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.

depressionpreventionquoteApproaches & 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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"C" Is for Calm--Four Ways to Click

blog1.5“C” is for Calm—Four Ways to Click

Twenty-five years ago, when I was studying the human nervous system in medical school, I learned that the body has an automatic system running in the back ground 24/7—the autonomic nervous system—like the system that runs in the back ground of your computer updating time and date without needing to be asked. I was taught that the autonomic nervous system had two branches with opposite functions. The sympathetic nervous system (SNS) keeps you awake, alert, and engaged in life when it is running at a steady level, while the parasympathetic nervous system (PNS) helps you relax and rejuvenate yourself after a period of activity.

In popular science the SNS and the PNS are associated with their most dramatic functions—the fight, flight, or freeze responses that are activated when a person is threatened. If a bear charges you on a hike or your boss yells at you at work, bam, your SNS fires causing energy and blood flow to be diverted to your large muscles, heart, and lungs. You automatically assess the situation and either gear up for a fight or run like hell away from the threat. On the other hand, if you come across a mother bear with her cubs and she is standing over you ready to pounce and there is nowhere to run or your spouse comes home drunk and mean again and has a history of attacking you, your parasympathetic nervous system might activate causing you to freeze and even fall on the spot as your heart and respiratory rate decrease dramatically and your body’s pain blogpullquoteFourWaystoClickkillers flood your system buffering the pain. Neither of these reactions are under your conscious control. You are automatically protected.

What happens, though, when what you are facing is a kind, welcoming face or your favorite pet? Do you need to then rely on conscious functioning, do you need to think about it before you act and engage? According to Stephen Porges, the answer is “non.” He has discovered a third branch of the autonomic nervous system—one he calls the smart vagus nerve—that innervates the muscles in the face, throat, vocal chords, even the tiny muscles in your inner ear. The smart vagus balances the SNS and PNS and gives us automatic responses to safety. Imagine meeting your best friend—chances are your mouth breaks into a smile, your eyebrows raise, and you tune in and listen a little more attentively. You share stories and maybe even eat a meal together. All of these activities stimulate the smart vagus nerve which travels to the heart and lungs and tells the SNS and PNS they are not needed. You feel calmer.

The capacity to feel calm in a healthy relationship is as natural and automatic as the ability to feel terrified in Friday the 13th. It is how we are wired. A culture that teaches “self-regulation” and finding comfort by standing on your own two feet over stimulates your SNS making it harder to recognize a healthy connection. In Four Ways to Click: Rewire your Brain for Stronger, More Rewarding Relationships you can evaluate your neural pathways for connection and strategize ways to rebalance your autonomic nervous system to help you feel responsive and less reactive in your healthiest relationships.

Amy Banks, M.D., has devoted her career to understanding the neurobiology of relationships. She was an instructor of psychiatry at Harvard Medical School and is the Director of Advanced Training at the Jean Baker Miller Training Institute (JBMTI) at the Wellesley Centers for Women at Wellesley College. She is the author with Leigh Ann Hirschman of the forthcoming book, Four Ways to Click: Rewire your Brain for Stronger, More Rewarding Relationships (Penguin Random House).

 

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Suicide Prevention: The Depression Link

depressedteenSuicide Prevention: The Depression Link

This is a repost from an article originally published on this blog September 6, 2013.

National Suicide Prevention Week (September 8-14) is a time to both raise awareness of suicide as a national public health issue, and to think critically about how suicide can be prevented. In the United States, suicide is the second leading cause of death among adolescents (Hoyert & Xu, 2012), and, in 2011, nearly 16 percent of adolescents in the United States reported seriously considering suicide. When thinking about preventing adolescent suicide, it is important to consider factors that increase the risk of suicidal thoughts and behaviors, such as depression. Suicidal thinking is a symptom of depression, and over half of the adolescents who completed suicide had a mood disorder at the time (Bridge, Goldstein & Brent, 2006; Nock et al., 2013). Fortunately, a number of researchers have developed empirically-supported interventions to prevent the onset of depression in teens, and prevention efforts that target adolescents at risk for depression may ultimately prove helpful in preventing suicidal behaviors as well. During this national week of suicide prevention awareness, it is important to recognize the link between depressive illness and suicide in youth, and the promising role of depression prevention in potentially preventing suicidal behavior.

