Major depression has become a common, persistent, and debilitating condition that has been associated with elevated psychiatric problems and an increased risk for academic failure, interpersonal problems, suicide attempts and legal problems in adolescents. Depression prevention programs for preadolescents are of great importance because many young people are in the early stages of a depression trajectory. Yet most rural communities lack the needed mental health services for youths who become symptomatic enough to require treatment. Since rural young people rarely see a primary care provider, schools become the most likely place for intervention and care delivery for psycho-social problems. However, rural school-based depression prevention programs require special methodological considerations. Rural schools can benefit from evidence-based, school-based depression prevention programs, but there are many challenges that impede the successful implementation of such programs. Particularly, interventions that have been found to work in urban schools may not fit well with the characteristics and program needs of students in rural schools.
In a recent article in Children & Schools, La Tonya Noel, Kathryn Rost and Jill Gower discuss a recent study of an implementation of an innovative, culturally- and age-appropriate intervention with at-risk girls in a rural community. They used a participatory action research model to develop and inform the culturally-adapted intervention to reduce depressive symptoms and prevent the onset of major depression among middle school girls.
The authors note that interventions that are not culturally grounded and based on the needs of a given community are unlikely to receive much support from key stakeholders, which makes it unlikely that the intervention will ever be implemented or sustained. Thus they recommend adapting evidence-based programs to meet the needs of the community, while still maintaining the core, effective curriculum components. In this case, they adapted a pre-existing program to a rural setting, and toward a younger population. One problem they faced was finding people to implement the program; there are insufficient mental health care professionals working in rural environments, and school staff personnel are often prioritized toward efforts that satisfy state-wide educational audits. Therefore the authors chose to train older students to deliver manualized interventions to younger students, in exchange for college credit and community service hours. These older peers were trained as facilitators, and manuals were adapted as new information from the participants became available.
Pre- and post-test results of the study indicated a statistically significant improvement in both the peer facilitators’ knowledge of effective intervention techniques and participants’ satisfaction with their training. One participant said, “On a scale of 1 to 10, I believe the session relevance was about a 9.”
The authors hope this study will help to stimulate further research and implementation of preventative depression interventions in school environments in rural areas.