COI Statement. Acknowledgements

Transcription

1 Antecedents of Treatment Resistant Depression in Children Bullied by Peers National Centre Against Bullying Conference 2016 Melbourne, July Presenter: Dr Karyn Healy Parenting and Family Support Centre Acknowledgements Data drawn from trial of Resilience Triple P funded by: Australian Research Council (Discovery Grant) Supplemented by philanthropic donations by the Butta and Filewood families Paper co-authorship of Professor Matt Sanders COI Statement As a Resilience Triple P author with Professor Matt Sanders, I may in future earn royalties from publication of the program Resilience Triple P is owned by the University of Queensland. The University licenses Triple P International Pty Ltd to publish Triple P programs worldwide. Royalties from publication are distributed to university faculty, school, centre and contributory authors. No author has a share or ownership in Triple P International. Treatment resistant refers to the failure of an individual to improve despite receiving treatment which is usually effective in reducing symptoms. Overview Relationship between victimisation and depression Background on children studied Child and family factors relevant to depression Methodology and results Implications for schools What parents can do to protect children against depression following victimisation Fava, M., & Davidson, K. G. (1996). Definition and epidemiology of treatment-resistant depression. Psychiatric Clinics of North America, 19(2),

2 Relationship between victimisation and depression School bullying is the single-most important modifiable risk factor for mental illness in children and adolescents. (Scott, Moore, Sly & Norman, 2014). Serious mental health risks from being bullied in primary school After taking into account previous emotional adjustment and family factors, The Downward Spiral of Victimisation and Emotional Reactivity being bullied at age 8-10 produces higher rates of: Depression and anxiety 2 yrs later (Arseneault et al., 2008), Self-harm and psychotic problems by 12 years of age (Fisher et al., 2012; Schreier et al, 2009) Depression and psychiatric problems in early adulthood and up to 32 years later (Sourander et al 2007; Farrington, Loeber, Stallings, &Ttofi, 2011). Emotionally reactive Victimised by peers (Hodges & Perry, 1999) The Downward Spiral for Children who are Passive Victims Internalising problems depression and anxiety The Downward Spiral for Children who are Provocative Victims Externalising angry lashing out Targeted by peers for bullying (Hodges & Perry, 1999) Targeted by peers for bullying e.g. Spence, De Young, Toon and Bond,2009 2

3 Families in trial of Resilience TP Background on sample of children studied 111 families of children were recruited who were reported (by parents) to be bullied at school. Bullying was defined as hurtful behaviour which is typically repeated, and can be physical, verbal or indirect social, and carried out in person or through technology. The child experienced either ongoing bullying for the past month or recurrent problems over more than one year. The child was aged between 6 and 12 years, and attended a regular school The 111 families were randomly allocated to Resilience Triple P or control conditions. Resilience Triple P Reference for trial paper publication Social Skills training for children (4 sessions in groups with other children & parents) Facilitative Parenting training for parents (4 sessions in group with other parents) Facilitative Parenting is. parenting which is supportive of children s development of peer skills and relationships Healy, Sanders & Iyer, 2013 Facilitative Parenting involves Being warm and responsive Coaching children s problemsolving 3

4 Outcomes of Trial of Resilience TP Results: Child depression Compared with families in the control condition, children whose families received Resilience Triple P showed: Greater reductions in overt victimisation Greater reductions in emotional distress Greater reductions in depression Better acceptance by peers Less aggressive behaviour towards peers Liking school more Improved sibling relationships Healy & Sanders (2014). Child Depression: Parent report Depression at 9 mths for children with elevated depression at start Assessment Control Group n = 34 Resilience Triple P Group n = 39 General sample Change over conditions over time p =. 008 Treatment effect size d =.51(med) n = 27 n = 7 Improved to within normal Still clinical depression n = 13 n = 27 n = 26 Improved to within normal Still clinical depression The focus of the current study Aims of current study Comparison of the 13 children who were still depressed 6 months following intervention from the 26 children who were no longer depressed. Resilience Triple P Group n = 39 n = 13 n = 26 Improved to within normal Still clinical depression To test if child social factors and parenting post intervention predict persistence of depression symptoms 6 months later 4

5 Sample Demographics: 39 Children Age of children involved Child gender Number 8 Girls Boys 6 4 Number yrs 7 yrs 8 yrs 9 yrs 10 yrs 11 yrs 12 yrs Child Diagnosis Prior Psychiatric Diagnosis No diagnosis ASD ADHD/ ADD Specific learning disability Sensory integration disorder Anxiety Multiple diagnoses Other Child and family factors likely to impact child depression Child and Family Factors Relevant to Child Depression Victimisation by peers (Reijntjes, Kamphuis, Prinzie & Telch, 2010) Cognitive processing of peer situations (Prinstein, Cheah & Guyer, 2005) Support from peers (Auerbach et al, 2011) Parenting: - warm supportive parenting (Bilsky et al., 2013) Methodology and Results - over-controlling parenting(mcleod, Weisz & Wood, 2007) - facilitative parenting (Healy, Sanders & Iyer, 2013) 5

