THE CONTEXT TO ADOLESCENCE
THE CONTEXT TO ADOLESCENCE
Professor Graham Martin OAMMD, FRANZCP, DPM
Professor Graham Martin OAMMD, FRANZCP, DPM
ADOLESCENCEADOLESCENCE
A transition period from immaturity to maturity
Early 11-14yrs Middle 15-18yrs Late 19-21 yrs
A transition period from immaturity to maturity
Early 11-14yrs Middle 15-18yrs Late 19-21 yrs
There is no ‘one’ adolescenceThere is no ‘one’ adolescence
At last count there were over 190 different cultural backgrounds in Australia
Life is different for Lebanese young people in Sydney compared
with Asian kids in Cabramatta Young People from Thursday Island compared
with those from OAFS in Adelaide
At last count there were over 190 different cultural backgrounds in Australia
Life is different for Lebanese young people in Sydney compared
with Asian kids in Cabramatta Young People from Thursday Island compared
with those from OAFS in Adelaide
Adolescence used to have3 stages
Adolescence used to have3 stages
Based on physiological status Early (from Puberty) - Identity Confusion Middle - Working through Late - Identity re-formation
Now the variability is what is obvious
Based on physiological status Early (from Puberty) - Identity Confusion Middle - Working through Late - Identity re-formation
Now the variability is what is obvious
Rites of PassageRites of Passage
Work Keys to the door Alcohol Cars Circumcision Sex Challenge
Work Keys to the door Alcohol Cars Circumcision Sex Challenge
TEENAGE LABOUR FORCE PARTICIPATION 1978-1997TEENAGE LABOUR FORCE PARTICIPATION 1978-1997
0
10
20
30
40
50
60
1978198019821984198619881990199219941996
Male FTFemale FTMale ptFemale pt
The TrajectoryThe Trajectory
Indicated
Case identification
Cousin MichaelCousin Michael
The trajectory interruptedThe trajectory interrupted
Growth of the Ego(after Erik H. Erikson)
Growth of the Ego(after Erik H. Erikson)
Basic Trust vs MistrustBasic Trust vs Mistrust
Autonomy vs Shame & DoubtAutonomy vs Shame & Doubt
Initiative vs GuiltInitiative vs Guilt
Industry vs InferiorityIndustry vs Inferiority
Identity vs Role ConfusionIdentity vs Role Confusion
Intimacy vs IsolationIntimacy vs Isolation
Generativity vs StagnationGenerativity vs Stagnation
Ego Integrity vs DespairEgo Integrity vs Despair
Key Developmental IssuesKey Developmental Issues
Identity Autonomy Intimacy Sexuality Achievement
Identity Autonomy Intimacy Sexuality Achievement
Toward What?Toward What?
Clear Identity Body Image
Relative Autonomy Task Orientation Commitment ‘Adult’ relationship development
Clear Identity Body Image
Relative Autonomy Task Orientation Commitment ‘Adult’ relationship development
Hierarchy of NeedsHierarchy of Needs
Basic Biological and Physiological Needs
Air, Food, Water, Shelter, Warmth, Sex, Sleep
Basic Biological and Physiological Needs
Air, Food, Water, Shelter, Warmth, Sex, Sleep
Need for Safety and SecurityProtection, Security, Order, Law, Limits, Stability
Need for Safety and SecurityProtection, Security, Order, Law, Limits, Stability
Social Needs - BelongingFamily Affection, Relationships, Work, Group relationships
Social Needs - BelongingFamily Affection, Relationships, Work, Group relationships
Need for Self-EsteemAchievement, Affection, Responsibility,
Reputation
Need for Self-EsteemAchievement, Affection, Responsibility,
Reputation
Need for Self-ActualisationPersonal Growth and Fulfilment
Need for Self-ActualisationPersonal Growth and Fulfilment
Abraham Maslow,‘Motivation and Personality’, 1954)Abraham Maslow,‘Motivation and Personality’, 1954)
eg McKelvey/Vietnameg McKelvey/Vietnam
Development of HealthDevelopment of Health
ResilienceResilience
“the ability to bounce back, recover from, or adjust to misfortune or change”
Burns, 1996
“the ability to bounce back, recover from, or adjust to misfortune or change”
Burns, 1996
Resilience facing AdversityFergusson and Lynskey, 1996