Most of us bring our children to see their doctors annually, because prevention-focused well-child care is a cornerstone of pediatric practice. Unfortunately, prevention is generally not part of the equation when it comes to youth mental health. With limited health care dollars and limited mental health resources available, clinicians and policymakers tend to focus on alleviating mental health concerns once they arise. Yet research suggests that many young people do NOT get treatment for mental health concerns once they arise, and mental health concerns, such as depression, are associated not only with suicide risk, but also with long-term adverse impacts on educational attainment, relationship functioning, risk of substance abuse, and future depressive episodes, even among those who receive treatment. Moreover, of those teens who DO receive treatment for depression, only about half fully recover and, among those who do recover, relapse is quite common.

blogpullquoteDepressionLinkTreating youth depression once it emerges may be much more distressing, and much less effective, than identifying early symptoms of illness and treating them before they develop into a full-blown disorder. Prevention approaches have the potential to reach a large number of adolescents, and may be more acceptable than treatment because services can be rendered in non-clinical settings (e.g., schools, primary care settings), and do not require adolescents to identify themselves as ill.

So how can adolescent depression be prevented? The core of many depression prevention programs is resilience. Not all adolescents with risk factors for depression develop the disorder; the ones who do not develop depression are resilient, which means they have the emotional skills and/or the social supports to “bounce back” from adversity. Many programs to prevent adolescent depression are designed to teach coping and emotional regulation skills, and/or to strengthen supportive relationships, in order to provide youth at elevated risk with the tools they need to be resilient.

Research on the prevention of youth depression is quite encouraging! For example, in our longitudinal, multi-site study of adolescents at risk for depression, we found that teens who participated in a group cognitive-behavioral prevention program were less likely to experience a depressive disorder at nine- (Garber et al., 2009) and 32- (Beardslee et al., in press) months follow-up, relative to at-risk teens who were assigned to a treatment-as-usual control group. Likewise, our colleagues working on the Penn Resiliency Project have found that children and adolescents who participate in their school-based cognitive-behavioral program are less likely to experience depressive symptoms than are children and adolescents assigned to control conditions. Similarly, in a study of Interpersonal Psychotherapy approaches to preventing youth depression, Young and colleagues found that teens who participated in a skills-based intervention targeting interpersonal role disputes, role transitions and interpersonal deficits reported fewer depressive symptoms at six-months follow-up than teens who were assigned to a school counseling control group.

Here at WCW, we are currently studying the efficacy of a primary-care, Internet-based depression-prevention program for adolescents who are at risk for the development of depression, based on a past history of depression and/or current symptoms of depressive disorder. While many of these youth depression prevention programs are still being evaluated in randomized controlled research trials, early results suggest that prevention programs may work. It seems we can indeed provide teens with strategies that they can use over time, as they encounter stress and challenging life events, so that they are able to stay healthy and avoid the onset of significant mental health concerns.

What are the risks for depression in adolescents? When should you be worried about your teen? When we talk about risks for depression, we often think in terms of specific factors (i.e., factors identified through empirical research to be associated specifically with increased risk for youth depression) and nonspecific factors (i.e., factors that are associated with increased risk for a range of disorders, including depression). Specific risk factors for adolescent depression include having low self-esteem, being female, developing a negative body image, low social support, a negative cognitive style, and ineffective coping. The strongest specific risk factor for the development of depression, above and beyond these other factors, is having a parent with depressive illness. In fact, offspring of depressed parents are at about a two- to four-fold increased risk of developing depressive disorders, relative to children of parents without depression. Nonspecific risk factors that also increase risk of youth depression include poverty, exposure to violence, social isolation, child maltreatment, and family breakup.

Although the presence of these risk factors is associated with an increased risk for youth depression, as noted above, many at-risk children are resilient and never develop a depressive disorder. Having supportive adults present, strong family relationships, strong peer relationships, coping skills, and skills in emotion regulation all can contribute to resiliency. Even depressed parents can promote resilience in their teens by encouraging teens to engage in outside activities, maintain supportive relationships, and recognize themselves as separate from issues and concerns that are affecting other family members.

How can you recognize signs and symptoms of depression in your child, and how can you help? Depressed teens are often sad or irritable, and may exhibit a range of additional symptoms, such as withdrawal from friends and usual activities, sleep difficulties (i.e., difficulty sleeping or sleeping all the time), somatic complaints (i.e., headaches, stomach aches), poor school performance, self-critical talk, changes in eating patterns, difficulty sitting still, and may start writing or thinking about death. If you are concerned about your teen, then express your concern openly and honestly. Tell your child that you care, and that you want to help. Don’t be afraid to ask your child if he is experiencing suicidal thoughts – asking will NOT make him contemplate suicide or take his own life. Reach out to your child’s pediatrician for assistance and referrals. Let your child know that treatments are available, and that you are going to work together to get your child the help she needs.

