Depression & Suicide

in the School Setting

PRISCILLA GONZALEZ FERNANDO, M.A., R.P., CSCLP
SPARKS-PSHOA 2016, 15 APRIL 2016, ACE HOTEL, PASIG CITY
DEPRESSION
What is Depression?
 Depression is a medical disorder that causes a person to
feel persistently sad, low, or disinterested in daily
activities.
 While everyone may have occasional moments of feeling
sad or "blue," or a temporary period of sadness in response
to a major loss, a depressive disorder causes those feelings
to continue for an extended period. The tendency to
develop depression involves complex genetic and
environmental factors.

http://www2.massgeneral.org/schoolpsychiatry/info_depression.asp
Depression in Children & Teens
 Depression in young people often looks different than it does in
adults.
 Children or adolescents with depression may look sad or tearful
more frequently than they had previously.
 They may be constantly irritable, or they may be tired, listless, or
uninterested in favorite activities.
 In general, depression is an episodic condition in which a child has
symptoms for several weeks or months, which may then gradually
resolve. A child or adolescent may have recurring depression or a
single episode.

http://www2.massgeneral.org/schoolpsychiatry/info_depression.asp
Depression in Children & Teens
 Depression is not easily recognized or may be mistaken as another
problem, such as lack of motivation.
 Many of these symptoms could easily be mistaken for behavior
problems associated with academic or social difficulties, such as
apathy, low performance, or uncooperativeness. It is important for
school personnel to know the signs so that early identification and
intervention can occur

Depression: Supporting Students at School BY THOMAS HUBERTY, PHD,

ABPP, NCSP, Indiana University, Bloomington
 Responding to a Student's Depression. R. Marc A. Crundwell and Kim Killu.
In Interventions That Work October 2010, Volume 68 Number 2, Pages 46-51
 Responding to a Student's Depression. R. Marc A. Crundwell and Kim Killu.
In Interventions That Work October 2010, Volume 68 Number 2, Pages 46-51
 Responding to a Student's Depression. R. Marc A. Crundwell and Kim Killu.
In Interventions That Work October 2010, Volume 68 Number 2, Pages 46-51
Issues in Recognizing Depression
1. The essential features of depression are as recognizable in youth as they are in adults,
and the same diagnostic criteria are used for both age groups (Mitchell, McCauley,
Burke, & Moss, 1988).
2. Irritability is more common in depressed youth than in depressed adults.
3. Teachers often overlook children with depression because symptoms like a sad mood or
fatigue are more internal and subjective than the kinds of disruptive behavior shown by
kids with more externalizing disorders, such as attention deficit disorder. ---
 Depressed young people often don't ask for help at school because of negative thinking
patterns: No one cares about my feelings, nothing can be done to help me, and so on (Cash,
2003). Younger students often lack the necessary language skills and self-awareness to report
—or recognize—their own depressed state.

Responding to a Student's Depression. R. Marc A. Crundwell and Kim Killu.

In Interventions That Work October 2010, Volume 68 Number 2, Pages 46-51
How Depression Feels

Tired
How Depression Feels

Tired
How Depression Feels

Unworthy
How Depression Feels

Doesn’t
need a
trigger
How Depression Feels

Not in
control
How
Depressi
on Feels

Doesn’t
need a
trigger
How Depression Feels

Helpless.
How Depression Feels

Helpless.
How Depression Feels

Endless.
Hopeless.
How Depression Feels

Endless.
Hopeless.
How Depression Feels

Endless.
Hopeless.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
How Depression
Feels

Hidden.
Alone. No
one knows.
"The hardest part of living with depression and
anxiety for me is feeling like I have to hide it," Sarah
said. "I've always been known as the happy one in
my group of friends. Everyone's always so shocked
when I tell them I have depression or they see the
self-harm scars."
"It's much harder than it should be to say, 'Hey, I have
depression and I've been struggling with self-harm
since I was 10 and I just really need your support to
get me through tonight,'" Sarah explained.

http://www.upworthy.com/a-comic-that-accurately-sums-up-depression-and-
anxiety-and-the-uphill-battle-of-living-with-them
'Today, I am coming out with something that only few of you know. 'I am ready to have a conversation about my
mental illness. Last year, I was diagnosed with depression. 
'And in all honesty, I believe it was a problem for quite a while before that, but I think it just got worse to the point
of hardly functioning.’

