Early Detection and Intervention for Adolescent Mood

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Facilitating Mental Health Promotion and Early
Detection of At Risk Youth
D. A. Santor, Ph.D.Provincial Centre of
Excellence for Child and Youth Mental Health
School of PsychologyUniversity of
OttawaOttawa, Canada
A. Bagnell, MD. Maritime Psychiatry IWK Health
Centre Dalhousie UniversityHalifax,
Canada
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Q How do we allocate resources?
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Two Challenges
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Current Strategies to address Mental Health
Difficulties in schools
? school based health centres ? mass screening ?
universal mental health interventions
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Strategy 1 School based health centres.
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Whats the chance of visiting the school health
centre given that you have difficulty, or
distress, or want help for a problem?
Santor, LeBlanc , Poulin, Kusumukar (2005b)
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What proportion of young people with difficulties
actually use school based health centres?
Santor, LeBlanc , Poulin, Kusumukar (2005b)
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Strategy 2. Mass Screening
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Columbia TeenScreen Program
The ultimate goal of the TeenScreen Program is
to ensure that all youth are offered a mental
health check-up before leaving high school. Our
primary objective is to help communities
establish permanent early identification programs
through which youth are screened for mental
disorders and suicide risk factors.
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Results
9th-12th grade students attending seven New York
high schools (N 1,729).
28 (n 489) of the students endorsed one of the
items and therefore met criteria for being at
risk of suicide.
The most balanced algorithm had a sensitivity of
0.75, a specificity of 0.83, and a positive
predictive value ranging from 16-33 (p. 75).
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US Task Force on Prevention (1996).
insufficient evidence to support use of mass
screening in either adults or children.
US Task Force on Prevention (2002).
reversed their 1996 recommendation recommending
screening adults for depression in physician
practices.
. but concluded that the evidence is
insufficient to recommend for or against routine
screening of children or adolescents.
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School factors affecting base rates

• ? 10 of student absent at any time,
• ? 10 drop out by year end.
• ? Young people who are absent and drop out tend
  to be young people experiencing difficulties, the
  very group you wish to screen.

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Factors Affect Screening (3) Symptom Course
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Strategy 3. School Based Programs
1. Universal everybody participates
2. Selective at risk
3. Indicated early signs
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Results
Universal Programs d 0.12 Selective Prevention
d 0.30 Indicated Prevention d 0.23
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How do we improve the effectiveness of universal
programs?
? improve knowledge up take ? monitor
implementation continuously ? extend learning
beyond the classroom
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Maximizing the Impact, Uptake and Sustainability
of School Based Health and Mental Health
Initiatives with On-line resources
Santor and Bagnell (2008)
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Is the internet a viable delivery system
? 75 percent of adolescents have used the
internet to locate health information online,
slightly more than the numbers downloading music
and playing games
? more than half of all young people may prefer
to obtain health information online as opposed to
other media
? 99 of youth had access to the internet and
that 79 of youth had internet access at home.
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Developing a Flexible internet-based delivery
system
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Internet as a delivery system
? Increasing the availability and accessibility.
? Improving knowledge transfer.
? Improving engagement and knowledge uptake.
? Extending knowledge uptake beyond the
classroom.
? Monitoring implementation and effectiveness in
real time.
? Monitor current and emerging health trends.
? Facilitating the identification of
difficulties.
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Content
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How is it used by students?
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im a 16 year old girl, for the past three months
i've been feeling alot different then i used to,
i find i have trouble sleeping at night and
trouble staying asleep. my body and head
constantly hurt though my doctor says i have no
medical problems i've been eating alot less and
my mood swings are out of control. during the
past three weeks things have only gotten worst
i've become extreamly sensitive crying about
everything and yesterday i cut my arms up with
some keys. i can't control my sadness and i was
hoping it would pass. my parents say its a phase
that everyone goes through but i think i need
some help. is this a phase? or do i need to see a
doctor??
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okay this might sound stupid but i have learned
about sex -- i know what goes on and everything,
i am very well educated on the subject, but i
sorta wonder in between all this orgasm stuff--
like i know what they are and how they happen and
that it vary's from guys to girl-- but is like
sex like one orgasm then its over ?like how can
this go on for along time? is sex really short
...cant it be long? like after the orgasm thing
what happens? like i ask do you go again
or...what? i hope you get what i am asking thanks!
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Infrastructure
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... Evaluation
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How is the Resource Used by Young People?
Utilization Data (N 500 or one typical school)
Santor, LeBlanc , Poulin, Kusumukar (2005c)
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How is the Resource Used Throughout the Day?
Santor, LeBlanc , Poulin, Kusumukar (2005c)
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How is the Resource Used Throughout the Year?
Santor, LeBlanc , Poulin, Kusumukar (2005c)
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Can Mass Screening be improved with on-line
resources?
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Results Screening On-Demand
The positive predictive value for the Symptom
Checklist for predicting sustained mood
problems (assessed at year end) was 0.45 in the
subgroup of website visitors who completed the
Symptom Checklist once. The positive predictive
value increases to 0.73 in the subgroup of
individuals who completed the Symptom Checklist
more than twice.
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Can we enhance school based interventions with
on-line resources?
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Registering
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? Schools currently implementing YooMagazine
Health and Mental Health Literacy Program
Total Number of Schools 100 Total
Number of Students with access 25,000
Total Number of Teachers 1000
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