National Suicide Prevention Week is an opportune time to consider the many ways that suicidal thoughts and actions can be combated, including preventing the onset of depression in adolescents, and getting teens help if they are depressed already.

Tracy Gladstone, Ph.D. is a Senior Research Scientist and Director of the Robert S. and Grace W. Stone Primary Prevention Initiatives at the Wellesley Centers for Women at Wellesley College. The Stone Primary Prevention Initiatives focus on research and evaluation designed to prevent the onset of mental health concerns in children and adolescents.

References:

Beardslee, W.R., Brent, D.A., Weersing, V.R., Clarke, G.N., Porta, G., Hollon, S.D., Gladstone, T.R.G., Gallop, R., Lynch, F.L., Iyengar, S., DeBar, L., & Garber, J. (in press). Prevention of depression in at-risk adolescents: Longer-term effects. Journal of the American Medical Association Psychiatry.

Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3‐4), 372-394.

Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance- United States 2011. Morbidity and Mortality Weekly Report, 61(4), 1-168.

Garber, J., Clarke, G.N., Weersing, V.R., Beardslee, W.R., Brent, D.A., Gladstone, T.R.G., DeBar, L.L., Lynch, F.L., D’Angelo, E., Hollon, S.D., Shamseddeen, W., & Iyengar, S. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. Journal of the American Medical Association, 301, 2215-2224.

Hoyert, D. L., & Xu, J. (2012). Deaths: preliminary data for 2011. National Vital Statistics Report, 61(6), 1-65.

Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA: The Journal of the American Medical Association Psychiatry, 70(3), 300-310.  

 

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Teen Dating Violence Awareness & Prevention

TDVblogTeen Dating Violence Awareness & Prevention

Last year, when President Barack Obama proclaimed February Teen Dating Violence Awareness and Prevention Month, he noted that an estimated one in ten teens will be hurt intentionally by someone they are dating and “while this type of abuse cuts across lines of age and gender, young women are disproportionately affected by both dating violence and sexual assault.” His Administration has committed many resources to addressing the problem. The Violence Against Women Act, reauthorized in 2013 by the U.S. Congress, funds enforcement of gender-based violence laws, provides victim services, and created new federal crimes involving interstate violence against women. The 1 is 2 Many campaign launched by Vice President Joe Biden aims to reduce sexual violence against those who experience the assaults at the highest rates--young women ages 16-24. And recently, a report from the White House Council on Women and Girls and the Office of the Vice President analyzed rape and sexual assault data, including the staggering number of sexual assaults on campuses, and issued a renewed call to action. Teen dating violence between adolescents who are “dating,” “going together,” “hanging out,” or however the adolescents label it, is a serious problem—from public health, education, and legal perspectives—with injuries, poorer mental/physical health, more ‘high-risk’/deviant behavior, and increased school avoidance being experienced and reported.

One concern I have is that federal policies, as evidenced by Congressional funding priorities, may not consistently address systemic issues that contribute to teen dating violence. For example, the federal government has invested generously in “healthy relationship” programs and initiatives that promote marriage as a cure-all for poor women and girls but have no requirement for evaluation, while also funding research that takes a gender-neutral approach to examining the problem.1 Data shows that males and females do not engage in mutual, reciprocal, and equivalent violence—so why wouldn’t there be a need to examine the gendered components of any intimate partner violence?

My research for over 30 years has focused on peer sexual harassment in schools, a form of gender violence, which I consider the training grounds for domestic violence. In fact, sexual harassment may also serve ablogpullquoteTeenDatingViolences a precursor to teen dating violence. Schools—where most young people meet, hang out, and develop patterns of social interactions—may be training grounds for domestic violence because behaviors conducted in public may provide license to proceed in private.

Since 2005, my more recent research with Bruce Taylor, of NORC, funded by the National Institute of Justice of the U.S. Department of Justice, has been in urban middle schools, with the youngest sample of 6th and 7th graders ever studied in a scientific, randomly controlled research project on teen dating violence. Our interventions, both school-wide and in the classroom, emphasize articulating and claiming one’s boundaries and personal space; never do we discuss “healthy relationships”—a perspective that I find subjective and judgmental yet seems to operate as the default approach to preventing teen dating violence. Happily, our data shows that our interventions are effective and we are currently expanding them to 8th graders and testing for longitudinal effects.

