Copyright Michelle Roling, M.Ed., LMHC 2007 Depression and Anxiety Amongst Our Students Michelle Roling M.Ed., LMHC Iowa State University Student Counseling

Copyright Michelle Roling, M.Ed., LMHC 2007

Depression and Anxiety Amongst Our Students

Michelle Roling M.Ed., LMHC

Iowa State University

Student Counseling Services

Private Practice Clinician


ANXIETY


Statistics: Number one health problem in America 25% of adults struggle with anxiety Stats in children are significantly under

reported and under-diagnosed Estimated that the 25% is an accurate number

across age groups


Early Anxiety = Adult Struggle?? Consensus in medical literature:

many “adult psychiatric disorders” first manifest themselves in childhood

when the childhood anxiety goes untreated it progresses into more complex and difficult to treat anxiety disorders


Common Signs: Feeling nervous Feeling frightened for no reason Worrying excessively Feeling scared at times of separation Shyness


What Causes Anxiety? Four areas to explore

Psychological Genetic Biological Medical


Psychological Increased internal and external stresses lessen

our ability to cope- Psychodynamic-instincts and impulses conflict;

internal battle about what to do Behavioral- “Doing” the anxious behaviors rather

than “doing” something that might manage the emotions

Spiritual- emptiness, nothingness in life leading to distress about mortality and eventual death


Genetic Studies show 50% ≥ of patients have family

member with an anxiety disorder Twin studies echo this finding


Biological PET scans- evidence of abnormal functioning

in several areas of the brain Several “chemicals” affected-

Serotonin Norepinephrine GABA


Medical- Medically induced anxiety

Cardiovascular disease Lung disease Some tumors Endocrine disorders- hypothyroidism Neurological disorders


Types of Anxiety Disorders Generalized Anxiety Disorder (GAD) Panic Disorder (PD) Obsessive- Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Social Phobia (SOC) Acute Stress Disorder Specific Phobia Adjustment Disorder with Anxiety Anxiety Disorder due to General Medial Condition Drug Induced Disorder Anxiety Not Otherwise Specified (NOS)


Generalized Anxiety Disorder Excessive worry,

apprehension, anxiety occurring most days for 6 months or more

Concern over multiple activities

Significant distress and impact on general function

Struggle to control the anxiety Restlessness Feeling ‘keyed up” On edge Fatigued Lack of concentration Mind going blank Tension Sleep disturbance


Panic Disorder Recurrent unexpected panic attacks Worry between attacks about having the next

attack Marked changes in behavior Frequently associated with Agoraphobia Differentiated from panic attacks- 4 of 13 symptoms- sudden discrete

episodes of: ear palpitations; sweating; trembling/shaking; shortness of breath; choking; chest discomfort/pain; nausea; dizzy/ lightheaded/ faint; feelings of unreality/detached; fear of loosing control; fear of dying; numbness/tingling; chills/hot flashes;


Obsessive Compulsive Disorder Persistent Obsessions

Unwanted thoughts, images, ideas and urges Persistent Compulsions

Uncontrollable repetitive behaviors Experience Notable Distress in their life Often pertaining to-

contamination/checking/cleanliness


Posttraumatic Stress Disorder Exposed to or witness to an event that

involved actual or perceived death or serious bodily injury

Continued re-exposure Dreams, images, thoughts

Symptoms persist for more than 1 month


Social Phobia Fear of one or more social situations Fear of being embarrassed or humiliated Leading to avoidance of situations

Consider the impact of technological interactions and the lack of face to face communication!!!!


Acute Stress Disorder Exposed to or witness to an event that

involved actual or perceived death or serious bodily injury

Continued re-exposure Dreams, images, thoughts

Symptoms persist for less than 1 month


Specific Phobia Fear is recognized as unreasonable and

excessive Specific object or situation

Animal type Environmental type Injection-Injury type Situational type


Adjustment Disorder with Anxiety With or without depressed mood Occurs within 3 months of an event Does not last longer than 6 months past the

event ending


Anxiety due to medical condition Physiological consequences of a distinct

medical condition


Drug-induced Anxiety Disorder Physiological consequences of the use of a

drug/medication


Anxiety NOS When anxiety exists, but does not meet

criteria previously explained


How do we know WHEN to treat? Anxiety interferes with daily functioning-

Confidence Attendance Interaction

Remember that with treatment symptoms can be reduced or eliminated for 70-90% of patients when treated!

