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Psychiatry Newsletter - Stigma-Fighting is Part of the Mix

Hopkins BrainWise - Summer 2013

Stigma-Fighting is Part of the Mix

Date: July 3, 2013

Stigma is the salt poured into the wound of psychiatric illness. And, in an awful irony, it feeds the very psychiatric problems that inspire it. Karen Swartz, as a psychiatrist, fully knows stigma’s effect on patients. But in 1998, she saw its power on a wider scale, with a resulting profound effect today.

 That year, after a cluster of suicides in Baltimore high schools, Swartz and Johns Hopkins colleagues stepped up to speak in schools on teenage depression. What they found shocked them. “We were troubled by how little people knew,” Swartz says.

 Moved to action, the group sifted through existing programs to help prevent suicide. Yet few tied that deadly symptom to depression or bipolar disorder. “We know over 90 percent of youth suicides are associated with a mental illness,” Swartz says, so the disconnect was glaring.

 Stigma existed and it was subtle. It took shape as a teenagers-will-be-teenagers attitude to explain suicide, skirting the psychiatric illness that lay at its heart. And though motives were good, says Swartz, what teens got was often inaccurate or unhelpful.

So she and colleagues founded the Adolescent Depression Awareness Program (ADAP). Now in its 14th year, the school-based approach, Swartz says, “still aims to improve knowledge about depression so we get someone in treatment before the point of being suicidal.” And in raising awareness in students, teachers and families, ADAP also fights stigma, both purposely and incidentally. “We want to stigmatize the behavior of suicide,” Swartz adds, “while destigmatizing depression.”

The program—validated at each step along the way—truly changes thinking about mood disorders. Students role-play as doctors diagnosing pneumonia, for example, then ADAP trainers “draw explicit parallels with depression, yet another disease,” Swartz says. Videos feature appealing teenage patients who struggle, get help and lead full lives.

 So far, ADAP-trained teachers have brought the three, hour-long sessions to 18 states and more than 44,000 high school students—18,000 of them in last year alone. 

Next year, a grant-supported study aims to see if ADAP prompts depressed students—or their newly savvy friends—to seek help. But the study will also measure how well ADAP shifts negative attitudes toward people with depression or bipolar illness.

Countering stigma has long been a theme, says ADAP program manager Kathryn Heley, who’s focused on measuring and taming it. Heley flagged several British stigma surveys for ADAP use, all developed by Graham Thornicroft, a professor at London’s Institute of Psychiatry who trained briefly at Johns Hopkins. Last spring, Heley collaborated with Thornicroft and his fellow stigma experts in London, adding her ADAP experience to a U.K.-wide campaign to stop mental health discrimination.

As for the Johns Hopkins group, until the surveys to measure attitude change are in, they learn from feedback. Swartz points to this comment by a teacher turned trainer: “I thought kids and adults who were ‘depressed’ were just weak and coddled and couldn’t manage life. I realize now that is obviously not the case.”  

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