Resilience facing AdversityFergusson and Lynskey, 1996
intelligence problem solving ability female gender ?? external interests/affiliations +ve parental attachment and bonding easy early temperament good peer relationships
intelligence problem solving ability female gender ?? external interests/affiliations +ve parental attachment and bonding easy early temperament good peer relationships
Profile of the Resilient ChildBenard 1991
Profile of the Resilient ChildBenard 1991
Social Competence responsiveness, flexibility, empathy, caring,
communication skills, sense of humour;
Problem Solving Skills critical thinking, generating alternatives,
planning, produces change;
Social Competence responsiveness, flexibility, empathy, caring,
communication skills, sense of humour;
Problem Solving Skills critical thinking, generating alternatives,
planning, produces change;
Profile of the Resilient ChildBenard 1991
Profile of the Resilient ChildBenard 1991
Autonomy self-esteem, self-efficacy, internal locus of
control, independence, adaptive/healthy distancing;
Sense of Purpose and Future goal directedness, achievement orientation,
high motivation, educational aspiration, persistence, hopefulness, coherence;
Autonomy self-esteem, self-efficacy, internal locus of
control, independence, adaptive/healthy distancing;
Sense of Purpose and Future goal directedness, achievement orientation,
high motivation, educational aspiration, persistence, hopefulness, coherence;
INFLUENCESINFLUENCES
Successful Ego Maturation Family Parameters Family Developmental Stage Gender and Same Sex Peers Education and Employment
Successful Ego Maturation Family Parameters Family Developmental Stage Gender and Same Sex Peers Education and Employment
Factors Influencing Body ImageFactors Influencing Body Image
Puberty and Adolescence
Role Models - Parents, Family(heredity) Teachers, and Coaches
Peers Society and the Media
Puberty and Adolescence
Role Models - Parents, Family(heredity) Teachers, and Coaches
Peers Society and the Media
Influence of PubertyInfluence of Puberty
Girls natural weight gain necessary for shifts away
from society's ideal body shape
Boys natural weight gain shifts towards society's
ideal body shape
Girls natural weight gain necessary for shifts away
from society's ideal body shape
Boys natural weight gain shifts towards society's
ideal body shape
Influence of PeersInfluence of Peers
Influence of friends increases
Emphasis on fitting in and being alike
Self absorbed
Focus: girls - how they look
boys - what they can do
Influence of friends increases
Emphasis on fitting in and being alike
Self absorbed
Focus: girls - how they look
boys - what they can do
Body Image Dissatisfaction% of Respondents Who Do Not Like How Their Body Looks
Body Image Dissatisfaction% of Respondents Who Do Not Like How Their Body Looks
53.7
34
71.4
36.3
65.1
36
0
20
40
60
80
100
10 & 11 yrs 12 yrs 13 & 14 yrs
Females
Males
Halton Region - October 2001
Fear of Fat% of Respondents Who are Afraid of Becoming Fat or Fatter
Fear of Fat% of Respondents Who are Afraid of Becoming Fat or Fatter
74.2
50.9
82.7
57.7
84.3
50
0
20
40
60
80
100
10 & 11 yrs 12 yrs 13 & 14 yrs
Females
Males
Halton Region - October 2001
Weight Control Behaviours% of Respondents Who Are Trying to Lose Weight
Weight Control Behaviours% of Respondents Who Are Trying to Lose Weight
33.9
22.7
37.5
24.8
42.6
21.2
0
20
40
60
80
100
10 & 11 yrs 12 yrs 13 & 14 yrs
Females
Males
Halton Region - October 2001
Frequency of Exercise % of Frequency of Exercise
Frequency of Exercise % of Frequency of Exercise
23.615.5
43.835.5
20.527
12.122
0
20
40
60
80
100
Females
Males
Halton Region - October 2001
Body Dissatisfaction USA 1972-97
Body Dissatisfaction USA 1972-97
0
20
40
60
80
Men/stomachs Women/stomachs Men/chest Women/breasts
197219851997
Percent dissatisfied
Sex / Body Partn of 4,000 refers to the 1997 survey only. Garner (1997).
