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Acting on the science to prevent depression
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Louis Pasteur communicated to doctors to wash their hands before surgery. After Pasteur, lifetimes doubled as doctors and communities dropped old habits to actively practice prevention of infection.
Today, science communicates to actively practice prevention of depression. Rather than waiting for symptoms to develop, psychoeducation activities can prevent a significant number of cases of depression (JAMA. 2009;301(21):2215-2224). For those who do still develop symptoms - the majority of which emerge during adolescence - psychoeducation increases awareness, resilience, and coping skills with the purpose of promoting early recognition and intervention in order to prevent serious crises from occurring. Treatment is effective for the majority of adolescents who develop symptoms of depression (JAMA. 2004;292:807-820).
As with hand washing, it is practical for all ages to learn and teach others the habits of awareness and resilience. We know that the key to such an understanding is universal preventive intervention. For example, all students in a grade can learn about depression awareness and prevention. This is provided at leading schools such as grade 7-12 Roxbury Latin (West Roxbury, MA), which consistently ranks among the best secondary schools in the country. |
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Parents and youth can partner with their pediatrician by requesting psychoeducation during each well child visit. Ask for an assessment such as the Pediatric Symptom Checklist (PSC)to flag common symptoms of depression such as recurring headache or stomachache and irritability to discuss with the pediatrician. The importance of prevention and early treatment is clear because depression is common, it appears in youth, and early action is most effective:
- half of us who will ever experience depression show symptoms by age 14 (Archives of General Psychiatry, Kessler, R., June, 2005)
- untreated depression can lead to a more severe, more difficult to treat illness (ibid)
- Treatment For Adolescents with Depression Study (TADS) confirms depression is treatable for majority using talk therapy (Cognitive Behavioral Therapy) and anti-depressants (Archives of General Psychiatry, Oct 2007)
- psychoeducation can prevent depression before symptoms appear (Prevention of Depression in at-risk adolescents, JAMA, Jun 2009)
- depression is a leading cause of disability (NIH Pub. No. 03-5121)
- most individuals who complete suicide have depression (NIH Pub.No. 06-4594, also National Strategy for Suicide Prevention)
- 80% of adolescent suicides are completed by boys (Report on Mental Health, Surgeon General)
It is easier to keep healthy kids healthy than to help kids after symptoms appear. For suggestions on achieving this, view the information within the Parent Resources page of this website. One example is the tip sheet, titled Challenging Negative Self -Talk, with six questions to help practice realistic thinking. Suggested topics to discuss with the pediatrician are addressed in articles and tip sheets.Depression prevention is psychoeducation and practicing skills of awareness, problem solving and coping. Early recognition and treatment of depression and other psychiatric illnesses appear to be the best way to prevent suicide, according to the American Foundation for Suicide Prevention. The graphic above illustrates that 'Universal' prevention helps every youth, rather than attempting to identify whom may have diagnosable symptoms at the moment. 'Indicated' prevention only targets high risk kids with psychoeducation. When we fail to prevent symptoms, 'Selective' or 'Clinical' intervention is required. We should not wait for these latter phases before acting. For example, the Roxbury Latin School in West Roxbury, MA teaches depression and its prevention as a routine element of its Personal Development course that all its students take; this is universal preventive intervention.
School Leaders can help prevent depression using resources from the School Curricula page available from leading research and treatment providers:
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| Children's Hospital Boston |
Johns Hopkins Hospital |
McLean Hospital |
Each resource may be used by community health officials and school leaders to:
- Implement universal preventive intervention through psychoeducation and communicate clear referral procedures.
- Initiate a wellness council with public and independent school leadership to share their curriculum content on building resilience, symptom recognition and referral procedures with parents and leaders from other community programs, including youth clergy.
- Support teen leadership and open communication with adults.
- Evaluate outcomes.
Clergy and youth leaders can help prevent depression by addressing basic mental health topics, help seeking and skill building. Examples may be viewed on the Peer Leader resources page.
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