This year, as we raise awareness about teen dating violence and offer scientific approaches to prevention, we must continue to invest in evidence-based and evaluated programs with rigorous research that inform truly effective public policies.

Nan Stein, Ed.D. is a Senior Research Scientist at the Wellesley Centers for Women at Wellesley College where she directs several national research projects on sexual harassment, and gender violence. Shifting Boundaries, her research project with Bruce Taylor, is an ongoing, multi-level study funded by the National Institute of Justice to evaluate the effectiveness of grade-differentiated dating violence and sexual harassment prevention curricula.

1.)Healthy_Marriage_and_Responsible_Fatherhood_Grantees.pdf. January 23, 2013. U.S. Department of Health and Human Services, Office of Family Assistance, an Office of the Administration for Children and Families. Retrieved February 3, 2014, from http://www.acf.hhs.gov/programs/ofa/resource/healthy-marriage-grantees

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Dispelling “violence against women and children” myths in human trafficking

handsreachingoutDispelling “violence against women and children” myths in human trafficking

New York Times columnist and anti-trafficking advocate Nicholas Kristof recently opened January’s Human Trafficking Awareness month with a Google+ Hangout entitled, “What does 2014 hold for the fight against modern-day slavery?” My answer is the need to dispel myths about sexual violence against women and children within the anti-trafficking movement so that we can all work effectively and sustainably toward ending exploitation. I hold little hope for truly ending human trafficking unless we understand the systemic nature of violence against women and children.

I strongly believe human trafficking and sexual slavery are a manifestation and continuation of interpersonal and systemic violence. For instance, the top two risk factors for sexual exploitation are a history of child sexual abuse and poverty. Yet, International Justice Mission founder and President Gary Haugen argued that an environment of impunity, not violence, is to blame:

[S]lavery is first and foremost a violent crime…and if you were to look at any other crime that would take place in our community that’s violent – let’s say rape – we would of course want to change those attitudes. We would of course want to make sure that the streets were well lit. We would want to make sure that women knew how to walk safely and avoid dangerous areas. But you would start, absolutely, that people who committed sexual assaults actually went to jail for it. You are more likely to get struck by lightning than go to jail for committing that violent crime.

blogpullquoteHumanTraffickingUtilizing such “rape myths” like the need for well-lit streets and women’s ability to walk safely perfectly illustrates Haugen’s limited understanding of sexual violence: the majority of sexual assault survivors know their assailants and most rapes occur at home.

“Law enforcement is absolutely a critical component,” said Rachel Lloyd, trafficking survivor and founder of Girls Educational & Mentoring Services (GEMS), “but it isn’t the only component…and it won’t be the thing that long-term changes the issue.”

We will not end human trafficking and slavery unless we understand the very nature of violence and how it permeates our culture. Among industrialized nations, the U.S. has the worst record of death from violence and child death from abuse and neglect. We have the second-highest incidence of child poverty. Estimates across various surveys suggest one in every four girls and one in four boys in this country are sexually abused, 90 percent of them by either a family member or someone they know and trust. We have created the “perfect storm” for trafficking.

We also must acknowledge how violence is perpetuated. We often overlook that most of the few exploiters who have been studied report a history of child sexual abuse. Men who buy sex also report histories of sexual abuse and describe themselves as “sex addicts.” Abused children can repeat the violation throughout their lives, often within gendered norms, according to trauma expert Bssel van der Kolk, M.D. Abused boys can re-victimize, thus fulfilling the masculine imperative of being dominant and in control, while abused girls can go on to form relational attachments with victimizing boys or men.

If we are to stop human trafficking we must prioritize healing the wounds of abused boys through comprehensive, trauma-informed care over jailing angry, isolated men who become traffickers. We must focus on ensuring abused girls have economic opportunity based on intellect rather than equating their worth with their bodies. I am not arguing we sympathize with offenders because they have been abused. However, I am saying that jailing exploiters and solicitors will not stop trafficking: cycles of child sexual abuse and poverty are the fuel that keeps the engine running. We need to empty the gas line.