Body Image DissatisfactionBody Image Dissatisfaction
27% of girls 12 - 18 years reported disordered attitudes about food
20% of these girls were 12 - 14 years dieting was the most prevalent weight loss
strategy 12% of girls 12 - 14 report binge-eating and
5% report self-induced vomitingJennifer Jones, Disordered eating attitudes and behaviours in teenaged girls: a school based study 2001
27% of girls 12 - 18 years reported disordered attitudes about food
20% of these girls were 12 - 14 years dieting was the most prevalent weight loss
strategy 12% of girls 12 - 14 report binge-eating and
5% report self-induced vomitingJennifer Jones, Disordered eating attitudes and behaviours in teenaged girls: a school based study 2001
Influence of the MediaInfluence of the Media
Media creates a distorted image of reality: normalizes & glamorizes what is a abnormal creates false impression that all women and
men are the same sends the message that one must continually
improve and is never good enough uses technology to alter and create an image
Media creates a distorted image of reality: normalizes & glamorizes what is a abnormal creates false impression that all women and
men are the same sends the message that one must continually
improve and is never good enough uses technology to alter and create an image
CONTAGIONCONTAGION
CONTAGION2CONTAGION2
Bio-Psycho-Socio-Cultural Influences
Bio-Psycho-Socio-Cultural Influences
BioBio
PsychoPsycho
SocioSocio
CulturalCultural
The Family ContextThe Family Context
Sig. otherSig. other
FatherFather
MotherMother
SelfSelf SiblingSibling
PARAMETERS OF FAMILY FUNCTIONING
after Epstein & Bishop (MCMASTER)
PARAMETERS OF FAMILY FUNCTIONING
after Epstein & Bishop (MCMASTER)
Roles Problem Solving Communication Affective Involvement Affective Responsiveness Behaviour Control General Functioning
Roles Problem Solving Communication Affective Involvement Affective Responsiveness Behaviour Control General Functioning
TRANSITION POINTS IN FAMILY DEVELOPMENT
After Barnhill and Longo, 1978
TRANSITION POINTS IN FAMILY DEVELOPMENT
After Barnhill and Longo, 1978
Creation of the Couple(Commitment)
Entry of the First Child(Development of Parenting Roles)
First Child Development(Acceptance of Child/New Marital Roles)
First Child enters the Wider World(Accepting other institutions as responsible)
Creation of the Couple(Commitment)
Entry of the First Child(Development of Parenting Roles)
First Child Development(Acceptance of Child/New Marital Roles)
First Child enters the Wider World(Accepting other institutions as responsible)
Adolescence(Acceptance of changed physique, Sexuality, Social
Roles toward leaving home)
First Child leaves the family(Accepting/Permitting/Encouraging Independence)
Separation of Parents(Continuation of Parenting without Marital Role)
Adolescence(Acceptance of changed physique, Sexuality, Social
Roles toward leaving home)
First Child leaves the family(Accepting/Permitting/Encouraging Independence)
Separation of Parents(Continuation of Parenting without Marital Role)
TRANSITION POINTS IN FAMILY DEVELOPMENTTRANSITION POINTS IN FAMILY DEVELOPMENT
Remarriage of Parent(Acceptance of Extended Adoptive Family)
Last Child leaves the family(Facing each other and the ‘Empty Nest’)
Retirement(Developing New Career/Grandparent Status)
Death of a Spouse(Acceptance of Single Status)
Remarriage of Parent(Acceptance of Extended Adoptive Family)
Last Child leaves the family(Facing each other and the ‘Empty Nest’)
Retirement(Developing New Career/Grandparent Status)
Death of a Spouse(Acceptance of Single Status)
TRANSITION POINTS IN FAMILY DEVELOPMENTTRANSITION POINTS IN FAMILY DEVELOPMENT
HannahHannah
The reconstituted familyThe reconstituted family
The Protective FamilyBenard 1991
The Protective FamilyBenard 1991
Caring and Support close relationship with one person, affection expressed
physically and verbally;
High Expectations structure , order, discipline, values, explicit expectation,
faith, hope for the future
Participation valued participant, domestic responsibility,
independence encouraged, autonomy respected
Caring and Support close relationship with one person, affection expressed
physically and verbally;
High Expectations structure , order, discipline, values, explicit expectation,
faith, hope for the future
Participation valued participant, domestic responsibility,
independence encouraged, autonomy respected
Development of Ill-HealthDevelopment of Ill-Health
THEORETICAL MODELSTHEORETICAL MODELS
Vulnerability-Stressimpairment becomes manifest when vulnerability and stress factors overwhelm biopsychosocial responses (Falloon, 1993)
