Psychiatry Newsletter - A Decade Old and Doing Wonderfully, Thank You
A Decade Old and Doing Wonderfully, Thank You
Date: November 2, 2009
Taking a public health approach to depression is something that everyone in academia agrees is a good idea. But they hesitate at the how-to part.
The immediate appeal of swallowing a pill will probably always trump putting better prevention in place despite long-term benefits of doing both.
Psychiatrist Karen Swartz and collaborators, however, have been both patient and determined. They also received unusually good advice when they set up Hopkins’ ADAP—the Adolescent Depression Awareness Program—now a decade-old public health project to fight stigma and encourage treatment.
ADAP began in 1999 after a cluster of suicides in Baltimore high schools shocked nearby Hopkins as well as the communities involved.
Swartz, with colleague Sallie Mink and others, stepped up to speak in the schools on teenage depression. But what they found shocked them. “We were troubled by how little people knew about depression,” says Swartz.
Fortunately, just as the Hopkins group was mobilizing to raise awareness, local corporate executives offered their strategic expertise. “They agreed with us about being proactive in pushing a school-based curriculum,” Swartz says.
In fact, they encouraged a national program.
“But we also heard, don’t rush this; do it in well-tested, pilot-studied stages.”
Hastening a project involving thousands of teens, widely varying school systems and possible untreated depression, however well-intended, has danger writ large. “Whenever funders or outside collaborators wanted to expand ADAP faster,” Swartz explains, “I was the cranky one who said no, we have to prove this first.”
Still, she says, the 10 years seem to have flown in developing a nationwide high school curriculum. It’s one that teaches students how mood disorders are diagnosed and treated and why that’s crucial.
Among the program’s tools are first-person videos that explore depression from both a teen’s viewpoint and the parent perspective.
“That the illness is treatable is our mantra,” says Swartz.
The program’s content and approach have been tested and refined by the hot coals of feedback in local schools. “We learned we talked too much, for one thing,” says Swartz.
Equal effort has gone into teacher training to enable the handoff from the clinicians who first taught ADAP. A mix of visiting medicos and teachers may ultimately be the way to go, though that, too, will be tested.
There’s no question that students learn: Pre- and post-program questionnaires consistently verify that. Some 15,000 have been taught so far as ADAP has spread to 15 states and Washington, D.C.
Yet the real fruit—to confirm it lessens stigma, suffering and teen suicide—still awaits harvest. That can happen, Swartz says, only after large-scale expansion and more intimate student tracking.
“I’d love to ask individual students how they respond to ADAP, if they’ve been depressed before. But we’d need parental consent for that,” Swartz explains, “and schools are more interested in having the curriculum than becoming our research partners.”
A new partnership with the National Network of Depression Centers—the nation’s foremost academic depression programs—could help.
It will widen ADAP’s reach while it improves access to therapy for students who need it. Having the network on ADAP’s side, Swartz says, may convince schools to support what she hungers for: studies that gauge impact.
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