Kate Price, M.A., project associate at the Jean Baker Miller Training Institute (JBMTI) at the Wellesley Centers for Women (WCW), is also a social scientist in the cultural construction of childhood. As a survivor of the commercial sexual exploitation of children (CSEC), Price authored a chapter in the textbook, Global Perspectives on Prostitution and Sex Trafficking: Europe, Latin America, North America, and Global (Lexington Books) and a JBMTI working paper, Longing to Belong: Relational Risks and Resilience of Commercially Sexually Exploited Children, examining CSEC through a Relational-Cultural Theory lens.

 

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Bullying Prevention Starts with Adults

bullyingblogBullying Prevention Starts with Adults

Policies, procedures, and protocols for bullying prevention and intervention are now a requirement for most schools across the country. Yet policies that are developed and implemented in isolation are insufficient to address the challenges of bullying behavior. It is also critical to create a school culture and climate of communication, collaboration, and trust where children and adults feel safe and supported to speak up about bullying.

Building a safe environment is a key element to preventing and addressing bullying in schools. New research from ChildTrends found that bullying prevention programs that use a whole-school approach to foster a safe and caring school climate – by training all adults to model and reinforce positive behavior and anti-bullying messages – were generally found to be effective.

The Open Circle Curriculum, an evidence-based social and emotional learning program, focuses on both proactively developing children’s social and emotional skills (like calming down, speaking up, and problem solving) and building a school community where children and adults feel safe, cared for and engaged in learning. We encourage a unique whole-school approach that includes training all adults in the school community – teachers, administrators, counselors, support staff, and families – to learn, model, and reinforce pro-social skills throughout the school day and at home.

blogpullquoteBullyingPreventionStudents are always watching. They are watching adults at their best and they are particularly watching adults when they are in conflict. While emphasis and expectations of behavior is often placed on the students, adults in schools should remember to take a step back and look at themselves, their relationships, and the behaviors students see them model. It’s imperative that adult communities in schools reflect the same expectations of behavior that we have for students. Otherwise a climate may develop where students and adults may not feel safe to identify, report, and effectively address bullying behavior.

When a consistent culture and climate is created both on the student and the adult level, bullying prevention efforts will be strengthened along with creating the best possible environment for learning.

Nancy MacKay, B.A., and Nova Biro, M.B.A. are Co-directors of Open Circle, a leading provider of evidence-based curriculum and professional development for social and emotional learning (SEL) in Kindergarten through Grade 5. Open Circle, a program of the Wellesley Centers for Women at Wellesley College, is at the end of its 25th anniversary year.

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Thanks for the great post ....Bullying Prevention Starts with Adults! I do agree with 3 P's which is Policies, procedures, and pro... Read More
Thursday, 28 November 2013 12:50
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Suicide Prevention: The Depression Link

depressedteenSuicide Prevention: The Depression Link

National Suicide Prevention Week (September 8-14) is a time to both raise awareness of suicide as a national public health issue, and to think critically about how suicide can be prevented. In the United States, suicide is the second leading cause of death among adolescents (Hoyert & Xu, 2012), and, in 2011, nearly 16 percent of adolescents in the United States reported seriously considering suicide. When thinking about preventing adolescent suicide, it is important to consider factors that increase the risk of suicidal thoughts and behaviors, such as depression. Suicidal thinking is a symptom of depression, and over half of the adolescents who completed suicide had a mood disorder at the time (Bridge, Goldstein & Brent, 2006; Nock et al., 2013). Fortunately, a number of researchers have developed empirically-supported interventions to prevent the onset of depression in teens, and prevention efforts that target adolescents at risk for depression may ultimately prove helpful in preventing suicidal behaviors as well. During this national week of suicide prevention awareness, it is important to recognize the link between depressive illness and suicide in youth, and the promising role of depression prevention in potentially preventing suicidal behavior.

Most of us bring our children to see their doctors annually, because prevention-focused well-child care is a cornerstone of pediatric practice. Unfortunately, prevention is generally not part of the equation when it comes to youth mental health. With limited health care dollars and limited mental health resources available, clinicians and policymakers tend to focus on alleviating mental health concerns once they arise. Yet research suggests that many young people do NOT get treatment for mental health concerns once they arise, and mental health concerns, such as depression, are associated not only with suicide risk, but also with long-term adverse impacts on educational attainment, relationship functioning, risk of substance abuse, and future depressive episodes, even among those who receive treatment. Moreover, of those teens who DO receive treatment for depression, only about half fully recover and, among those who do recover, relapse is quite common.

blogpullquoteDepressionLinkTreating youth depression once it emerges may be much more distressing, and much less effective, than identifying early symptoms of illness and treating them before they develop into a full-blown disorder. Prevention approaches have the potential to reach a large number of adolescents, and may be more acceptable than treatment because services can be rendered in non-clinical settings (e.g., schools, primary care settings), and do not require adolescents to identify themselves as ill.

