Adolescent Depression Awareness Program, Research Paper Example

Major depression is a common disorder among teenagers and has led to significant mortality rates. In the United States, suicide was the third leading cause of death among 15-24 year olds in 2010.[1] The Adolescent Depression Awareness Program (ADAP) was developed by John Hopkins University Department of Psychiatry in 1999 to address this public health concern. The university took note that despite the prevalence of depression and bipolar disorder amongst adolescent only 30% of the affected population received any type of treatment or intervention.[2]At the time of creation, there were many high school programs that addressed suicide prevention found around the country.  However it was found in one study by Garland, Shaffer and Whittle that 95% of these programs were ascribing to the belief that suicide is most often caused by stress and can happen to anyone.  Conversely only 4 % of programs viewed suicide as a result of mental health conditions.[3]  These programs operated on this belief despite repeated evidence that 90% of adolescents whom commit suicide have a psychiatric diagnosis.  These widespread programs also did not increase the participant’s knowledge about depression and suicide. In order to help the public address the real issue- psychiatric diagnosis rather than speak solely about suicide ADAP was created.  ADAP was created with the intention of educating students on depression and it’s link to suicide.[4]  In this way the creators hope to decrease suicide rates by educating individuals on causes and promoting help seeking. This paper serves to demonstrate the efficacy of ADAP and analyze the theory used to create this program.

ADAP is conducted in high schools around the country.  ADAP targets educators, parents, and students however students are the primary interest of the intervention.  The program is most geared toward the students, as they are the group the program aims to decrease the suicide rate in.  The study was conducted over a four-year period in six large public high schools in the state of Maryland.  The ADAP curriculum was taught by educators during the students’ health class. As per school policy, every student was required to take health class to graduate, which ensured all students would take the class by completion of the study.4 There is no clear explanation as to why this setting was selected.  It is likely high schools were used because they were being used in similar programs to target this epidemic for this specific population.  It is also probable that high schools were used because a large percentage of the target population attends high schools across the country.

ADAP appears to be using the Health Belief Model (HBM), although no theory is communicated explicitly in any of the literature. HBM focuses on change at the individual level and has six main constructs. These constructs are the influencers over whether or not an individual will decide to take action to prevent, screen for, and/or be treated for an illness. There are six main constructs included in the HBM. The first construct is perceived susceptibility. Perceived susceptibility is the individual’s belief that this illness can happen to them.  Perceived severity is the second construct and is defined as how severe the individual believes the condition and its consequences are. Next is a perceived benefit, which is the individual’s feeling on whether this course of action will decrease their susceptibility of the illness or severity of the illness.  The fourth construct, perceived barriers refers to the individual’s belief that the cost of taking action is outweighed by the benefits of such action. Cue to action is the fifth construct and refers to the individual’s exposure to factors that promote action. Finally, self-efficacy refers to the individual’s confidence in their ability to successfully take action. These six factors are used to determine an individual’s readiness to take action to prevent or treat a medical concern.[5]

ADAP appears to use these 6 constructs in the design and delivery of its program. ADAP serves to educate teens on the prevalence of depression. As such, ADAP increases the perceived susceptibility of its users.  ADAP also helps student’s to identify symptoms of depression and indicators that an individual may be depressed.  This strategy helps students to identify depression and change their beliefs/stigmas about the disorder.  The perceived severity of depression is also influenced by ADAP.  As ADAP aims to educate about depressions link with suicide- it clearly demonstrates that if untreated depression can have severe consequences.  It specifies suicide as a consequence; the literature also cites unwanted pregnancies, underachievement in school, and underemployment.[6] ADAP provides students with several treatment courses to take if they believe they are living with depression including medication, psychotherapy, and family therapy. ADAP also shows students videos of other adolescents living with depression and/or bi-polar disorder and their experiences with treatment,[7]increasing the individual’s perceived benefit of taking action.  To address the perceived barriers ADAP shows the videos mentioned above and does correct misinformation- mainly it disputes that suicide is a normal part of adolescences and encourages all individuals thinking about, or whom know who is someone is thinking about, suicide to inform a trusted adult.[8]For cue to action, the program takes place in high schools and is accessible and to all students in high school.  To increase self-efficacy the program trains students to recognize depression and the appropriate channels to help manage depression.

ADAP was put in a strategic setting given its health behavioral theory. The high school setting catered to both the population and health issue of interest: adolescent depression. As ADAP was in a high school it effectively reached its’ targeted population (adolescents). It was also run in a during the students’ health class effectively targeting the heath issue depression. Adolescent depression being taught to adolescents in a class designed to address health issues is very practical location to inform the population at hand.  This setting also furthered the theoretical approach.  HBM’s focus of cue to action is accomplished through this setting as it is being seen by and brought to the attention to the targeted population.

