Skip to main content

Depression and Rural School Mental Health: Best Practices

  • Chapter
  • First Online:
Handbook of Rural School Mental Health

Abstract

With depression affecting approximately one out of ten young people, it is likely that many children and adolescents will experience this disorder. However, a lack of mental health practitioners in rural areas—as well as a number of other barriers to receiving care—means that rural youth who experience depression in these regions might not receive the mental health care they require. Incorporating mental health services into the school system is an innovative way of ensuring that children and adolescents experiencing mental health difficulties such as depression receive the care they need. This chapter outlines the current state of the treatment of depression in youth in rural areas and ways in which this treatment can be incorporated into schools. Additionally, this chapter reviews the core components of evidence-based treatment of depression, with an emphasis on pragmatic modifications and considerations when this treatment is implemented in a rural school-based context. Exemplar school mental health programs and a case vignette are provided and discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Albright, A., Michael, K., Massey, C., Sale, R., Kirk, A., & Egan, T. (2013). An evaluation of an interdisciplinary rural school mental health programme in Appalachia. Advances in School Mental Health Promotion, 6, 189–202. doi:10.1080/1754730X.2013.808890

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • Anxiety and Depression Association of America (2016). Mental health apps. Retrieved from https://www.adaa.org/finding-help/mobile-apps.

  • Beidas, R. S., Mychailyszyn, M. P., Edmunds, J. M., Khanna, M. S., Downey, M. M., & Kendall, P. C. (2012). Training school mental health providers to deliver cognitive-behavioral therapy. School Mental Health, 4, 197–206. doi:10.1007/s12310-012-9074-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Blunden, S., Hoban, T. F., & Chervin, R. D. (2006). Sleepiness in children. Sleep Medicine Clinics, 1, 105–118. doi:10.1016/j.jsmc.2005.11.006

    Article  Google Scholar 

  • Bureau of Health Workforce Health Resources and Services Administration (HRSA) U.S. Department of Health & Human Services. (2016). Designated health professional shortage areas statistics as of July 24, 2016. Retrieved from https://datawarehouse.hrsa.gov/tools/hdwreports/Reports.aspx.

  • Calear, A. L., Christensen, H., Mackinnon, A., & Griffiths, K. (2013). Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population. Journal of Affective Disorders, 147(1–3), 338–344. doi:10.1016/j.jad.2012.11.036

    Article  PubMed  Google Scholar 

  • Carnevale, T. (2011). An integrative review of adolescent depression screening instruments: applicability for use by school nurses. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 51–57. doi:10.1111/j.1744-6171.2010.00256.x

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). 10 leading causes of death by age group, United States—2014. Retrieved from http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif.

  • Chorpita, B. F., Daleiden, E. L., & Weisz, J. R., (2005). Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Mental Health Services Research, 7, 5-20. doi: 10.1007/s11020-005-1962–6

    Google Scholar 

  • Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, V. R., & Curry, J. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 930–959. doi:10.1097/01.chi.0000127589.57468.bf

    Article  Google Scholar 

  • Costello, E. J., Keeler, G. P., & Angold, A. (2001). Poverty, race/ethnicity, and psychiatric disorder: A study of rural children. American Journal of Public Health, 91, 1494–1498.

    Article  PubMed  PubMed Central  Google Scholar 

  • Creed, T. A., Reisweber, J., & Beck, A. T. (2011). Cognitive therapy for adolescents in school settings. New York: Guilford Press.

    Google Scholar 

  • Cuijpers, P., Munoz, R. F., Clarke, G. N., & Lewinsohn, P. M. (2009). Psychoeducational treatment and prevention of depression: The “coping with depression” course thirty years later. Clinical Psychology Review, 29(5), 449–458. doi:10.1016/j.cpr.2009.04.005

    Article  PubMed  Google Scholar 

  • Dubow, E. F., Lovko, K. R., & Kausch, D. F. (1990). Demographic differences in adolescents’ health concerns and perceptions of helping agents. Journal of Clinical Child Psychology, 19, 44–54. doi:10.1207/s15374424jccp1901_6

    Article  Google Scholar 

  • Eberhardt, M., & Pamuk, E. (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Public Health, 94, 1682–1686.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ebert, D. D., Zarski, A. C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. Plos One, 10(3), 1–15. doi:10.1371/journal.pone.0119895

    Article  Google Scholar 

  • Elliott, B. A., & Larson, J. T. (2004). Adolescents in mid-sized and rural communities: Foregone care, perceived barriers, and risk factors. Journal of Adolescent Health, 35, 303–309. doi:10.1016/j.jadohealth.2003.09.015

