WCW Blog

The Women Change Worlds blog of the Wellesley Centers for Women (WCW) encourages WCW scholars and colleagues to respond to current news and events; disseminate research findings, expertise, and commentary; and both pose and answer questions about issues that put women's perspectives and concerns at the center of the discussion.

Preventing Depression in Young People

Preventing Depression in Young People

This policy brief originally appeared in the Spring/Summer 2016 Research & Action Report from the Wellesley Centers for Women as part of the multi-media series Advancing the Status of Women & Girls, Families & Communities: Policy Recommendations for the Next U.S. President.


depressionpreventionDepression is Prevalent but Prevention Programs Are Limited

According to the World Health Organization, depression is the leading cause of disability worldwide—it is the most common psychiatric disorder in the U.S., and is particularly common among lower income populations, and among women beginning in adolescence. The average age of onset for depression is 15, and about 20 percent of all people will have experienced an episode of depression by the end of adolescence. Youth depression is associated with a host of negative and long-term consequences, including poorer school performance, difficult peer and family relationships, increased risk of substance abuse, and poorer functional outcomes in adulthood. Of particular note is the connection between youth depression and suicide. Although not all people who commit suicide were depressed at the time, depression and suicidal behavior are indeed linked. Suicide is a tremendous problem in the U.S. and is the second leading cause of death among American adolescents.

Although depression is among the most treatable of all mental illnesses, and although we have evidence-based treatment approaches for depressed youth, the reality is that only about half of all depressed children and adolescents ever receive treatment, and only about half of those who do receive treatment actually improve as a result. Nearly all of those who recover from depression will experience a subsequent depressive episode within a few years. Specifically, 40 percent of youth who have experienced a past episode of depression will relapse within two years, and 75 percent will relapse within five years. This means that a typical 15 year-old who develops an episode of depression, if she is fortunate enough to receive treatment and benefit from it, will experience another depressive episode while she is graduating from high school and transitioning to adulthood.

Although nearly one in five young people experience an episode of depression by the end of adolescence, treatment protocols for youth depression only help about half of those they target, and relapse is common and debilitating. Funding for depression prevention efforts is limited, and preventive programs are difficult to access.

Promising Prevention Efforts

Youth depression is a problem of major proportions, affecting millions of children and families and interfering with children’s social, emotional, and academic functioning. Although evidence-based treatments for youth depression have been found to work well, treatment resources often are difficult to access. Most adolescents who recover experience relapse, and the long-term consequences of youth depression are significant.

Recently, promising research has suggested that depression is among the most preventable of major mental illnesses. We now know of strategies that work to prevent youth depression, including providing cognitive behavioral interventions to adolescents at high risk and helping youth to strengthen social relationships. Based on this research, many European colleagues now encourage a focus on preventive efforts for youth at risk for depression. Although funders and policymakers in the U.S. support preventive efforts for medical concerns, such as healthy eating and exercise to address heart disease, prevention, unfortunately, is often overlooked in mental health. Researchers, policymakers, and practitioners should focus attention on identifying youth at risk for depression, providing evidence-based preventive interventions to at-risk youth and families, and assisting at-risk youth in accessing preventive and/or treatment resources, as needed.

PreventingDepressionApproaches & Recommendations

Recommendations for enhancing a focus on the prevention of youth depression include:

