School-based safety interventions
Since the 1990s, schools have implemented a number of different programs aimed at preventing suicide and violence in children and teens. The stakes are high. Homicide is the second leading cause of death, and suicide the third leading cause of death, in Americans ages 10 to 24. These tragic deaths attest to underlying problems that occur far more frequently: depression, substance abuse, and aggression.
Left unaddressed, these issues create a volatile mix. The combination of depression and drugs or alcohol is especially dangerous: one analysis found that two-thirds of adolescents who attempted suicide had both a psychiatric disorder and a history of substance abuse. In the past few years, new information has emerged about how effective school-based programs are at preventing depression and violence, and what challenges remain.
Although depression can occur at any age, it affects adolescents and teens more often than younger children. A marked increase in depressive symptoms starts appearing around age 13, but the peak ages for onset are between 16 and 24. Yet depression can be difficult to diagnose in young people, mainly because symptoms seldom involve mood alone, and usually appear in conjunction with symptoms of a co-occurring disorder.
Symptoms of depression also tend to vary according to age and sex. In adolescents (ages 10 to 14), depression is likely to manifest as anxiety, refusal to go to school, or physical problems such as headaches or stomachaches. In older teens (ages 14 to 18), mood and thinking are more likely to be affected. They may show a loss of interest or pleasure in normal activities or negative thinking. In boys, depression may cause anger, acting out, risk-taking behaviors, or obsession with school work. In girls, it tends to cause tearfulness, apathy, social isolation, or weight gain or loss.
A variety of school-based depression screening programs exist. Signs of Suicide (SOS), for example, uses a video, a brief questionnaire, and classroom discussion to educate students about depression and suicide and help identify those at risk. TeenScreen uses a short screening questionnaire to identify students with symptoms suggesting depression, who then undergo a one-on-one interview with a mental health professional. Parents are notified if their children are deemed at risk, and offered a referral for mental health services.
School-based screenings used on their own, however, are controversial.
Prevention and treatment
To move beyond one-time screenings, many schools have implemented various types of ongoing depression-prevention efforts. Although specific approaches vary, these programs generally educate staff and students about depression and suicide, provide advice and practice in challenging negative thinking, and seek to build resilience and problem-solving skills. Several reviews have concluded that interventions to fend off depression may be modestly effective, at least in the short term. In studies conducted six months to three years after such interventions, however, it's not clear that they have any lasting effect. As one reviewer put it, a depression-prevention program is not like an inoculation that confers immunity; instead, the most effective programs are those that incorporate some type of booster sessions and ongoing follow-up.
Violence prevention programs
In an effort to reduce violence and aggression in schools, about 90% of schools now offer programs that teach anger management, discourage bullying, or teach mediation and social skills. Two analyses published in 2007 concluded that such school-based interventions are effective at reducing aggression and violence.
Regardless of design, all of the violence prevention programs examined were about equally effective as long as they were given on a regular basis. So the real task for school officials is to find a program they can reliably implement.
The worst kind of violence — a school shooting or other type of attack that leads to injuries and death — is fortunately rare. Even so, since the 1999 shootings at Columbine High School in Colorado, schools have been seeking advice about how to prevent such attacks.
A key determinant of whether someone came forward with information was whether he or she felt an emotional connection to an adult at the school — a teacher, administrator, or school safety officer. School staff and teachers can promote such connections through seemingly small acts that help build relationships — such as greeting students regularly, addressing them by name, and talking to them about life outside of school.
It all comes down to thinking about making connections. Schools need to weave that type of safety net — among students, school faculty, administrators, and staff — that will help to prevent a violent attack. Those same connections, forged as part of ongoing violence and depression-prevention efforts, can prevent other types of less dramatic, but pervasive, suffering as well.October 2008 update