Children and adolescents who are depressed: an ecological approach

Professional School Counseling, Feb, 2005 by Karen Abrams, Susan K. Theberge, Orv C. Karan

The purpose of this article is to provide school counselors with a framework for working with students who experience or display depressed feelings or behavior. Following an overview of depression, a framework based on the ecological model (Bronfenbrenner, 1979; Bronfenbrenner & Morris, 1998) is described. The framework offers school counselors a conceptual model to understand the diverse factors that can impact a student's life. The authors present composite case studies to illustrate ways that school counselors can utilize this framework to identify sources of depression as well as areas for intervention.

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Schools today are called upon to educate an increasing number of students with social and emotional needs that interfere with their academic success (Lockhart & Keys, 1998). As stress and emotional distress increase among children and adolescents, affordable mental health services are declining (Wylie, 1992). The rising number of students and families in need of mental health services, coupled with the decline in mental health programs (Wylie), places school counselors in the difficult position of sometimes being the only accessible mental health service provider for many students and families, particularly if they live in rural areas (Kennedy, 2004). School counselors may at times find themselves in the position of being the professional whom students and their families turn to first in moments of crisis and despair.

According to Israelashvili (1998), school counselors must be able to find the resources necessary to provide interventions that will help students cope with school despite their life challenges. School counselors are required to balance multiple needs as they attempt to fulfill many functions (Davis & Garrett, 1998) and, according to Kennedy (2004), are "asked to take on a wide variety of issues, from eating disorders and unemployment to depression and abuse and everything else in between" (p. 1). One of the challenges laced by school counselors is how to work with students who are experiencing one or more behavioral or emotional indicators of depression. Because most students spend a majority of their day in school, it is not unreasonable to assume that school counselors need to play a role in helping such students (Evans, Van Velsor, & Schumacher, 2002).

In our experience as professionals in the field of school counseling, we have found it helpful to think of the behavioral/emotional indexes of depression along a continuum (see Figure 1). At the far end of the continuum are those students who have been diagnosed with major depressive disorder. The National Institute of Mental Health (1999) has reported that as many as 3% of all children and 8% of all adolescents in the United States are classified as clinically depressed. Other data indicate that "over one in four youngsters will experience a serious episode of depression by the time they reach their eighteenth birthday" (Fassler & Dumas, 1997, p. 2). These students, represented at the upper end of the continuum, are experiencing clinical forms of depression that are of such severity that they are beyond the province of school counselors and are better served by specialized professionals such as psychiatrists, psychologists, and clinical social workers.

The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2000) categorizes depression as a mood disorder and includes specific descriptors of the various types of depressive disorders. Typical behavioral/emotional indexes of depressive disorders displayed by children and adolescents include a decreased ability. to experience pleasure; irritability and anger; sadness; changes in appetite and weight; somatic complaints such as headaches and stomachaches; a sense of worthlessness, excessive guilt, and hopelessness; psychomotor extremes of either lethargy, or agitation; exhaustion and lack of energy; trouble concentrating, thinking clearly, or making decisions; insomnia or, less often, hypersomnia; suicidal ideation, threats, or behavior; and preoccupation with recurrent thoughts of death (APA; Kauffman, 1997; Vernon, 1999).

Viewing depression along the continuum in Figure 1 brings to light large numbers of students who may not have a diagnosis of dysthymic or major depressive disorder but who may be experiencing one or more of the behavioral/emotional indices of depressive disorders listed above. These children and adolescents, represented by the left-hand side of the continuum in Figure 1, display one or more indicators of depression that, although not sufficient for a clinical diagnosis, are still serious enough to prevent them from functioning at their optimal level academically and socially. Other students may be suffering from a depressive episode after experiencing a significant loss or change. School counselors, as the first line of mental health resource personnel in our public schools, can and should play a very active role in assisting these students (Evans et al., 2002).