Adolescent Depression Awareness Program

By: Karen L. Swartz, M.D., Director, Adolescent Depression Awareness Program, Clinical Programs, The Johns Hopkins Mood Disorders Center

The Adolescent Depression Awareness Program (ADAP) is a school-based curriculum to educate high school students, teachers, and parents about teenage depression. The mission of ADAP is to make the curriculum available nationally for health teachers to incorporate into their classes. Through education, ADAP will increase awareness about depression and the need for evaluation and treatment.

Karen L. Swartz, M.D., assistant professor in the Department of Psychiatry at the Johns Hopkins University School of Medicine, founded ADAP in 1999. A psychiatrist at Johns Hopkins Hospital for over fifteen years, Dr. Swartz has clinical expertise in the treatment of mood disorders and a special dedication to educating patients and their families about depression. In response to a series of teenage suicides in 1998, Dr. Swartz began volunteering to speak to parents, teachers, and students about depression. After a year of working with a variety of school communities in the Baltimore area she began to develop ADAP’s formal curriculum to become part of high school health classes.

Many high schools do not have a formal curriculum to address depression. Among schools that address depression in health classes, very few discuss depression as a medical illness. With an estimated 5% of adolescents having depression, this is one of the most common illnesses teenagers face. The high rate of suicide in depressed teens underscores the importance of all high school students receiving quality education about depression and learning that depression is a treatable medical illness – the core message in the ADAP curriculum.

The ADAP student curriculum is three hours and employs multiple teaching modalities. Some of the teaching formats include: interactive lectures and discussions, videos of teenagers describing their experiences with depression and bipolar disorder, homework and video assignments to reinforce key points, and group interactive activities. The goal of the curriculum is to promote depression literacy, which the ADAP team has defined as knowledge of the symptoms of depression, understanding the process of medical diagnosis in order to compare depression to other medical illnesses, and knowledge of treatment or help available for depression. Suicide is addressed in the program as a serious symptom of depression, rather than as an independent focus. The importance of help-seeking behavior (i.e., sharing concerns with parent, teacher, school nurse, or counselor) is also addressed in the program.

An important element of ADAP is not only to teach the students accurate information about adolescent depression, but to assess the efficacy of the program in changing students’ knowledge of and help-seeking attitude for adolescent depression. The team developed the ADAP Depression Knowledge Questionnaire (ADKQ) as the assessment tool. The ADKQ asks 13 “yes/no” questions and asks students to list five symptoms of depression and two symptoms of mania. The students are given a test prior to the program (pre-test) and a follow-up test six weeks after the program (post-test) in order to determine if they are gaining critical knowledge about depression. For a series of publications, the ADAP team analyzed results from a subset of the students from large public school districts. The percentage of students scoring greater or equal to 80% correct on the ADKQ more than tripled (from 20% to 62%) from pre-test to post-test.

ADAP is successful in changing students’ knowledge of and help-seeking attitude for adolescent depression. A key component of the program’s effectiveness is the ADAP training for new instructors. Future ADAP instructors attend didactic seminars taught by expert clinicians, listen to community members share their personal experiences with mood disorders, and study a training video and a detailed training manual. The ADAP instructor training is extremely successful in giving the trainees the knowledge and skills they need to effectively teach the ADAP curriculum in high schools.

The program has been developed following a long-range plan to create a high quality curriculum to achieve the program’s mission of national expansion. Now in the tenth year of the program, the ADAP team has systematically developed a curriculum that has been taught to over 12,000 students. ADAP is in the early stages of national expansion and the program has been taught in Maryland, North Carolina, Oklahoma, Virginia, and Washington DC. As the training program is now in a replicable format and ADAP has shown that high school students are learning the depression curriculum, the ADAP team has worked to establish collaborations nationwide. New collaborations for the coming year include:

  • Delaware – Brandywine and Smyrna School Districts and Mental Health Association
  • Red Wing, MN – Red Wing Public Schools
  • Prescott, AZ – Northern Arizona University School of Nursing

As ADAP focuses on national expansion, the team will be dedicated to raising funds and putting its training programs into a web-based format in order to reach a larger audience. This is a major effort for ADAP, requiring experts to ensure the same level of quality and accuracy that has gone into its efforts to date.

Based on recent feedback from participating teachers, parents, and students, the ADAP program has been very well received by school communities. Educators at schools have noted that the information contained within the curriculum is valuable and essential. The program not only offers a better medical understanding and awareness of adolescent depression and mood disorders, it also offers hope and reassurance that treatment options are available. With that positive feedback, ADAP looks to a successful 2009 and significant progress towards reaching its mission of national expansion.

One of the highlights for 2009 will be the expansion of ADAP to Delaware. The enthusiastic leadership of the Brandywine and Smyrna School Districts and Superintendents as well as the leadership of the Mental Health Association in Delaware have been critical in launching this effort.