Vulnerability-Stressimpairment becomes manifest when vulnerability and stress factors overwhelm biopsychosocial responses (Falloon, 1993)
THEORETICAL MODELSTHEORETICAL MODELS
Vulnerability-Stresssocial factors interact with prior maternal loss + current vulnerability factors to produce cognitive set of low self esteem, reducing the ability to work through current loss. This leads to hopelessness (Brown, 1987 & 1994)
Vulnerability-Stresssocial factors interact with prior maternal loss + current vulnerability factors to produce cognitive set of low self esteem, reducing the ability to work through current loss. This leads to hopelessness (Brown, 1987 & 1994)
THEORETICAL MODELSTHEORETICAL MODELS
Cognitive Depression is based in the development of
a negative sense of self from childhood loss reinforced over time and leading to cognitive distortions (Beck, 1973)
Helplessness is a learned maladaptive style (Seligman, 1975)
Attributions for failure are learned(Abramson, 1978)
Cognitive Depression is based in the development of
a negative sense of self from childhood loss reinforced over time and leading to cognitive distortions (Beck, 1973)
Helplessness is a learned maladaptive style (Seligman, 1975)
Attributions for failure are learned(Abramson, 1978)
THEORETICAL MODELSTHEORETICAL MODELSEcological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998)
Ecological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998)
CognitiveCognitive
RepresentationalRepresentationalBiologicalBiological
SocioemotionalSocioemotional
depressotypicorganizationdepressotypicorganization
THEORETICAL MODELSTHEORETICAL MODELSEcological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998)
Ecological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998)
CognitiveCognitive
RepresentationalRepresentationalBiologicalBiological
SocioemotionalSocioemotional
depressotypicorganizationdepressotypicorganization
MacroMacro
ExoExo
MicroMicro
OntogenicOntogenic
DEPRESSIONDEPRESSION
Hypothalamic-Pituitary Adrenal (HPA) axis
Hypothalamic-Pituitary Adrenal (HPA) axis
Stress related - fight or flight Corticotrophin releasing factor (hypothalamus) Adrenocortocotrophic hormone (anterior pituitary) Glucocorticoids (Cortisol) (Adrenal Cortex) Increases blood sugar, heart rate, and inhibits overreaction
of the immune system Serotonin modulates the threshold of stimulation
Stress related - fight or flight Corticotrophin releasing factor (hypothalamus) Adrenocortocotrophic hormone (anterior pituitary) Glucocorticoids (Cortisol) (Adrenal Cortex) Increases blood sugar, heart rate, and inhibits overreaction
of the immune system Serotonin modulates the threshold of stimulation
Cortisol as a predictorCortisol as a predictor
Depressed Adolescents followed 10 years Suicide attempters had increased Cortisol in
4, 6, &12 hours prior to sleep, but reduced at 2-4 hours before sleep (ie dysregulation of HPA axis)
Matthew et al. 2003 Columbia group
Depressed Adolescents followed 10 years Suicide attempters had increased Cortisol in
4, 6, &12 hours prior to sleep, but reduced at 2-4 hours before sleep (ie dysregulation of HPA axis)
Matthew et al. 2003 Columbia group
Disorders: Mean Age of OnsetDisorders: Mean Age of Onset ADHD - symptoms prior to age 7 (by definition) Anxiety - Different forms throughout childhood
(Separation, GAD, Phobic, OCD) Post-traumatic Stress Disorder throughout
childhood Oppositional Defiant Disorder from about 6yrs Conduct Disorder from about 10yrs Delinquency from about 12yrs Depression from peak mean age of onset 15yrs Psychosis from peak mean age of onset 18yrs
ADHD - symptoms prior to age 7 (by definition) Anxiety - Different forms throughout childhood
(Separation, GAD, Phobic, OCD) Post-traumatic Stress Disorder throughout
childhood Oppositional Defiant Disorder from about 6yrs Conduct Disorder from about 10yrs Delinquency from about 12yrs Depression from peak mean age of onset 15yrs Psychosis from peak mean age of onset 18yrs
Unipolar Major DepressionUnipolar Major Depression
Currently the 4th most costly illness in the world, but will be 2nd by the year 2020.
WHO Global Burden of Disease Study
Murray and Lopez, 1997
Currently the 4th most costly illness in the world, but will be 2nd by the year 2020.
WHO Global Burden of Disease Study
Murray and Lopez, 1997
Depression in Young PeopleDepression in Young People
Mood Depressive Syndrome
or Symptom Complex
Disorder or Illness
Mood Depressive Syndrome
or Symptom Complex
Disorder or Illness
So what is Depression ?So what is Depression ?