    Article  PubMed  Google Scholar 

  • Fontanella, C. A., Hiance-Steelesmith, D. L., Phillips, G. S., Bridge, J. A., Lester, N., Sweeney, H. A., & Campo, J. V. (2015). Widening rural-urban disparities in youth suicides, United States, 1996–2010. JAMA Pediatrics, 169, 466–473. doi:10.1001/jamapediatrics.2014.3561

    Article  PubMed  PubMed Central  Google Scholar 

  • Fortney, J. C., Harman, J. S., Xu, S., & Dong, F. (2010). The association between rural residence and the use, type, and quality of depression care. The Journal of Rural Health, 26, 205–213. doi:10.1111/j.1748-0361.2010.00290.x

    Article  PubMed  Google Scholar 

  • Frank, R. G., Hiskamp, H. A., & Pincus, H. A. (2003). Aligning incentives in the treatment of depression in primary care with evidence-based practice. Psychiatric Services, 54, 682–687. doi:10.1176/appi.ps.54.5.682

    Article  PubMed  Google Scholar 

  • Hauenstein, E. J., Petterson, S., Rovnyak, V., Merwin, E., Heise, B., & Wagner, D. (2007). Rurality and mental health treatment. Administrative Policy in Mental Health and Mental Health Services Research, 34, 255–267.

    Article  Google Scholar 

  • Hedden, S. L., Kennet, J., Lipari, R., Medley, G., Tice, P., Copello, E. A. P., … Hunter, D. (2014). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm.

  • Hernan, A., Philpot, B., Edmonds, A., & Reddy, P. (2010). Healthy minds for country youth: Help-seeking for depression among rural adolescents. The Australian Journal of Rural Health, 18, 118–124. doi:10.1111/j.1440-1584.2010.01136.x

    Article  PubMed  Google Scholar 

  • Hoyt, D. R., Conger, R. D., Valde, J. G., & Weihs, K. (1997). Psychological distress and help seeking in rural America. American Journal of Community Psychology, 25, 449–470.

    Article  PubMed  Google Scholar 

  • Jameson, J. P., & Blank, M. B. (2010). Diagnosis and treatment of depression and anxiety in rural and nonrural primary care: National survey results. Psychiatric Services, 61, 624–627. doi:10.1176/appi.ps.61.6.624

    Article  PubMed  Google Scholar 

  • Jones, A. R., Cook, T. M., & Wang, J. (2011). Rural-urban differences in stigma against depression and agreement with health professionals about treatment. Journal of Affective Disorders, 134(1–3), 145–150. doi:10.1016/j.jad.2011.05.013

    Article  PubMed  Google Scholar 

  • Jureidini, J. N., Doecke, C. J., Mansfield, P. R., Haby, M. M., Menkes, D. B., & Tonkin, A. L. (2004). Efficacy and safety of antidepressants for children and adolescents. British Medical Journal, 328, 879–883. doi:10.1136/bmj.328.7444.879

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuo, E. S., Vander Stoep, A., Herting, J. R., Grupp, J., & McCauley, E. (2013). How to identify students for school-based depression intervention: can school record review be substituted for universal depression screening? Journal of Child and Adolescent Psychiatric Nursing, 26, 42–52. doi:10.1111/jcap.12010

    Article  PubMed  Google Scholar 

  • Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression. Behavior Modification, 25, 225–286.

    Article  Google Scholar 

  • Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385–401. doi:10.1016/S0005-7894(05)80353-3

    Article  Google Scholar 

  • Lovato, N., & Gradisar, M. (2014). A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice. Sleep Medicine Reviews, 18, 521–529. doi:10.1016/j.smrv.2014.03.006

    Article  PubMed  Google Scholar 

  • Melnyk, B. M., Kelly, S., & Lusk, P. (2014). Outcomes and feasibility of a manualized cognitive-behavioral skills building intervention: group COPE for depressed and anxious adolescents in school settings. Journal of Child and Adolescent Psychiatric Nursing, 27, 3–13. doi:10.1111/jcap.12058

    Article  Google Scholar 

  • Merwin, E., Hinton, I., Dembling, B., & Stern, S. (2003). Shortages of rural mental health professionals. Archives of Psychiatric Nursing, 17, 42–51. doi:10.1053/apnu.2003.1

    Article  PubMed  Google Scholar 

  • Michael, K. D., Albright, A., Jameson, J. P., Sale, R., Massey, C., Kirk, A., & Egan, T. (2013). Does cognitive behavioral therapy in the context of a rural school mental health programme have an impact on academic outcomes? Advances in School Mental Health Promotion, 6, 247–262. doi:10.1080/1754730X.2013.832006

