Youth Depression in School Settings: Assessment, Interventions, and Prevention

Prevalence of depression in junior and senior adolescents

Background

Depression affects the development of adolescents and makes it difficult for them to adapt to future life. The purpose of this study was to elucidate the population characteristics of adolescent depression.

Methods

This study measured depression based on the Patient Health Questionnaire-9 items and sociodemographic questionnaire. A total of 8,235 valid questionnaires were collected from six schools in Haikou and Qionghai, Hainan Province, covering the ages of 13 to 18. The questionnaires included high schools with multiple levels, including general high schools, key high schools, and vocational high schools. Latent category analysis (LCA) was used to identify potential categories of depressive symptoms among adolescents. Latent Class Analysis (LCA) was used for determining depressive symptom latent categories and their proportional distribution among adolescents.

Results

LCA analysis divided the data into 3 categories, namely no depression, low depression, and high depression groups. The percentage of the high depression group was 10.1%, and that of the low depression group was 48.4%. The Jorden index was greatest for a PHQ-9 score of 14.5. The 1st grade of junior middle school students entered the high and low depression groups 1.72 and 1.33 times more often than seniors. The number of the 1st grade of high school students included in the high and low depression groups was 1.55 and 1.42 times of the 3rd grade of high school students group. The detection rate of the high depression group of vocational school adolescents was 13.5%, which was significantly higher than that of key high schools (9.6%) and general high schools (9.0%).

Conclusion

This study found that 1st grade of junior middle school students and the 1st grade of high school students were more likely to fall into depressive conditions. Moreover, Adolescent girls require more attention than boys. Vocational school students need more psychological guidance.

Collaboration with Schools and School-Based Health Centers

Since the early 1900s when school-based health services were first introduced, models of school-based health have evolved toward comprehensive and integrated models that include mental health. New and innovative models of Comprehensive Mental Health Systems offer a range of prevention and intervention strategies that are delivered across collaborative systems of community and school-based mental health. Studies of school-based health services indicate positive outcomes in health, mental health, and education. Child and adolescent psychiatrists can work with schools by providing direct service, consultation, and technical assistance to increase access, improve health equity, and optimize mental health outcomes for all youth.

Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis

BACKGROUND

Depression among adolescents is rising globally and is the leading cause of illness and disability among adolescents. While antidepressants and psychotherapy are effective, only about 40% of depressed adolescents receive treatments due to lack of professionals and barriers such as cost and personal obstacles including stigma, lack of motivation, and negative perceptions of treatment. Use of alternative and complementary treatments for depression is growing. One such treatment is mindfulness meditation.

OBJECTIVE

We examined the effects of mindfulness interventions on depression among adolescents and explored the moderator effects of participants, methods, and intervention characteristics.

METHODS

We searched 17 databases from their inception to April 2019 to identify studies written in English. Search terms included depress* AND mindful* OR meditat* AND adolescen* OR student*; 29 studies met inclusion criteria. Two researchers independently coded data from all primary studies. Discrepancies were discussed with a third researcher to reach consensus. Using the random effects model, we computed the effect sizes (ESs) of mindfulness interventions on depression using standardized mean differences (Hedge's g) with 95% confidence intervals (CI). Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity.

RESULTS

Across 29 studies (N=3688), 1839 adolescents participated in mindfulness interventions; 1849 served as controls. Mean ages ranged from 10.2 to 19.5 years. Mindfulness groups showed reduced depression compared to control groups (g=.14, 95%CI[.01-.28], p<.042). Funded studies showed greater improvement in depression (g=.34, 95%CI[.09-.58], p<.008) compared to unfunded (g=.05, 95%CI[-.12-.22], p<.554). Interestingly, while only two research teams studied mindfulness-based cognitive therapy, they showed trends toward improvement (p=0.09) in depression (g=.76, 95%CI[.18-1.34], p<.010, s=2) compared to adapted mindfulness interventions (g=.13, 95%CI[-.04-.30], p<.140, s=16) or mindfulness-based stress reduction (g=.07, 95%CI[-.16-.29], p<.559, s=11). Mindfulness interventions with individual counseling tended (p=0.09) to improve depression (g=.46, 95%CI[.07-.85], p<.021, s=3) more than without (g=.10, 95%CI[-.04-.24], p<.168, s=26). Depression improved more when follow-up measures occurred further from the intervention (Slope=.002, τ²=.74, Q_between=4.10, p=.043, s=29). No quality indicators moderated the ES of mindfulness interventions on depression.

CONCLUSION

Mindfulness interventions are mildly effective interventions to reduce depressive symptoms among adolescents. Clinicians trained in mindfulness interventions might encourage mindfulness meditation as adjunctive/alternative treatment for adolescents with mild or moderate depressive symptoms as well as for at-risk adolescents to prevent depression. Funding, type of mindfulness interventions, individual counseling, and time to follow up were moderators of the effects of mindfulness interventions on depression in adolescents.