So how can adolescent depression be prevented? The core of many depression prevention programs is resilience. Not all adolescents with risk factors for depression develop the disorder; the ones who do not develop depression are resilient, which means they have the emotional skills and/or the social supports to “bounce back” from adversity. Many programs to prevent adolescent depression are designed to teach coping and emotional regulation skills, and/or to strengthen supportive relationships, in order to provide youth at elevated risk with the tools they need to be resilient.

Research on the prevention of youth depression is quite encouraging! For example, in our longitudinal, multi-site study of adolescents at risk for depression, we found that teens who participated in a group cognitive-behavioral prevention program were less likely to experience a depressive disorder at nine- (Garber et al., 2009) and 32- (Beardslee et al., in press) months follow-up, relative to at-risk teens who were assigned to a treatment-as-usual control group. Likewise, our colleagues working on the Penn Resiliency Project have found that children and adolescents who participate in their school-based cognitive-behavioral program are less likely to experience depressive symptoms than are children and adolescents assigned to control conditions. Similarly, in a study of Interpersonal Psychotherapy approaches to preventing youth depression, Young and colleagues found that teens who participated in a skills-based intervention targeting interpersonal role disputes, role transitions and interpersonal deficits reported fewer depressive symptoms at six-months follow-up than teens who were assigned to a school counseling control group.

Here at WCW, we are currently studying the efficacy of a primary-care, Internet-based depression-prevention program for adolescents who are at risk for the development of depression, based on a past history of depression and/or current symptoms of depressive disorder. While many of these youth depression prevention programs are still being evaluated in randomized controlled research trials, early results suggest that prevention programs may work. It seems we can indeed provide teens with strategies that they can use over time, as they encounter stress and challenging life events, so that they are able to stay healthy and avoid the onset of significant mental health concerns.

What are the risks for depression in adolescents? When should you be worried about your teen? When we talk about risks for depression, we often think in terms of specific factors (i.e., factors identified through empirical research to be associated specifically with increased risk for youth depression) and nonspecific factors (i.e., factors that are associated with increased risk for a range of disorders, including depression). Specific risk factors for adolescent depression include having low self-esteem, being female, developing a negative body image, low social support, a negative cognitive style, and ineffective coping. The strongest specific risk factor for the development of depression, above and beyond these other factors, is having a parent with depressive illness. In fact, offspring of depressed parents are at about a two- to four-fold increased risk of developing depressive disorders, relative to children of parents without depression. Nonspecific risk factors that also increase risk of youth depression include poverty, exposure to violence, social isolation, child maltreatment, and family breakup.

Although the presence of these risk factors is associated with an increased risk for youth depression, as noted above, many at-risk children are resilient and never develop a depressive disorder. Having supportive adults present, strong family relationships, strong peer relationships, coping skills, and skills in emotion regulation all can contribute to resiliency. Even depressed parents can promote resilience in their teens by encouraging teens to engage in outside activities, maintain supportive relationships, and recognize themselves as separate from issues and concerns that are affecting other family members.

How can you recognize signs and symptoms of depression in your child, and how can you help? Depressed teens are often sad or irritable, and may exhibit a range of additional symptoms, such as withdrawal from friends and usual activities, sleep difficulties (i.e., difficulty sleeping or sleeping all the time), somatic complaints (i.e., headaches, stomach aches), poor school performance, self-critical talk, changes in eating patterns, difficulty sitting still, and may start writing or thinking about death. If you are concerned about your teen, then express your concern openly and honestly. Tell your child that you care, and that you want to help. Don’t be afraid to ask your child if he is experiencing suicidal thoughts – asking will NOT make him contemplate suicide or take his own life. Reach out to your child’s pediatrician for assistance and referrals. Let your child know that treatments are available, and that you are going to work together to get your child the help she needs.

National Suicide Prevention Week is an opportune time to consider the many ways that suicidal thoughts and actions can be combated, including preventing the onset of depression in adolescents, and getting teens help if they are depressed already.