Sad Mood over time Appetite Disturbance Sleep Disturbance Agitation or Retardation Loss of Interest and Pleasure Low Energy or Fatigue Worthlessness or Guilt Slow Cognition with poor
Concentration and Memory
Sad Mood over time Appetite Disturbance Sleep Disturbance Agitation or Retardation Loss of Interest and Pleasure Low Energy or Fatigue Worthlessness or Guilt Slow Cognition with poor
Concentration and Memory
Psychosocial DifficultiesPsychosocial Difficulties
Self-consciousness Low self-esteem Reduction in activity
are key issues in depressed young peopleLewinsohn, Gotlib & Seeley, 1997
Self-consciousness Low self-esteem Reduction in activity
are key issues in depressed young peopleLewinsohn, Gotlib & Seeley, 1997
The different forms of DepressionThe different forms of Depression
Dysthymia Unipolar Major Depression Bipolar Illness
(may be diagnosed using the
same criteria as for adults)
Dysthymia Unipolar Major Depression Bipolar Illness
(may be diagnosed using the
same criteria as for adults)
Depression in Young PeopleDepression in Young People
Major studies in USA, Canada, Dunedin and Christchurch all conclude that Major Depression occurs in 6-7% of 15 year olds and up to 15% by the age of 18 yrs.
Major studies in USA, Canada, Dunedin and Christchurch all conclude that Major Depression occurs in 6-7% of 15 year olds and up to 15% by the age of 18 yrs.
Case identificationCase identification
Prevalence
In a community sample, 30% had at least one symptom of DSM-IIIR Major Depression
But
only 2.6% were diagnosed
using structured interviewRoberts, Lewinsohn & Seeley, 1995
Recurrence
After 1st episode Major Depression, 47% recur within 1 year, and 69% by 2nd year
Emslie, Rush, Weinberg et al, 1997
Episodes may be more brief, but occur more frequently
Comorbidity
Personality Disorder traits significantly increased to 3.8%
May be associated with negative course
Lewinsohn, Rohde, Seeley & Klein, 1997
Comorbidity (contd.)
First episode schizophreniaAddington, Addington & Patten, 1998
ADHDButler, Arredondo & McCloskey, 1995
AutismHellings, Kelley, Gabrielli et al., 1996
Intellectual disabilityMasi, Marchesi & Pfanner, 1997
Somatic disorderCohen, Pine, Must, Kasen & Brook, 1998
Comorbidity (contd.)
Diabetes (IDDM)Kovacs, Goldston, Obrosky & Bonar, 1997
Sickle Cell DiseaseYang, Cepeda, Price, Shah & Mankad, 1994
Post Traumatic Stress DisorderHubbard, Realmuto, Northwood & Masten, 1995
Young PregnancyDeal & Holt, 1998
HomelessnessReilly, Herrman, Clarke, Neil & McNamara, 1994
Psychotic Symptoms
Delusions and/or hallucinations occur in 10% of major depression
Quinlan, King, Hanna & Ghaziuddin, 1997
Structural changes
• MRI scan showed depressed teens had a 17% reduction in the size of the hippocampus (motivation, emotion and memory formation)
• Thought to be related to depression, though stress and trauma can also cause shrinkage
McMaster & Kusamakar, 2003 Nova Scotia, Canada
‘Out of the Blues’‘Out of the Blues’
Referrals(186) 50% male
Referrals(186) 50% male
Appointments Offered(108) 53.7% male
Appointments Offered(108) 53.7% male
Assessed(94) 50% male
Assessed(94) 50% male
One session only12 males; 6 femalesOne session only
12 males; 6 females
94 Assessmentsmean age 18.2 years
94 Assessmentsmean age 18.2 years
DISTRIBUTION OF AGE
0
5
10
15
20
25
13 14 15 16 17 18 19 20 21 22 23 24
AGE
Primary DiagnosisPrimary Diagnosis
MAJOR DEPRESSION 30 (39.5%)DYSTHYMIA 18 (23.7%)ADJUST. DIS. w. DEP. MOOD 13 (17.1%)BIPOLAR DISORDER 5 (6.6%)ANXIETY 4 (5.3%) PTSD 2 (2.6%)ADHD 2 (2.6%) BEREAVEMENT 1 (1.3%)DRUG -INDUCED PSYCHOSIS 1 (1.3%)
MAJOR DEPRESSION 30 (39.5%)DYSTHYMIA 18 (23.7%)ADJUST. DIS. w. DEP. MOOD 13 (17.1%)BIPOLAR DISORDER 5 (6.6%)ANXIETY 4 (5.3%) PTSD 2 (2.6%)ADHD 2 (2.6%) BEREAVEMENT 1 (1.3%)DRUG -INDUCED PSYCHOSIS 1 (1.3%)
Beck Depression InventoryScores at Time 1
Beck Depression InventoryScores at Time 1
LEVELS OF DEPRESSION Time 1.
