Significance of the Problem
A public health policy issue I am interested in concerns about depression among high school students. Only about 40 years ago, depressive disorders in adolescents were largely neglected since most physicians doubted that the problem could exist at such an early age. However, it has been proven depression may not only appear in teenagers but also increase associated morbidity and mortality rates (Parker, 2013). Therefore, the importance of the issue is hard to overestimate as plenty of human lives are at stake.
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The proposed policy is to introduce depression screening at schools to detect the problem in time. The immediate target of the policy is the local level. Later, the issue will have to be discussed at the state level since it is not enough to solve the problem only locally. There is a necessity to develop universal guidelines for screening that would be applicable in all schools across the state. This will considerably facilitate the procedure of policy implementation via standardization. The legislator that is to be contacted first is Janice Kerekes, Clay County Board Member Representative, District 1.
Analysis of the Problem
The specific problem surrounding the issue of depression among adolescents is the absence of timely diagnosis as the first step to depression management. More than 30% of depressed adolescents are not recognized and do not receive treatment, while the clinical spectrum of their condition may vary from simple sadness to bipolar disorder, which can be irreversible if not detected in due time (Parker, 2013).
The research shows that approximately 9% of school students at the end of adolescence meet criteria for depression whereas 20% of them state that they suffer from the condition since early childhood (Allison, Nativio, Mitchell, Ren, & Yuhasz, 2014).
Currently, there is no regulation that would oblige schools to conduct a screening that would allow detecting the condition in high school children. Thus, in order to improve the situation, it is necessary to introduce changes to regulatory issues. Mandatory annual screenings for adolescents are recommended as the most effective option. Nurses will be for conducting them in high schools. This necessity is supported by the fact that depression is now the major cause of psychosocial impairments, increased hospitalization, alcohol and drug abuse, antisocial behavior, and suicide.
There is also evidence that more than 50% of cases of negative mood changes in adolescents can be eliminated through social therapy that makes it possible to monitor and modify distorted thinking by encouraging social activities and resolving conflicts (Allison et al., 2014). This helps prevent severe impairments of the psyche caused by clinical depression. In case of a more serious condition, early intervention makes it easier to do without antidepressants or tranquilizers and mitigate the effects with psychotherapy only.
Analysis of the Policy Issue
School is the main place outside the home where teenagers spent the majority of their time. Therefore, detecting behavior deviations and providing preventive measures is the primary responsibility of a school nurse. Despite the fact that there are two acts regulating suicide prevention (the Youth Suicide Prevention Act of 1987 and the Public Health Service Act of 1990), there are no universal guidelines for screening and follow-up. Having no elaborated plan of action, school superintendents often have to decide for themselves how to manage the problem. Researchers have found that no program of those that have been developed has been tested in a randomized trial, which means that none of them are evidence-based (Parker, 2013).
The ultimate goal of depression screening it to separate students who have symptoms of the disease (true positives) from those who do not have them (true negatives) in order to identify depression and suicidality risk groups. The related goals include:
- creating a list of depression indicators on the basis of the observed cases for teachers and parents to be able to identify the problem at an early stage;
- creating other learning conditions to those whose depression is getting aggravated owing to the unfavorable environment;
- providing psychotherapy to teenagers suffering from various forms of depression based on the gravity of the condition;
- ensuring follow-up and cooperation with parents.
There are three major options for schools to choose from:
- to include problem education into the curriculum programs;
- to provide training for teachers;
- to introduce the regular screening.
Evaluation of Options
Although the first option has been studied more profoundly, its effectiveness is still doubtful. On the contrary, there is extensive evidence that curriculum programs do not prevent depression or suicidal behavior in high school students. They do not feel that theoretical education is connected with their real-life condition (Prochaska, Le, Baillargeon & Temple, 2016). Moreover, many of them try to conceal it out of fear of bullying (Bauman, Toomey, & Walker, 2013).
The second option, in-service training for teachers can potentially assist them in identifying students that are at risk. However, there is little research on the efficacy of the measure, which does not allow making inferences about its superiority over the other two (Cunningham & Suldo, 2014). Besides, the assessment of a person without medical education can be rather subjective.
Finally, the third option involves a comprehensive evaluation of students’ psychological state including self-reported data, results of various psychological tests, and interviews (Prochaska et al., 2016). This measure is more preferable since it can be applied in all schools regardless of the curriculum and provide more objective results.
It is recommended to issue a new regulation for schools obliging them to introduce a depression screening program for high school students. At the first stage of the program, students will need to complete an evaluation form, the major goal of which is to identify those who are at elevated risk. In the second stage, the risk group is assessed via computer tests. At the final stage, a school nurse interviews those students whose results raise concerns to be able to diagnose their stage of depression.
Policymakers have to provide schools with psychometrically validated screening tools that must be tested as per their sensitivity (the ability to detect students with depression), specificity (the ability to identify those who do not have any related conditions), positive predictive value (the relation between whose who screen positive and who are actually positive), and negative predictive value (the relation between whose who screen negative and who are actually negative).
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American Academy of Child and Adolescent Psychiatry provides updates on this and other topics related to the mental health of children and teenagers. The website of the organization features numerous annual reports and recommendations for all stakeholders involved. Furthermore, there are also strict pharmaceutical guidelines for every mental disorder. The academy has a 60-year history in the field and therefore can serve as a reliable source of information on policy and other psychological conditions.
There is a nationwide problem with the detection, treatment, and prevention of teenage depression. For nurses, it means that the quality and nature of care delivery may be negatively affected by the wrong diagnosis. Since the problem is fraught with long-term consequences and leads to poor socialization, performance at work, family relations, and state of health, neglecting it may mean that in the future, nurses will have to deal with the population, suffering from a whole spectrum of mental conditions. Thus, due-time screening is crucial for schools to introduce.
Allison, V. L., Nativio, D. G., Mitchell, A. M., Ren, D., & Yuhasz, J. (2014). Identifying symptoms of depression and anxiety in students in the school setting. The Journal of School Nursing, 30(3), 165-172.
Bauman, S., Toomey, R. B., & Walker, J. L. (2013). Associations among bullying, cyberbullying, and suicide in high school students. Journal of Adolescence, 36(2), 341-350.
Cunningham, J. M., & Suldo, S. M. (2014). Accuracy of teachers in identifying elementary school students who report at-risk levels of anxiety and depression. School Mental Health, 6(4), 237-250.
Parker, G. (2013). Teenage depression: Some navigational points for parents and professionals. World Psychiatry, 12(3), 272-274.
Prochaska, J. D., Le, V. D., Baillargeon, J., & Temple, J. R. (2016). Utilization of professional mental health services related to population-level screening for anxiety, depression, and post-traumatic stress disorder among public high school students. Community Mental Health Journal, 52(6), 691-700.