Tracy Gladstone, Ph.D. is a Senior Research Scientist and Director of the Robert S. and Grace W. Stone Primary Prevention Initiatives at the Wellesley Centers for Women at Wellesley College. The Stone Primary Prevention Initiatives focus on research and evaluation designed to prevent the onset of mental health concerns in children and adolescents.

References:

Beardslee, W.R., Brent, D.A., Weersing, V.R., Clarke, G.N., Porta, G., Hollon, S.D., Gladstone, T.R.G., Gallop, R., Lynch, F.L., Iyengar, S., DeBar, L., & Garber, J. (in press). Prevention of depression in at-risk adolescents: Longer-term effects. Journal of the American Medical Association Psychiatry.

Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3‐4), 372-394.

Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance- United States 2011. Morbidity and Mortality Weekly Report, 61(4), 1-168.

Garber, J., Clarke, G.N., Weersing, V.R., Beardslee, W.R., Brent, D.A., Gladstone, T.R.G., DeBar, L.L., Lynch, F.L., D’Angelo, E., Hollon, S.D., Shamseddeen, W., & Iyengar, S. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. Journal of the American Medical Association, 301, 2215-2224.

Hoyert, D. L., & Xu, J. (2012). Deaths: preliminary data for 2011. National Vital Statistics Report, 61(6), 1-65.

Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA: The Journal of the American Medical Association Psychiatry, 70(3), 300-310.  

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The Birds, the Bees, and the Stomach Butterflies

teenboydadThe Birds, the Bees, and the Stomach Butterflies

March is Talk with Your Teen about Sex Month. Why talk about sex with our kids?

In her recent talk at Wellesley College, Cecile Richards, President of Planned Parenthood Federation of America, reminded us that parents are the most important source of sex education for their children. National studies agree. When parents talk about sex with their kids, it can help them postpone having sex and make it more likely teens will use protection when they do have sex. Our research at Wellesley Centers for Women found that this is particularly important in delaying sex for boys.

Here are some take-home messages from our own and others’ research on how parents and teens talk about sex and relationships. The quotes are from our interviews with parents of middle school students.

“I’m willing to go there with her (talk about sex), because I know that I had trouble speaking with my mom about it when I was younger. So I know I need to be there and play that role. And if I don’t talk to her about it, she’ll find out on her own, and that’s not the way that I want that to happen.”

Why is it so hard for us to talk to our kids about sex?

“It’s hard for me to say, ‘Well this is how your penis works.’ You know? Okay, I’ll try to figure it out and I don’t want to sound stupid in front of the kid.”

- Parents often feel embarrassed and may not know how to start conversations about sex
- Parents don’t know where to get accurate information to share with their kids
- Kids are embarrassed too, but it’s important for them to hear from you
- Once you start (even with a small conversation), it will get easier

How do we do it? Tips on talking with teens about sex

“You’re basically informing them and, you know, letting them know that you’re there. And then you kind of just have to take it as it comes, because you never know what’s going to happen.”

- Figure out what’s important to you and share it with your kids
- Listen to what your kids have to say (or what they may have trouble saying)
- Keep the door open – sometimes the first conversation is just an icebreaker
- Give your kids medically accurate information about sex
- Talk with your kids before they have sex

Who can help?

“He still talks about things that he learned in (sex education) class. He still makes a reference to it when we’re talking about things. One of the funny things that doesn’t happen anymore is any reference to sex, we don’t shy away from it if it does come up. He’s just more accepting that it’s a part of life at this point.”

- Just because you didn’t talk about sex growing up with your own family, doesn’t mean you can’t talk with your own kids about sex
- Even when you’re embarrassed, you can still have good conversations with your teens about sex
- You are not alone

  • o Think about friends and family you trust who can be part of the conversation (e.g., aunts, uncles, older siblings, godparents)

o Find out if your teen has a sex education class at school and ask your teen about it
o Here are some resources for information and support to talk to your teens about sex:

10 tips for parents (The National Campaign to Prevent Teen and Unplanned Pregnancy)

Communicating with Youth: Themes for Parents to Remember (Planned Parenthood League of Massachusetts)

Help your teen make healthy choices about sex (Centers for Disease Control and Prevention)

Jennifer Grossman, Ph.D. is a research scientist at the Wellesley Centers for Women. She co-directs an evaluation of a middle school sex education curriculum and leads a project investigating what works and what gets in the way of family communication about sexuality among diverse families.

 

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