    Article  Google Scholar 

  • Michael, K. D., George, M. W., Splett, J. W., Jameson, J. P., Sale, R., Bode, A. A., … Weist, M. D. (2016). Preliminary outcomes of a multi-site, school-based modular intervention for adolescents experiencing mood difficulties. Journal of Child and Family Studies, 25, 1903–1915. doi:10.1007/s10826-016-0373-1

    Article  Google Scholar 

  • Michael, K. D., & Merrell, K. W. (1998). Reliability of children’s self-reported internalizing symptoms over short to medium-length time intervals. Journal of American Academy of Child and Adolescent Psychiatry, 37, 194–201. doi:10.1097/00004583-199802000-00012

    Article  Google Scholar 

  • Mufson, L., Dorta, K. P., Wickramarante, P., Nomura, Y., Olfson, M., & Weissman, M. M. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577–584. doi:10.1001/archpsyc.61.6.577

    Article  PubMed  Google Scholar 

  • Mufson, L., & Sills, R. (2006). Interpersonal Psychotherapy for depressed adolescents (IPT-A): An overview. Nordic Journal of Psychiatry, 60, 431–437. doi:10.1080/08039480601022397

    Article  PubMed  Google Scholar 

  • Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573–579.

    Article  PubMed  Google Scholar 

  • National Sleep Foundation. (2016). Sleep hygiene. Retrieved from https://sleepfoundation.org/ask-the-expert/sleep-hygiene.

  • Ng, M. Y., Eckshtain, D., & Weisz, J. R. (2015). Assessing fit between evidence-based psychotherapies for youth depression and real-life coping in early adolescence. Journal of Clinical Child & Adolescent Psychology, 0, 1–17. doi:10.1080/15374416. 2015.1041591.

    Google Scholar 

  • Noel, L. T., Rost, K., & Gromer, J. (2013a). A depression prevention program for rural adolescents: modification and design. Children & Schools, 35, 199–211. doi:10.1093/cs/cdt018

    Article  Google Scholar 

  • Noel, L. T., Rost, K., & Gromer, J. (2013b). Depression prevention among rural preadolescent girls: A randomized controlled trial. School Social Work Journal, 38, 1–18. doi:10.1007/s10802-005-9014-7

    Google Scholar 

  • O’Shea, G., Spence, S. H., & Donovan, C. L. (2015). Group versus individual interpersonal psychotherapy for depressed adolescents. Behavioural and Cognitive Psychotherapy, 43, 1–19. doi:10.1017/S1352465814000216

    Article  PubMed  Google Scholar 

  • Owens, J. S., Watabe, Y., & Michael, K. D. (2011). Culturally responsive school mental health in rural communities. In C. S. Clauss-Ehlers, Z. Serpell, & M. D. Weist (Eds.), Handbook of culturally responsive school mental health: Advancing research, training, practice, and policy (pp. 31–42). New York, NY: Springer.

    Google Scholar 

  • Puskar, K. P., Tusaie-Mumford, K., Sereika, S. M., & Lamb, J. (1999). Screening and predicting adolescent depressive symptoms in rural settings. Archives of Psychiatric Nursing, 13, 3–11.

    Article  PubMed  Google Scholar 

  • Robinson, W. D., Springer, P. R., Bischoff, R., Geske, J., Backer, E., Olson, M., … Swinton, J. (2012). Rural experiences with mental illness: Through the eyes of patients and their families. Families, Systems, and Health, 30, 308–321. doi:10.1037/a0030171

    Article  PubMed  Google Scholar 

  • Rost, K., Fortney, J., Fischer, E., & Smith, J. (2002). Use, quality, and outcomes of care for mental health: The rural perspective. Medical Care Research and Review, 59, 231–265.

