What was our focus?
Our first workshop focussed on our first priority "How can we better identify depression in young people?". By no means a small question, and we were determined to come up with solutions to how we could improve the identification process. Whether this be helping parents notice when their child may be struggling with low mood, improving identification in schools and clinical settings and of course how could we help young people identify that they may be experiencing depression?
Who was there?
We are inclusive of young people, parents, researchers, clinicians, and charity partners. Having members from different and diverse backgrounds is so important when coming together to think about how we can improve identification of depression to ensure no perspectives are overlooked. Alongside our ADvaNCE coordinators and fantastic members, we were thrilled to have guest speakers Dr Joanna Andersson and Dr Jerica Radez present their research.
Dr Anderson presented her research on mental health assessment programmes in secondary schools and Dr Radez presented her research which looked at barriers and facilitators of identifying depression in young people. After our guest speaker presentations, our lived experience researcher Georgia Herring presented young people’s perspectives about how we can improve how we identify depression in young people through our survey findings.
What did we do?
As the attendees who had signed up to the workshop arrived at the meeting, we were super excited to meet and greet our first members! Once we were all present, our senior co-coordinators Dr Victoria Pile and Dr Faith Orchard introduced ADvaNCE and our key priorities which are the basis for each workshop, these priorities are Identification, Intervention and Empowerment.
We then introduced our guest speakers who presented short talks about their recent research in this field. We then held Q&A sessions where the group could ask questions about the research. This was a great way to inform our understanding of the research in this area and also gave us a chance to share information and allowed people from different backgrounds and disciplines to network with people.
After our short Q&A sessions, our lived experience researcher Georgia Herring presented our survey findings from young people to help inform our understanding of what young people think would be helpful or unhelpful when identifying depression in young people. We were able to gather quantitative (numerical) and qualitative (written) information, using graphs to show methods young people preferred as well as key quotes from young people sharing their thoughts and experiences.
After taking a short comfort break, we returned to our screens to be randomly allocated in to break-out rooms, consisting of 6 people from the meeting, including an ADvaNCE coordinator to guide the discussions. In our groups we reflected on the presentations and young people’s perspectives and came up with two solutions for how we could improve how we identify depression in young people. We then reconvened with the wider group and the ADvaNCE coordinator for each break-out room group feedback their groups solutions. Once every groups solutions had been shared, we then openly discussed our solutions, building on idea’s using the knowledge and expertise from our diverse members.
Before we knew it, it was 11am and time to say goodbye! We thanked our members for attending and informed them of our next workshop date. We were blown away by the positive feedback we received on twitter and by email and we couldn’t wait for our next workshop and the important discussions we would have about our next priority: What are the best early interventions for young people experiencing depression?
Whats did we learn?
Young people's perspectives
Why do you think it might be hard to identify depression in young people?
The options young people most frequently selected were:
1) People might mistake a young person's behaviour when experiencing depression or low mood as being grumpy, quieter or a 'typical teenager'.
2) Negative beleifs from family, friends and society make it difficult for young people to tell others they are experiencing depression or low mood.
“I think it is often mislabelled as general stress or changes in hormones that affects everyone especially by parents and schools. From what I've seen help is usually only given once it gets really serious. There is also still a lot of STIGMA around it as people don't want to seem weak or attention seeking, especially among young men.”
What do you think could help parents recognise depression in young people?
The options which YP’s expressed as being most helpful were:
1) Making sure schools and clubs communicate with parents about their teenager’s wellbeing regularly
2) Providing parents with more information about depression
3) Encouraging parents to talk to their teenager about mental health.
“Maybe hosting seminar type events in local areas to teach and engage parents on how to notice and properly deal with depression.”
What school-based methods do you think would be helpful for identifying depression in young people?
Young people most frequently selected the following options as being most helpful:
1) Links between mental health services and schools.
2) Being able to visit a mental health professional at school.
3) Mental health training for teachers both before and after qualifying.
“It’s kind of scary to let anyone else know that you feel a way about yourself and life … my teachers didn’t believe I actually had mental health problems till I got a letter from my doctor. Young people don’t really know that what they are feeling is depression as it is put, that is normal for teenagers to have mood swings.”
"They don't know how and/or do not feel safe enough to bare all to another person.”
Identifying depression in schools:
Universal screening (screening all students for depression) in schools is the most accurate and acceptable model to parents but is cost/time intensive and can produce false positives.
Curriculum-based models (workshops, lessons that fit in to school-day) are more acceptable to school staff and fits with curriculum but is costly and received more parental concerns.
Training teachers to identify depression in students is acceptable and easy to implement but the effectiveness of this is unclear and it is costly, time consuming and complex to implement if delivered face to face rather than online.
Whereas nominating a single staff member to receive mental health identification training requires minimal resources but is more likely to produce false negatives, The staff member is more likely to identify and refer high risk and behavioural students and may miss pupils with internalised problems like depression.
Barriers and Facilitators to identification: What stops adolescents with depression and anxiety seeking help?
1200 adolescents with no history of diagnosis were screened in 2 secondary schools in the UK.
Screening identified adolescents who had symptoms of depression and conducted qualitative interviews with these adolescents .
All young people identified with major depressive disorder (MDD) also had symptoms of anxiety.
Results:
Theme 1, Making sense of difficulties: This theme consisted of the adolescents' ability to recognise their depression and where to get help. Adolescents did not tend to realise the symptoms they were experiencing were due to depression, particularly adolescent boys who reported they thought the irritability and anger they felt was 'normal'.
Theme 2, Disclosing problems: This theme encapsulated adolescents worries and fears about seeking help. This included, talking to someone about their difficulties, fears of what family and friends would think of them, and difficulty verbalising their thoughts and emotions.
Theme 3, Ambivalence to seeking professional help: This theme highlights the importance of self-reliance and autonomy for young people combined with their reliance on the adults around them for support, including expectations about professional help.
Theme 4, Instrumental role of others: None of the young people sought help on their own in this study and relied on parents, GP's , teachers or school councillors to facilitate help seeking. This theme also highlighted the importance of the young person's family knowing where to turn to help. In addition, the role of schools in supporting family appeared important, particularly when family resources were limited.
Patterns in depressed young people: Adolescents with depression reported more difficulty verbalising their difficulties and symptoms including hopelessness which impacted help-seeking.
Adolescent boys with depression were identified in this study and are highly unrepresented in CAMHS - screening may be an important way to identify adolescent boys experiencing depression.
Next steps?
After each workshop we have sent a short survey to our members, asking them to rate the solutions that were generated at the workshop, along with some feedback questions to help us improve each workshop.
We have already begun planning our next workshop which will focus on improving treatments for depression in young people, and have used our members feedback to make positive changes to our upcoming workshops.
We plan to bring our top rated solutions to young people for their input and feedback.
Our hope is to publish a paper containing these final solutions to guide research directions in the field to promote real action and change.
References
Anderson, J., Ford, T., Soneson, E., Coon, J., Humphrey, A., Rogers, M., . . . Howarth, E. (2019). A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties. Psychological Medicine,49(1), 9-19. doi:10.1017/S0033291718002490
Herring, G., T., Pile., V. Orchard., F. Loades. M., E. Chan., S. Reynolds, S. (2021). The Young People's 'Have your say' Survey. (Unpublished).
Radez, J., Reardon, T., Creswell, C. et al. Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-020-01707-0
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