (children) HDR (clinicians)
Effect size Plt.001
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Birmaher, Brent, Kolko, Baugher, Bridge, Holders,
Iyengar, and Ulloa, 2000
n107
Age 13-18
Setting Middle school
Treatment CBT, systemic behavioral family therapy, or non-directed supportive therapy
Duration 12-16 weeks
Delivery of the intervention Members of the research team
Measure/Instrument BDI, CGAS, CNCEQ (children) CBQ, FAD, and the Areas of Change Questionnaire (parents adolescents)
Effect size P.001
16
Kataoka, Stein, Jaycox, Wong, Escuerdo, Tu,
Zaragosa, and Fink, 2003
n198
age 10-15
Setting Middle school
Treatment CBT
Duration 24 weeks
Delivery of the intervention Bilingual, bicultural social workers
Measure/Instrument CPSS, CDI (children)
Effect size Plt0.01
17
Mufson, Dorta, Wickramarante, Nomura, Olfson, and
Weissman, 2004
n63
Age 12-18
Setting Middle High School
Intervention IPT
Duration 12-16 weeks
Delivery of the intervention social workers doctoral level clinical psychologists
Measure/Instrument HAMD, CGI C-GAS, (clinician) BDI, SAS-SR (children)
Effect size P0.72
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Merry, McDowell, Wild, Bir, and Cunliffe, 2003
n399
age 13-15
setting Middle school
Treatment CBT
Duration 12-16 weeks
Delivery of the intervention Teachers trained by the researchers
Measure/Instrument BDI-II, RADS (students)
Effect size P0.72
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Rufollo Fischer, 2009
n60
Age 11-18
Setting Middle schools high school
Treatment CBT
Duration 12-16 weeks
Delivery of the intervention School social workers
Measure/Instrument CDI, BDI II (children) CIS (parents) interviews with children teachers on school engagement and peer relationships
Effect size Plt0.01
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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)

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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)

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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)

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Discussion
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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.

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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

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Questions Comments