0
5
10
15
20
25
30
0 to 9 10 to 18 19 to 29 30+
BECK DEPRESSION INVENTORY (BDI) Scores
LEVELS OF DEPRESSION Time 1.
0
5
10
15
20
25
30
0 to 9 10 to 18 19 to 29 30+
BECK DEPRESSION INVENTORY (BDI) Scores
Suicidal BehavioursSuicidal Behaviours
26 (36%) scores in >10 on the ASQ-R; 37 denied an attempt; 34 attempters:
More than a year ago = 53-12 months ago = 101-3 months ago = 4In last 1 month = 15
26 (36%) scores in >10 on the ASQ-R; 37 denied an attempt; 34 attempters:
More than a year ago = 53-12 months ago = 101-3 months ago = 4In last 1 month = 15
Out of the BluesOut of the Blues
Individual (11)Individual (11)
Individual plus Medication (46)Individual plus Medication (46)
CBT (6)CBT (6)
CBT plus Medication (9)CBT plus Medication (9)
Family Therapy (1)Family Therapy (1)
Family Therapy plus Medication (3)Family Therapy plus Medication (3)
Therapy(76)Therapy(76)
OOTB - BDI scores over time
OOTB - BDI scores over time
Depression from Time 1 to Time 3
10
12
14
16
18
20
22
24
26
28
BDI -T1 BDI-T2 BDI-T3
OOTB - Ham-D scoresOOTB - Ham-D scoresHAMILTON DEPRESSION RATING
SCALE - DEPRESSION
0
5
10
15
20
25
30
35
TIME 1 TIME 3
OOTB - HoNOS over timeOOTB - HoNOS over timeHoNOS
0
2
4
6
8
10
12
14
16
TIME 1 TIME 3
OOTB - Suicidal BehavioursOOTB - Suicidal Behaviours
5 attempts between Time 1 and Time 2(2 medically serious)
3 attempts between Time 2 and Time 3(one a repeat attempter)
(none medically serious)
5 attempts between Time 1 and Time 2(2 medically serious)
3 attempts between Time 2 and Time 3(one a repeat attempter)
(none medically serious)
Overall ConclusionOverall Conclusion
Within the limitations of the study, it did not appear to make much difference which combinations of therapy young people received.
Within the limitations of the study, it did not appear to make much difference which combinations of therapy young people received.
INITIAL PHONE CALL initial management &
safety issues interim supports appointment time no
more than 2 weeks
INITIAL PHONE CALL initial management &
safety issues interim supports appointment time no
more than 2 weeks
Access is Crucial Referral Process
Access is Crucial Referral Process
Resources and Prevention
“Although therapeutic intervention is humane, desirable, and rewarding to....both therapists and clients, it does....little or nothing to reduce the number of new cases (the incidence) of any particular disorder”
Albee, 1982
“Although therapeutic intervention is humane, desirable, and rewarding to....both therapists and clients, it does....little or nothing to reduce the number of new cases (the incidence) of any particular disorder”
Albee, 1982
Prevention of DepressionPrevention of Depression
Resilience
Risk
Prevention of DepressionPrevention of DepressionFamily Dysfunction, Parental Conflict, DivorceTraumatic experience*Physical IllnessGrief and LossTarget PessimismParental Mental Illness, particularly DepressionSocio-economic deprivation and UnemploymentBeing in care or in the juvenile justice systemHomelessnessAbuse, particularly sexual abusePregnancy in young people
Risk
Family Dysfunction, Parental Conflict, DivorceTraumatic experience*Physical IllnessGrief and LossTarget PessimismParental Mental Illness, particularly DepressionSocio-economic deprivation and UnemploymentBeing in care or in the juvenile justice systemHomelessnessAbuse, particularly sexual abusePregnancy in young people
Risk
Prevention of DepressionPrevention of Depression
Protective Factors & Resilience
Temperament building
Resilience building in school
Learned Optimism programs
Options and Choices; personal judgment
Developing sense of self through sport, games, drama
Developing supportive relationships at peer level
and with adults
Stress inoculation
Developing national pride
Protective Factors & Resilience
Temperament building
Resilience building in school
Learned Optimism programs
Options and Choices; personal judgment
Developing sense of self through sport, games, drama
Developing supportive relationships at peer level
and with adults
Stress inoculation
Developing national pride