‘So today, I got this tattoo. I feel that my leg was the best place for the meaning behind it. 
'When everyone else sees it, they see “I’m fine,” but from my viewpoint, it reads “save me.” 
'To me, it means that others see this person that seems okay, but, in reality, is not okay at all. 
'It reminds me that people who may appear happy, may be at battle with themselves.’

 http://www.dailymail.co.uk/femail/article-3216935/Woman-depression-optical-illusion-tattoo-saying-m-fine-seen-reads-save-sufferers-hide-
REALLY-feeling.html#ixzz45sFfm3aF 
Intervention
 Treatment for depression usually speeds the process of reducing
symptoms, reduces recurrence, and diminishes the time the child
may be at risk for suicide or other consequences of the depressive
episodes (such as school failure, loss of friends, or family conflict). 

http://www2.massgeneral.org/schoolpsychiatry/info_depression.asp
Intervention
 The Treatment for Adolescents with Depression Study (TADS)
found that a combination treatment of medication and
psychotherapy works best for most teens with depression.
 With medication, psychotherapy, or combined treatment, most youth
with depression can be effectively treated. Youth are more likely to
respond to treatment if they receive it early in the course of their
illness.

From NIMH: Depression in Children and Adolescents Fact Sheet

Supporting the Depressed Student
 An important fact to remember is that depressed children are not
choosing to underperform or withdraw. They want to be successful
and often are seeking guidance and support from teachers and
others, but lack the ability to be successful.
 Teachers may be uncertain how to approach and interact with
depressed students, but should remember that they do not need to be
therapists or counselors to provide support.

Depression: Supporting Students at School BY THOMAS HUBERTY, PHD,

ABPP, NCSP, Indiana University, Bloomington
Supporting the Depressed Student
 Develop a Working and Collaborative Relationship With the
Depressed Student
 Avoid Negative Techniques, e.g. scolding, punishment, sarcasm,
disparagement, criticism, indifference.
 Make Adjustments or Accommodations in Assignments or Tasks,
such as: giving more time, breaking assignments into smaller pieces,
offering extra help in organizing schedules or study time, pairing the
student with others who are interested to help.
 Arrange for Experiences of Success.

Depression: Supporting Students at School BY THOMAS HUBERTY, PHD,

ABPP, NCSP, Indiana University, Bloomington
Supporting the Depressed Student
LISTEN.
VALIDATE.
BE NON JUDGMENTAL.
BE PRESENT.
ASK HOW YOU CAN HELP.
Best not to say…
 “But you seem so happy!”
 “Your life is amazing, though!”
 “Have you tried…?”
 “Just get out there and get active — you’ll feel a lot better.”
 “But why are you depressed?”
 “Let’s just go grab a drink and take your mind off it.”
 “You don’t look depressed.”
 “Don’t worry, you’re strong enough to get through this.”
 “But don’t I make you happy?”
 “Just try not to think about it.”
 “But hey, at least you don’t have it as bad as some people.”
 “I understand, I get depressed sometimes, too.”
http://www.buzzfeed.com/annaborges/you-cant-just-choose-
 “It gets better, just hang in there.”
happiness#.gvpYl0V7r
Common Misconceptions
 Depression is not a real medical problem. “It’s all in your head.”
 Depression is something that strong people can “snap out of” by
thinking positively. “Happiness is a choice.”
 It’s a sign of mental weakness
 Depression only happens when something bad happens in your life,
such as a breakup, the death of a loved one, or failing an exam.
 Depression will just go away on its own.
 Talking about depression only makes it worse.

http://www.mentalhealthamerica.net/sites/default/files/Breaking_Down_the_Myths_About_Depression.pdf
http://www.huffingtonpost.com/2014/09/03/depression-myths_n_5715453.html
SUICIDE
Teenagers & Suicide
 Suicide rates differ between boys and girls. Girls think
about and attempt suicide about twice as often as boys, and
tend to attempt suicide by overdosing on drugs or cutting
themselves. Yet boys die by suicide about four times as
often girls, perhaps because they tend to use more lethal
methods, such as firearms, hanging, or jumping from
heights.

From “About Teen Suicide,” KidsHealth.org

Teenagers & Suicide

 Sure, it's a time of tremendous possibility but it also can be

a period of stress and worry. There's pressure to fit in
socially, to perform academically, and to act responsibly.
 Adolescence is also a time of sexual identity and
relationships and a need for independence that often
conflicts with the rules and expectations set by others.

From “About Teen Suicide,” KidsHealth.org

Who’s at Risk?
 Young people with mental health problems — such as
anxiety, depression, bipolar disorder, or insomnia — are at
higher risk for suicidal thoughts.
 Teens going through major life changes (parents' divorce,
moving, a parent leaving home due to military service or
parental separation, financial changes) and those who are
victims of bullying are at greater risk of suicidal thoughts.