    Article  PubMed  Google Scholar 

  • Ruble, A. E., Leon, P. J., Gilley-Hensley, L., Hess, S. G., & Swartz, K. L. (2013). Depression knowledge in high school students: effectiveness of the adolescent depression awareness program. Journal of Affective Disorders, 150, 1025–1030. doi:10.1016/j.jad.2013.05.033

    Article  PubMed  Google Scholar 

  • Sburlati, E. S., Schniering, C. A., Lyneham, H. J., & Rapee, R. M. (2011). A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clinical Child and Family Psychology Review, 14, 89–109. doi:10.1007/s10567-011-0083-6

    Article  PubMed  Google Scholar 

  • Seeley, J. R., Stice, E., & Rhode, P. (2009). Screening for depression prevention: identifying adolescent girls at high risk for future depression. Journal of Abnormal Psychology, 118, 161–170. doi:10.1037/a0014741

    Article  PubMed  PubMed Central  Google Scholar 

  • Shirk, S. R., Gudmundsen, G., Kaplinski, H. C., & McMakin, D. L. (2008). Alliance and outcome in cognitive-behavioral therapy for adolescent depression. Journal of Clinical Child & Adolescent Psychology, 37, 631–639. doi:10.1080/15374410802148061

    Article  Google Scholar 

  • Shirk, S. R., Kaplinski, H., & Gudmundsen, G. (2009). School-based cognitive-behavioral therapy for adolescent depression: A benchmarking study. Journal of Emotional and Behavioral Disorders, 17, 106–117. doi:10.1177/1063426608326202

    Article  Google Scholar 

  • Singh, G. K., Azuine, R. E., Siahpush, M., & Kogan, M. D. (2013). All-cause and cause-specific mortality among US youth: Socioeconomic and rural-urban disparities and international patterns. Journal of Urban Health, 90, 388–405. doi:10.1007/s11524-012-9744-0

    Article  PubMed  Google Scholar 

  • Singh, G. K., & Siahpush, M. (2002). Increasing rural-urban gradients in US suicide mortality, 1970–1997. American Journal of Public Health, 92, 1161–1167.

    Article  PubMed  PubMed Central  Google Scholar 

  • The TADS Team. (2007). The treatment for adolescents with depression study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132–1144. doi:10.1001/archpsyc.64.10.1132

    Article  Google Scholar 

  • Tudiver, F., Edwards, J. B., & Pfortmiller, D. T. (2010). Depression screening patterns for women in rural health clinics. The Journal of Rural Health, 26, 44–50. doi:10.1111/j.1748-0361.2009.00264.x

    Article  PubMed  Google Scholar 

  • U.S. Food and Drug Administration. (2013). FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Retrieved from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108905.htm.

  • United States Department of Agriculture. (2015). Rural America at a glance: 2015 edition. http://www.ers.usda.gov/media/1952235/eib145.pdf.

  • Van Voorhees, B. W., Fogel, J., Reinecke, M. A., Gladstone, T., Stuart, S., Gollan, J., … Bell, C. (2009). Randomized clinical trial of an internet-based depression prevention program for adolescents (Project CATCH-IT) in primary care: 12-week outcomes. Journal of Developmental & Behavioral Pediatrics, 30, 23–37. doi:10.1097/DBP.0b013e3181966c2a

    Article  Google Scholar 

  • Wallis, A., Roeger, L., Milan, S., Walmsley, C., & Allison, S. (2012). Behavioural activation for the treatment of rural adolescents with depression. Australian Rural Health, 20, 95–96. doi:10.1111/j.1440-1584.2012.01261.x

    Article  Google Scholar 

  • Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640.

    Article  PubMed  Google Scholar 

  • Warner, C. M., & Fox, J. K. (2012). Advances and challenges in school-based intervention for anxious and depressed youth: Identifying and addressing issues of sustainability. School Mental Health, 4, 193–196. doi:10.1007/s12310-012-9087-8

    Article  Google Scholar 

  • Weist, M. D., & Murray, M. (2007). Advancing school mental health promotion globally. Advances in School Mental Health Promotion, Inaugural Issue, 1, 2–12. doi:10.1080/1754730X.2008.9715740

    Google Scholar 

  • White, M. (2007). Maps of narrative practice. New York: W.W. Norton & Company, Inc..

    Google Scholar 

  • Young, J. F., Kranzler, A., Gallop, R., & Mufson, L. (2012). Interpersonal psychotherapy-adolescent skills training: Effects on school and social functioning. School Mental Health, 4, 254–264. doi:10.1007/s12310-012-9078-9

    Article  PubMed  PubMed Central  Google Scholar 

  • Ziller, E., Anderson, N., & Coburn, A. (2010). Access to rural mental health services: Service use and out-of-pocket costs. The Journal of Rural Health, 26, 214–224. doi:10.1111/j.1748-0361.2010.00291.x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carissa M. Orlando .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Orlando, C.M., Bode, A.A., Michael, K.D. (2017). Depression and Rural School Mental Health: Best Practices. In: Michael, K., Jameson, J. (eds) Handbook of Rural School Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-319-64735-7_11

Download citation

Publish with us

Policies and ethics