6 Hypothesis: that children with treatment resistant depression 6 months after participating in the program would be discriminated from children who were nolonger depressed by: higher levels of depression, peer victimization, and negative interpretations of peer behaviour, lower levels of peer support and facilitative parenting immediately following program participation. Design Independent Variables Post intervention measures of: depression peer victimisation negative interpretations of peer behaviour peer support facilitative parenting Dependent Variable Depression 6 months later (depressed or not depressed according to clinical cut-off on scale) Measures Respondent Variable Measure Teacher Overt Victimisation Preschool Peer Victimization Scale (Crick, Casas, & Ku, 1999) Social Victimisation Acceptance by peers of same sex Acceptance by peers of opposite sex Preschool Social Behavior Scale (Crick, Casas, & Mosher, 1997) Child Victimization by peers in last week Things kids do (Healy & Sanders, 2008a) Internalising interpretations Internalising feelings Friendedness Sensitivity to peer behaviour interview (Healy & Sanders 2008b) The Loneliness Scale (Asher & Wheeler, 1985) Results Parent Child depression Preschool feelings checklist (Luby, Heffelfinger, et al, 1999) Facilitative parenting Facilitative Parenting Scale (Healy & Sanders 2008c) Results A combination of the variables measured post intervention significantly discriminated between children with persistent depressive symptoms 6 months later from children who were no longer depressed,(p =.009). Variables which Best Distinguished Treatment-Resistant Depression The post intervention variables which significantly distinguished children with or without elevated depression 6 months later were: acceptance by opposite sex peers (r =.64), child depression (r = -.53), acceptance by same sex peers (r =.50), facilitative parenting (r =.38), and social victimisation (r = -.22). 6

7 How well do these variables predict whether a child is depressed 6 months later? Facilitative Parenting Subscales: Which Discriminated Depression 6 months later? Classification of cases using the discriminant function resulted in correct classification of: 87.2 % of the total sample 90.2 % of the not-depressed group 69.2 % of children still-depressed at 9 months. Repeat of Analysis using Facilitative Parenting Subscales Four facilitative parenting subscales significantly discriminated treatment-resistant depression: Parent Coaches Not Conflict (between parent and child) Not Overly Directive Not Aggressively Defensive Implications for schools What does this mean for schools Schools need to be aware that children who are bullied by peers are at ongoing increased risk for ongoing depression and monitor students wellbeing Addressing overt victimisation is not enough: children can remain at-risk of depression even following reduction of overt victimisation Supportive relationships with peers and parents are important following victimisation in protecting child against further depression Teachers can assist children to strengthen their relationships with peers Signs of depression in children Persistent sadness Increased irritability, anger or hostility Disinterest in previously enjoyed activities Significant changes to appetite Insomnia or hyposomnia Frequent vague, non-specific physical complaints Fatigue or lack of energy Feelings of worthlessness or guilt Absences from school or drop in performance in school Recurrent thoughts of death or suicide Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition TR (2013) American Psychiatric Association. 7

8 How teachers can promote positive peer support Take care not to inadvertently mark the child as different to other children Create opportunities for the child to work in class with other children with similar interests Encourage the child (including through the parent) to be involved in extra-curricular activities Demonstrate acceptance of all students Demonstrate and teach kind and respectful behaviour Address disrespectful behaviour firmly and consistently Address any behaviour of the child which may be upsetting or annoying to peers Implications for parents Implications for parents Be aware that children who are bullied by peers are at ongoing increased risk for ongoing depression and watch out for warning signs Coach your child in how to improve relationships and solve problems with peers Resolve conflict between you and your child calmly Help your child to make their own decisions rather than telling them what to do Refrain from attacking others on behalf of your child: instead work with your child and work with your child s school to address problems Maintain a warm supportive relationship with your child Implications for parents Be aware that children who are bullied by peers are at ongoing increased risk for ongoing depression and watch out for warning signs Coach your child in how to improve relationships and solve problems with peers Resolve conflict between you and your child calmly Help your child to make their own decisions rather than telling them what to do Refrain from attacking others on behalf of your child: instead work with your child and work with your child s school to address problems Maintain a warm supportive relationship with your child Coaching your child When your child comes to your with a problem: JUST LISTEN to understand the issue. ENCOURAGE YOUR CHILD to - Set a goal for what they want to achieve by asking What do you want? - Plan what to do to achieve their goal by asking What are you going to do? - Try out their plan starting with practising with you, then trying it out - Review how it went afterwards Thanks for your time and attention. Any questions? k.healy@psy.uq.edu.au 8