From “About Teen Suicide,” KidsHealth.org

Factors that increase the risk of suicide
among teens include:
a psychological disorder, especially depression, bipolar
disorder, and alcohol and drug use (in fact, approximately
95% of people who die by suicide have a psychological
disorder at the time of death)
 feelings of distress, irritability, or agitation
 feelings
of hopelessness and worthlessness that often
accompany depression

From “About Teen Suicide,” KidsHealth.org

Factors that increase the risk of suicide
among teens include:
a previous suicide attempt
a family history of depression or suicide
 emotional, physical, or sexual abuse
 lack of a support network, poor relationships with parents
or peers, and feelings of social isolation
 dealingwith bisexuality or homosexuality in an
unsupportive family or community or hostile school
environment
From “About Teen Suicide,” KidsHealth.org
Warning Signs
Teens who are thinking about suicide
might:
 talk about suicide or death in general
 give hints that they might not be around anymore
 talk about feeling hopeless or feeling guilty
 pull away from friends or family
 write songs, poems, or letters about death, separation,
and loss
From “About Teen Suicide,” KidsHealth.org
Warning Signs
Teens who are thinking about suicide
might:
 startgiving away treasured possessions to siblings or
friends
 lose the desire to take part in favorite things or
activities
 have trouble concentrating or thinking clearly
 experience changes in eating or sleeping habits
From “About Teen Suicide,” KidsHealth.org
Warning Signs
Teens who are thinking about suicide
might:
 engage in risk-taking behaviors
 lose interest in school or sports

From “About Teen Suicide,” KidsHealth.org

What Can Parents Do?
Many teens who commit or attempt suicide
have given some type of warning to loved
ones ahead of time. So it's important for
parents to know the warning signs so teens
who might be suicidal can get the help they
need.

From “About Teen Suicide,” KidsHealth.org

What Can Parents Do?
Some adults feel that kids who say they are
going to hurt or kill themselves are "just
doing it for attention." It's important to
realize that if teens are ignored when
seeking attention, it may increase the
chance of them harming themselves (or
worse).

From “About Teen Suicide,” KidsHealth.org

What Can Parents Do?
Keep a close eye on a teen who is
depressed and withdrawn. Understanding
depression in teens is very important since
it can look different from commonly held
beliefs about depression. For example, it
may take the form of problems with friends,
grades, sleep, or being cranky and irritable
rather than chronic sadness or crying.
From “About Teen Suicide,” KidsHealth.org
What Can Parents Do?
It's important to try to keep the lines of
communication open and express your
concern, support, and love. If your teen
confides in you, show that you take those
concerns seriously….
It's important not to minimize or discount
what your teen is going through, as this can
increase his or her sense of hopelessness.
From “About Teen Suicide,” KidsHealth.org
What Can Parents Do?
If your teen doesn't feel comfortable talking
with you, suggest a more neutral person,
such as another relative, a clergy member,
a coach, a school counselor, or your child's
doctor.

From “About Teen Suicide,” KidsHealth.org

What Can Parents Do?
Remember that ongoing conflicts between a parent and
child can fuel the fire for a teen who is feeling isolated,
misunderstood, devalued, or suicidal. Get help to air
family problems and resolve them in a constructive way.
Let the mental health professional know if there is a
history of depression, substance abuse, family violence,
or other stresses at home, such as an ongoing
environment of criticism.

From “About Teen Suicide,” KidsHealth.org

What should I do if I believe someone to be suicidal?

 Do not minimize their feelings or problems.

 Listen to them, support them, believe them, and let them know that
they are not the first person to feel this way.
 Do not keep a secret about suicidal behavior. There is help
available--mental health professionals such as counselors and
psychologists have special training to help young people who are
suicidal.
 Itis important to stay with the person until they are connected to
their support system. If you feel someone is in imminent danger,
call 911.
https://www.dcsdk12.org/sites/default/files/studentwellness/Tips_after_Suicide-Helping_Students_Cope.pdf
If a student commits suicide
 Normalize and validate the whole range of feelings such as anger, sadness, shock,
fear or confusion.
 When talking with students, state that the student died by suicide (NOT committed
suicide or successfully attempted).
 To avoid contagion (copy cat) situations, give students the facts, but do not attempt
to explain details or why the student ended his/her life. Doing so may communicate
to vulnerable students that death is a way to obtain incredible amounts of attention.
 Do not allow students to romanticize or view suicide as an acceptable means to
deal with problems. Focus instead on helping students cope with their own grief.
 Remind students that there are positive coping strategies (talking to a trusted friend
or adult, writing thoughts or feelings, exercise, rest) for life’s difficulties and that
there are resources for anyone contemplating suicide.

https://www.dcsdk12.org/sites/default/files/studentwellness/Tips_after_Suicide-Helping_Students_Cope.pdf
If a student commits suicide
 Do not feel you must give advice or suggestions. It is acceptable to say, “I
don’t know, or I don’t know the answer, or “This is hard on us all”.
 Do not attempt to impose your explanation on why this has happened.
 Do not attempt to reassure that everything is okay.
 Do not tell them you know how he/she feels (because you probably don’t).
 Be willing to say nothing.
 Do not lecture or use well-intentioned clichés that minimize or take away
from a student’s need to mourn. For example, do not say things like “time
heals all wounds.”

https://www.dcsdk12.org/sites/default/files/studentwellness/Tips_after_Suicide-Helping_Students_Cope.pdf