The study found that there was an increase in students’ knowledge about depression by the end of the program term.  A pre-test on depression was given on the first day of class and a post-test was given on the last ay of class. The number of students scoring 80% or above more than tripled between the pre-test and the post-test. It was demonstrated that the program did increase the knowledge about depression among those enrolled in the program.  More importantly it was demonstrated that students developed a better understanding that depression is a treatable medical illness.[9]  The program was thus effective in meeting its’ first goal of increasing adolescent knowledge about depression.

It is not know whether or not the program contributed to decreasing suicide rates or increasing help-seeking behavior.  The study conducted measured only knowledge about depression before and after the program.  The study did not measure suicide rate levels or behavioral changes after the program.  Nor did it compare help-seeking behavior in schools with ADAP with schools absent of ADAP.  This is a significant limitation to the ADAP program.  If the overall concern is adolescent depression leading to high suicide rates than a program should aim to decrease suicide rates or at least increase help-seeking behavior.  It is unfortunately unknown at this time whether or not this increase in knowledge about this illness is an effective preventative measure. HBM would believe that though it’s education and promotion of treatment ADAP increased the likeliness that individuals would seek help for their mental health issues.

Despite direct evidence of “helpfulness” found in this particular study, similar studies have found promising results that support ADAPs’ mission.  The program developers were smart to go the route of education, according to numerous sources discussing the effectiveness of metal health literacy. Mental health literacy is focused on educating the public about mental health conditions with the aim of increasing their knowledge and the ability to take action based on that knowledge to benefit one’s own mental health or that of another.[10]  One study performed on mental health literacy amongst adolescents showed that teens that recognized mental health disorder were three to four times more likely to take some sort of helping action.[11] Therefore, despite lack of evidence for increased help-seeking behavior found in this study, an increase in this type of behavior could be a consequential result of ADAP.

ADAP could have had some changes in its implementation that may have proved to be more effective in decreasing suicide rates.  As well noted in HBM theory, cue to action is an important part of any help seeking behavior.  ADAP is given only to 9^th grade students, as students I the schools studied take health class in 9^th grade. Having the program follow the students throughout their high school years may have proven to been more fruitful, as it would serve as an active reminder about depression and ways to treat depression. The program could have hung school flyers to serve as daily reminders or even recruited students to create a student club about awareness.  If the program expanded it’s outreach and longevity in the students high school career it may be more effective in promoting help-seeking and maintaining working knowledge.

The program still has shown that it is effective at educating the public about this mental health concern.  Successfully educating individuals on a medical health topic of concern is a contribution to the field, in and of itself.  If the objective is solely education, ADAP is an effective public health education program.  ADAP can be a model to follow if one would like to educate a targeted population on a medical condition that it is highly susceptible to.

References

[1] Ruble AE, Leon PJ, Gilley-Hensley L, Hess SG, Swartz Kl. Depression knowledge in high school students: Effectiveness of the adolescent depression awareness program. Journal of Affective Disorders. 2013; 150: 1025-1030.

[2] John Hopkins Medicine. Adolescent Depression Awareness Program (ADAP). n.d. Available at: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/moods/ADAP/ Accessed on September 20, 2014.

[3] Garland A, Shaffer D, Whittle B. A national survey on school-based adolescent suicide prevention programs. J Am Acad Child Adolesc Psychiatry. 1989; 28: 931-934.

[4] Swartz KL, Kastelic EA, Hess SG, et. al. The effectiveness of a school-based adolescent depression education program. Health Educ Behav. 2007. 1-11.

[5]Edberg MC. Essentials of Health Behavior 2^ndEd.  Burlington, MA: Jones & Bartlett Learning; 2013.

[6]Ruble AE, Leon PJ, Gilley-Hensley L, Hess SG, Swartz Kl. 1026.

[7] Swartz KL, Kastelic EA, Hess SG, et. al. 4.

[8] Swartz KL, Kastelic EA, Hess SG, et. al. 4.

[9] Swartz KL, Kastelic EA, Hess SG, et. al. 9.

[10]Jorm AF. Mental health literacy: empowering the community to take action for better mental health. Am Psychol. 2012; 3: 231-234.

[11] Olsson DP, Kennedy MG. Mental health literacy among young people in a small US town. Early Interv Psychiatry. 2010; 4: 291-298.