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Out in the Schools, Teaching Kids About Teenage Depression

Psychiatrists Elizabeth Kastelic, left, and Karen Swartz at Oakland Mills High
It's just 6:15 on a cold, gray morning in early March, but already Karen Swartz is headed south on I-95 from her home in north Baltimore. Destination: Oakland Mills High School, Columbia, Md. A psychiatrist, Swartz, is director of Hopkins' Affective Disorders Consultation Clinic and associate director for residency education in the Department of Psychiatry. On this day, though, she'll be out on the front lines, teaching a classroom full of 9th graders about a problem that is all too common among teenagers: depression.

Swartz will teach a series of four classes over a period of three days. She will lecture, leaddiscussions and show a 30-minute video about teenage depression. She will hand out written assignments for class and for homework in which students might have to describe, say, some of the symptoms of depression and mania. She will run sessions for teachers and parents. Through it all, she will deliver one, central, take-home message: Depression is a common and treatable medical illness.

For four years, Swartz, three other psychiatrists and two psychiatric nurses have been fanning out into private, parochial and public high schools throughout central Maryland, southern Pennsylvania and Washington, D.C., to teach students, teachers and parents about teenage depression and bipolar illness. In that time, they have reached no fewer than 3,500 students.

Their project, known as the Adolescent Depression Awareness Program, or ADAP, represents a collaboration between the Department of Psychiatry and a non-profit group called DRADA, for Depression and Related Affective Disorders Association. ADAP is funded through foundation grants and individual contributions, and eventually Swartz, who is principal investigator, plans to apply for federal funding. "We want to create a standard curriculum that could be adopted nationwide," she says.

The curriculum has already been systematically tested, assessed and fine-tuned. As one measure of its effectiveness, students are asked to answer "yes-no" questions before and after the program. Here's an example: Depression can be controlled through willpower. Last year, 57 percent of the students in five Howard County public high schools gave the right answer ("no") before the program. After the program, 72 percent said "no."

"When students come out of this," says Swartz, "they are armed with good information." Swartz and colleague Elizabeth Kastelic, also a psychiatrist, say that although the students they have encountered are remarkably diverse, all have been consistently receptive, engaged and surprisingly savvy. "They already know a lot," says Kastelic. "They know about serotonin. I certainly didn't when I was in 9th grade. Today, though, they see cover stories in Newsweek and find lots of information about bipolar disorder in the media."

ADAP evolved informally in the mid-1980s not long after Ray DePaulo, now director of Psychiatry, and Wendy Resnick, a psychiatric nurse, established DRADA as a means of reaching out into the community with accurate, up-to-date information to support patients and families dealing with serious mood disorders. DRADA's director of education, Sallie Mink, also a psychiatric nurse, started making occasional presentations on teenage depression in area private schools.

The school program was developed into a full-fledged research project by Swartz. Meanwhile, the Alexander

Wilson Schweizer Fellowship had been established by friends of the Schweizers, a Baltimore family who had lost a son in 1998, to support junior faculty working in the area of mood disorders. In 2000, the Schweizer fellows began working with Swartz on the program. Kastelic is the current Schweizer fellow.

Increasingly, schools across the region see teenage depression as a serious problem and want help from professionals. "We're in demand. The schools want us," says Mink.

Clearly, if the ADAP curriculum goes national, it cannot practically be taught by psychiatrists. The idea is that other health colleagues will teach the curriculum, say Swartz and Kastelic. This spring, they are training a group of Hopkins social workers, nurses, occupational therapists and counselors to be the next generation of ADAP teachers. "Ultimately," says Swartz, "we hope that this will be taught in health classes by health teachers."

And yet, in its early stages at least, the program's success has depended on the psychiatrists themselves being in the schools. They are a relatively young group of men and women, and students have been able to relate. "We think we've done a little to demystify what it is to interact with a psychiatrist and hope we've been able to put a personal face on psychiatry," says Swartz. "My friends and colleagues exclaim: 'You're going into schools? You're the PI, and you're out there at 6:15 driving on the Beltway to see two classes of kids?' But to get the input we needed, we knew we'd have to do just that. We're much further along on this because we've been in there, watching this develop firsthand."


DRADA's 17th Annual Mood Disorders Research/Education Symposium
Turner Auditorium, Thursday, April 23,
11 a.m.-5:45 p.m.

Presentations on mood disorders, the
Adolescent Depression Awareness Program (ADAP), and more.
Mark Vonnegut, M.D.,
son of Kurt Vonnegut and author of
The Eden Express, delivers
"A Patient's Perspective."
Cost: $85: DRADA members
$95: Non-members
Info/registration: 410-955-4647
(CEUs available)





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