  • Increase use of depression prevention interventions by increasing funding for research. Although several depression prevention interventions have been found to decrease the onset of depressive symptoms or disorders among at-risk youth, such programs are still not readily available in community-based mental health settings, and many practitioners do not know how to implement evidence-based protocols. More funding is needed for large-scale effectiveness trials that examine ways of disseminating evidence-based interventions in real-world settings and for large-scale trials that compare the efficacy of different evidence-based programs for different populations.
  • Attend to family processes that influence depression risk and that promote depression prevention. Research suggests that parental depression is a significant risk factor for depression onset in youth, and that family processes both maintain and may help alleviate depression. Policymakers, funders, and practitioners must attend to the important role of families in identifying and supporting youth at risk for depression who are appropriate for preventive efforts. In addition, interventions to prevent youth depression may benefit from a focus on enhancing family understanding of youth depression, improving parenting skills, and also on addressing parental depressive symptoms that may affect the efficacy of interventions targeting at-risk youth.
  • Integrate youth depression prevention efforts into places where youth are most readily accessed. Efforts to prevent youth medical concerns are an established focus of public health strategies, resulting in, for example, vaccinations from physicians and auditory screenings Integrate youth depression prevention efforts into places where youth are most readily accessed. Efforts to prevent youth medical concerns are an established focus of public health strategies, resulting in, for example, vaccinations from physicians and auditory screenings at school. Unfortunately, routine screening for depression and suicide risk is generally overlooked both in primary care and in schools, although these are the places that youth are most readily accessed and serviced. Policymakers, funders, and practitioners must support additional training for school and medical personnel in identifying at-risk youth, evaluating youth for mental health concerns, and connecting youth to appropriate mental health services. Additionally, research is needed to evaluate primary care and school-based depression prevention interventions, so that, when at-risk adolescents are identified, evidence-based depression prevention services are readily available in locations that are comfortable and accessible to those in need.

Tracy Gladstone, Ph.D. is an associate director and senior research scientist at the Wellesley Centers for Women as well as the director of the Robert S. and Grace W. Stone Primary Prevention Initiatives, which focus on research and evaluation designed to prevent the onset of mental health concerns in children and adolescents.

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Learning from Amy

motherchildillustrationLearning from Amy

This article was originally published December 19, 2013 on Girl w/ Pen by Susan McGee Bailey, who served as executive director of the Wellesley Centers for Women and a Professor of Women’s & Gender Studies and Educationat Wellesley College for 25 years.

Heather Hewett’s December 5th blog post on Girl w/Pen, “What’s a Good Mother?” hit a nerve. My daughter Amy was born in 1970, the same year Shulamith Firestone’s The Dialectic of Sex and Robin Morgan’s anthology, Sisterhood is Powerful were published. Betty Friedan’s Feminine Mystique had already become part of my daily conversation. I read Firestone, Morgan, Germaine Greer, Our Bodies, Ourselves—everything I could find on ‘women’s liberation’. It all made so much sense. My husband and I agreed; we would share parenting. Our family wouldn’t follow the usual gender patterns, we’d be equal partners and we’d steer our daughter clear of sex stereotyped toys, clothes, and expectations. A huge cultural shift was underway; we’d be part of it.

We have been; but not in the ways I anticipated 40 years ago. Children complicate lives in unexpected ways. Amy was born with a variety of disabilities, some immediately evident, others less so. She tested our facile feminism; we chose different answers. I am a single parent.

Parenting a child with physical and developmental challenges is a politicizing activity. Mothering such a child alone is a radicalizing one. Mothering a child with disabilities requires not only the culturally sanctified female roles of caregiving and ‘traditional good mothering’, but aggressive independent action. You must lobby the legislature, pressure the school board, argue with the doctor and defy the teacher. And, oddly, while these ‘unfeminine’ behaviors might, in other contexts, be deemed deviant or too aggressive, performed in the context of mothering a child with special needs they are considered appropriate, even laudable.

blogpullquoteLearningFromAmyBut for a single mother, even this culturally permissible deviance is insufficient. My life with Amy is different from the lives of most of my colleagues and friends. I could not provide emotional, physical and financial support for Amy without re-envisioning motherhood. Amy and I have lived with a shifting assortment of male and female students, single women as well as married women with children. Work for me is not possible without round the clock care for Amy. This is true for all mothers and children, but it is a need that is normally outgrown. Not so in our case. Amy fuels my passion for feminist solutions; not simply for childcare, but for policy issues across the board. I know first hand too many of the dilemmas confronting women, from the mostly invisible, predominately female workers who care for others in exchange for poverty level wages to successful business women struggling to be perfect mothers, perfect wives and powerfully perfect CEOs.

While there may be no individual solutions, there are individual decisions. As a mother and a feminist, I long ago made the decision to work toward a society in which power and responsibility as well as independence and dependence are equally available to women and men.

