Preventing Depression in Children and Adolescence
Low mood, unhappiness, tearfulness and irritability are common features of teen depression, particularly when not related to anything specific. Extreme reactions are also a sign. For example, if someone dies it is common for everyone to feel upset, but if the grief seems more extreme or lasts much longer it could indicate depression.
Teen depression is important as it can indicate the start of further and deeper symptoms. The fact that depression is both persistent and long-lasting has encouraged greater focus on the provision of effective interventions at a young age. The initial onset of depression is typically around adolescence or early adulthood (16-20).
Various preventative approaches have been used. These have been categorized as Selective, Indicative or Universal prevention measures. Selective prevention refers to measures used in people who are vulnerable or have high risk of depression. An example would be the children of a depressed mother. Indicative prevention targets people who have already showed some signs of depression, perhaps in a fairly minor way. Universal prevention makes none of the previous assumptions. Here, a group of people in a particular area, group, class or age range are targeted. The disadvantage of the universal approach is that whilst it embraces everyone in a particular category, help is being offered to many people who would generally be considered as low risk for depression.
Some studies have found selective and indicative prevention to be more effective, although relatively few studies have followed up volunteers beyond 6 months. There is also a question of what really constitutes a prevention effect? To this end only a handful of studies claim that intervention has truly prevented depression. That is, where a control group showed an increase in depressive symptoms compared with a group in which some form of active intervention was shown to decrease, or at least prevent increase, in depressive symptoms.
One interesting example is The Penn Resiliency Program (PRP) which uses a school-based program that teaches adaptive coping skills to children at high risk of depression. Over 2,000 children have been studied in at least 13 different controlled studies. What emerges is an indication that PRP seems to be long-lasting and effective when compared with no-treatment control groups. However, in one study of rural schoolchildren in Australia, no benefits of using PRP were reported (Roberts et al, 2003).
According to the World Health Organization, depression affects 121 million people worldwide. It is amongst the leading causes of disability and by 2020 is estimated to become the second leading contributor to the global burden of disease. It stands to reason that anything that reduces the burden on individuals and society has merit. If programs such as PRP can demonstrate an ability to prevent depression, then such programs should surely be rolled out more extensively and controlled evaluations undertaken.