The earlier the less impact on the individual


Link between Anxiety and Depression Studies demonstrate that anxiety left untreated

can lead to the development of Major Depressive Disorder

Dual diagnosis occurs regularly for students


Depression


Statistics In the last 25 years the general rate of suicide has

decreased while it has tripled for those between the ages of 15-24

Suicide is the most common cause of death for this population in the United States

Over 40% of students with depression think of hurting themselves (FDA)

Nearly 1 in 6 students think about suicide in a year (CDC)


Diagnosis Based on 5 symptoms lasting for

only 2 weeks or more


Common SignsMajor Depressive DO Depressed Mood much

of the day

Signs in Students: Irritable or cranky

moood; preoccupation with song lyics that suggest life is meaningless


Common SignsMajor Depressive DO Decreased

interest/enjoyment in once-favorite activities

Signs in Students: Loss if interest in

sports, video games and activities with friends


Common SignsMajor Depressive DO Significant weight

loss/gain

Signs in Students: Failure to gain weight

as normally expected; anorexia or bulimia; frequent complaints of physical illness (headache, stomach..)


Common SignsMajor Depressive DO Insomnia or

hypersomnia

Signs in Students: Excessive late-night

TV; refusal to wake for school in the morning


Common SignsMajor Depressive DO Psychomotor

agitation/retardation

Signs in Students: Talk of running away

from home or efforts to do so


Common SignsMajor Depressive DO Fatigue or loss of

energy

Signs in Students: Persistent boredom


Common SignsMajor Depressive DO Low-self-esteem;

feeling of guilt

Signs in Students: Oppositional and or

negative behavior


Common SignsMajor Depressive DO Decreased ability to

concentrate; indecisive

Signs in Students: Poor performance in

school; frequent absences


Common SignsMajor Depressive DO Recurrent suicidal

ideation or behavior

Signs in Students: Recurrent suicidal

ideation or behaviors- writing about death, giving away favorite things


Pay attention to general changes in your student: Appearance- self-neglect or new attention to

self Isolation Recklessness Outbursts- depression often hides behind

anger


What Causes Depression? Three factors to consider

Biological factors Psychological factors Environmental factors


Biological factors Genetic link-familial and inherited Pre-frontal cortex changes-larger left-side Neurotransmitters-decreased (norephinephrine, dopamine and

serotonin) Hydrocortisone- increased Gender trends- important re: prevention strategies

adults f = myoung adults f ≥ madolescents f ≥ mpre-puberty f ≤ mchildhood f = m


Psychological factors The way people think and behave

Real loss or symbolic loss Unconscious anger over loss weakens the ego Self-hate and self-destructive behavior

Irrational and illogical thought process Negative cognitive view

Gloominess, pessimism, self-criticism, skepticism… Learned helplessness

Prolonged exposure to uncontrollable events leading to apathy


Environmental factors Stressful experiences-

divorce of parents Siblings Moves hormonal changes…

Social roles: f- loss of relationships; m-disappointment re: sports


Types of Depressive Disorders Major Depression Dysthymia Bi-polar Adjustment Disorder with Depression


How do we know WHEN to treat? Children with depression are 5 times more

likely to attempt suicide If there is a gun in the home there is 5 times

more likeliness of a suicide by the student Early intervention is ideal!!!!!!


Treatment for Anxiety and Depression Accurate Diagnosis Therapy Medication Team approach


Diagnosis Assessments Medical physical Asking questions


Therapy Talk, talk, talk Challenge negative cognitions Incorporate self-care Model Coping skills


Medications People are scared due to FDA warnings First line of defense for biologically based

disorders


Treatment team Student Parents Therapist Doctor School staff


Ideas for schools --- Coping carts Self-care days Drop boxes for comments/concerns Ask for help cards Open discussions re: mood Activities in class encouraging self-disclosure-

bibliotherapy/reports/journals/art/book alterations/awareness weeks/passive and active programming


Resources www.nami.org www.teenshealth.org www.aboutourkids.org- great book list Depression in Children and Adolescents:

information for Families and Educators www.naspcenter.org

Documents

Copyright Michelle Roling, M.Ed., LMHC 2007 Depression and Anxiety Amongst Our Students Michelle Roling M.Ed., LMHC Iowa State University Student Counseling