But it’s a lovely winter day, snow is sparkling on the pine trees, and across the street children are sledding. To talk of the challenges of motherhood without sharing the lessons in joy Amy offers is only a part of the story. My particular good fortune is in Amy’s special way of seeing the world. Oliver Sacks in The Man Who Mistook His Wife for a Hat writes about people he calls ‘simple’. “If we are to use single word here, it would have to be ‘concreteness’--their world is vivid, intense, detailed, yet simple, precisely because it is concrete, nether complicated, diluted nor unified by abstraction.” Amy never misses a sunset, a baby or a bird. She notices and she insists that others notice.

“Mother, come here! Now!”

“Amy, I’m busy, I’ll be there in a minute, OK?”

“No, not OK, red bird will fly away, come NOW!”

I hurry to see red bird. What kind of silly person would think it reasonable to miss a cardinal in the snow?

This is only one of many joys my daughter has taught me.

It’s the Christmas season, a time of hope. Lately life has begun to look bleaker each day as we move further toward a nation of haves and have nots; but today I choose to believe in hope. Someday, not so far away, women and men working together will beat the odds. We will succeed in creating a more just and equal world.

Susan McGee Bailey, Ph.D. has received numerous awards for her research and public advocacy, is frequently quoted in the media, and has appeared on a variety of radio and television programs. In 2011 the National Council for Research on Women spotlighted her as a feminist icon. She has worked for more than 35 years with community organizations addressing the needs of disabled children.

 

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Caregiving across the Life Span

elderlymotherdaughterCaregiving across the Life Span

November is National Family Caregivers Month, a time to recognize those who care for family, friends, and neighbors, including the elderly, sick and disabled. While the elderly are healthier now than in previous generations, about 17 percent of Americans 65 and older need assistance with one or more daily activities, such as bathing or dressing (Himes, 2002); many more need assistance with chores, errands or transportation. Family members in the community provide most of this assistance; for example, 26 percent of adult daughters and 15 percent of adult sons report spending at least 100 hours/year caring for or helping their older parents (Johnson & Lo Sasso, 2000).

While important, these numbers obscure the many ways in which we are each embedded in networks of care. Some of us are directly involved in hands-on caregiving, but care also encompasses “caring about” – paying attention in such a blogpullquoteCaregivingAcrossLifeSpanway that one sees and recognizes the need for care – and “caring for” – responding to other’s needs by taking responsibility for initiating caring activities (Fisher & Tronto, 1990).

I think of my 88-year-old mother, living independently, even though she is vision-impaired and cannot drive. Her children, who do not live nearby, call her regularly, provide financial support and make sure her bills are paid, and take responsibility for ensuring that she receives the care she needs. When they do visit, she has a list of chores ready for them. Her friends provide rides to church and occasional lunches out. Her neighbor calls her daily, takes her food shopping and to doctors’ appointments. Another neighbor brings her books on tape, and helps her figure out the technology to listen to the audiobooks. But my mother is not just a receiver of care. She calls friends who need to talk, makes sure that someone is checking on others living alone, provides advice and labor for activities at church, as well as advice to her children, neighbors and friends. In her younger days, she was the one providing transportation to others, visiting people in the hospital or at home, or providing housing and financial support for her adult children.

These networks of care are often invisible, but they are essential to our communities. As our population ages, and those who provide care are increasingly employed outside of the home, caregiving demands are potentially in direct conflict with employment responsibilities. This reality demands recognition of caregivers not just this month, but year-round, by employers who can provide workplace flexibility – to accompany someone to doctors’ visits, provide transportation, or help with food shopping – and paid family and medical leave for intensive caregiving when needed.

Nancy Marshall, Ed.D., is an Associate Director and Senior Research Scientist at the Wellesley Centers for Women at Wellesley College. She leads the Work, Families & Children team at the Centers. For more than 20 years, researchers on the Work, Families and Children team have studied the lives of children and adults, and the workplaces, early care and education programs and families in which they live, work and grow. The Team applies an ecological systems model to the study of the lives of children and adults. From this perspective, individual lives are best understood in the context of social institutions, such as families, the workplace, and early care and education settings.

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