Mental Health Awareness Month was established in May of 1949 to increase awareness of the importance of mental health and wellness in Americans’ lives and to celebrate improvements in mental health treatment. Nearly 75 years later as we honor mental health awareness in this country, we are confronted with an alarming rise in mental health needs among America’s youth that the U.S. Surgeon General advises could be helped in part with school-based prevention and intervention supports.
One approach to school-based mental health is being tested in an IES-funded efficacy replication study called School Adolescent Mood Project: Efficacy of IPT-AST in Schools. This project is being led by Dr. Jami Young, associate chair of research in the Department of Child and Adolescent Psychiatry and Behavioral Sciences, faculty member in the PolicyLab at the Children’s Hospital of Philadelphia (CHOP), and professor of psychiatry at the University of Pennsylvania Perelman School of Medicine. Dr. Young was interviewed by Rebecca Sun, IES Intern, to help us learn more about conditions on the ground in her study and how telehealth-delivered Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is working in these schools.
Tell us about the schools you are working in and the different mental health needs you are seeing. How do you think the pandemic influenced what you are seeing now?
In the School Adolescent Mood Project (SAM project), we have been working closely with 16 schools in Pennsylvania and New Jersey that serve 9th and 10th grade students. Over the past three years, what we are seeing in these 16 schools is very different than what we are used to seeing in our past two decades of school-based depression prevention work. Compared to our earlier studies (see this one for example), in the current SAM project, the rate of teens with elevated scores on our depression screening has more than doubled, as has the percentage of students with scores indicating more significant depression.
The increases we have seen in the SAM project mirror increases in depression and anxiety that have been reported by others during the pandemic, including the most recent findings reported by the CDC. Our still unpublished screening data from the SAM project suggest that there are a substantial number of adolescents who are experiencing mental health difficulties and would benefit from services in schools and/or the community. There is much work that needs to be done, including increases in funding and workforce expansion, to grow and sustain school-based services to support these students. Additionally, establishing connections between schools and mental health agencies is essential, so students who need more intensive services can receive timely care.
What do the youth in your study say are their biggest concerns?
We are seeing many adolescents who are reporting significant issues with depression and anxiety. Unfortunately, we have also seen an increase in adolescents who report suicidal thoughts and behaviors. The pandemic was difficult for many adolescents as they experienced school closures, loss of loved ones to COVID-19, and feelings of loneliness and social isolation. Even with the return to in-person learning and afterschool activities in the 2021-2022 school year that allowed many students to regain a sense of normalcy, other adolescents found the return to school to be a challenging adjustment. In the SAM project, we saw an increase in the number of adolescents who reported serious thoughts of wanting to kill themselves or who had made a suicide attempt from the 2020-2021 school year when most schools were virtual or hybrid to the 2021-2022 school year when schools were back to in person learning. Unfortunately, we have continued to see an increase in the percentage of adolescents reporting thoughts of wanting to kill themselves this academic year.
Our school partners have also noted a significant increase in students with suicide-related concerns. One school counselor shared, “I think we have done more suicide risk assessments this year than the past 5 years combined.” This points to a critical need to fund and implement evidence-based screening, assessment, and prevention initiatives for youth suicide.
What have you learned so far about the feasibility and effectiveness of providing the IPT-AST intervention in a telehealth format?
We needed to think creatively about how to ensure that students received the support that they needed and to consider how we could promote continuity of care if schools needed to close again. We made the decision to deliver IPT-AST through telehealth. We thought the COVID pandemic was an important opportunity to capitalize on the recent growth and innovations in digital health and to study the acceptability and efficacy of IPT-AST when delivered through telehealth.
We’ve interviewed a subset of adolescents who participated in our IPT-AST groups to get their feedback about the program, including how they felt about IPT-AST being delivered through telehealth. We are still analyzing these interviews and looking at our other data on acceptability and feasibility, including attendance and satisfaction data. Anecdotally, we have noticed a change in the acceptability of telehealth over the course of our study. In our first year, providing our group online meant that students could receive services and interact with their peers even when school was closed. As we have moved further from school closures, more adolescents have expressed a desire to return to in-person groups. Several adolescents have suggested we consider hybrid models that incorporate both in-person and virtual sessions. One positive benefit of running IPT-AST groups online is that we have been able to include students from different schools in the same group. If we find positive benefits of telehealth-delivered IPT-AST, it will be interesting to see whether some schools and districts prefer to continue this approach as it will enable providers to deliver these services outside of the school day.
Do you think the pandemic has eased the stigma surrounding seeking mental health?
We do not measure stigma specifically in our study but hope that all the attention around mental health has been beneficial. As May is Mental Health Awareness Month, we think it is important to emphasize that mental health is health. If we can continue to spread this message, stigma around mental health will continue to decrease. We are hopeful that the increased focus on youth mental health, decreases in stigma, and proposed policy solutions to increase access to mental services will mean that more adolescents will be able to get the care they need.
This blog was produced by Emily Doolittle (Emily.Doolittle@ed.gov), NCER team lead for social behavioral research.