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Posts Tagged ‘
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The Myth
- We only grieve death.
- People should leave grief at home.
- We grieve in slow predictable pattern.
- Grieving means letting go of the person who died.
- Grief finally ends.
The Reality
- We grieve all losses.
- We cannot control where we grieve or what will trigger our grief.
- Grief is an uneven process with no timeline.
- Grieving means going on with our life; while mainting memories, connections, and feelings of grief and loss.
- Over time, most people learn to live with loss.
Normal Reactions to Loss
Grief is a highly individualized experience that varies depending on who we are, whom we have lost, and how the loss affects our daily life. Grief is not only an emotional response to death or other loss. Typically, we also experience physical, psychological, spiritual, and behavioral reactions. Some of the immediate reactions may include, but are not limited to:
- Emotional: Feelings of shock and relief
- Physical: Shortness of breath, numbness, listlessness, feeling empty, chest pain, loss of energy, confusion
- Cognitive and Behavioral: Denial, disorientation
After the immediate shock, some later reactions may include:
- Emotional: Anger, fear, guilt, panic, loneliness, depression
- Physical: Lack of energy, chest pains, fatigue, tension
- Behavioral: sleeplessness and withdrawal or sleeping too much, overeating, substance use such as sleep aids, drugs, alcohol
Reactions to Sudden or Traumatic Loss
When a death is sudden, unexpected, or violent, and may have been caused by an accident, suicide, or homicide, the grieving process becomes more complicated. The family struggles with trying to make sense of the death and often searches for answers. The grieving process may take longer as family members experience fear and anxiety, guilt over what was done or not done, and anger due to feeling helpless and powerless.
Individuals may feel worse pain months or a year following the loss as the numbness that helped to protect them immediately following the death is gone and the loss is fully realized.
Anticipatory Grief
Grief can begin long before the death of a loved one when life-threatening symptoms first appear, particularly in cases involving cancer, AIDS, or other long-term illness. Anticipatory grief does not replace the grief that loved ones experience after the death. Grief reactions may include feelings of sadness, depression, and anxiety as family members consider questions such as, "What will I do?" and "How will I live?", or “How can I go on?”
Conflicting studies research the question of whether the opportunity to grieve before the death lessens the length of bereavement after death or eases the pain of grief. Since grief is so complex and an individualized to the person experiencing grief, it is difficult to provide a definitive answer. Many factors affect the grieving process, including the nature of the relationship, the manner of death, and other factors.
Unresolved Grief
People who experience intense grief for an extended length of time or depression, substance abuse, or post-traumatic stress disorder in reaction to the death have unresolved or complicated grief. Grief counseling or support groups are often helpful in these cases. Counseling or group support is used to help the mourner experience, express, and adjust to painful grief-related changes and emotionally separate from the loved one and go on with life. Many times talking to others who have experienced a deep, personal loss such as the death of a loved one can help someone cope with grief.
Grief in the Workplace
Most employers provide two or three days of bereavement leave to allow time for family members to make funeral arrangements and attend services. Grief does not end with the funeral, however. In fact, it is often just beginning. Some companies are now offering grief counseling for bereaved employees and sensitivity training for their co-workers. Counseling helps the bereaved to work through their grief and training helps co-workers to understand what the bereaved are experiencing. These services will be particularly valuable as the Baby Boomers age and cope with the loss of their parents or spouses.
Sources:
- AARP
- Hospice Foundation of America
- National Cancer Institute
- National Hospice and Palliative Care Organization
- U.S. Department of Health and Human Services, Human Resources and Services Administration
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Introduction
Eating disorders have the highest mortality rate of any mental illness—20 percent of affected individuals without treatment. The mortality rate drops to 2 to 3 percent with treatment. One percent of females between the ages of 10 and 20 have anorexia nervosa and 2 to 3 percent have bulimia. Males account for only 1 percent of those with eating disorders.
- Incidence of eating disorders has doubled since the 1960s
- Increasing numbers of children as young as age six suffer from the illness
- 10 percent report onset of illness at age 10 or younger
- Incidences of eating disorders are increasing among diverse ethnic groups
- 42 percent of 1st-3rd grade girls want to be thinner
- 9 percent of nine-year-olds have vomited to lose weight
- 13 percent of high school girls purge
- Osteoporosis
- Muscle atrophy
- Heart muscle shrinkage and irregular heart beats
- In adolescence, growth retardation and peak bone mass reduction
- Frequently co-occurs with depression, substance abuse, or anxiety disorders
- Common causes of death are cardiac arrest or electrolyte imbalance, or suicide
- Dehydration
- Heart and gastrointestinal problems
- Teeth erosion
- Electrolyte disturbances, irregular heart beats, and heart failure
- Laxative dependence
- Use among bulimics is 40 to 75 percent
- 15 percent abuse laxatives several times each day
- Abuse among high school students range from 3.5 to 7 percent
- Abuse can cause failure to absorb nutrients, electrolyte imbalances, loss of colon function, and development of renal stones
- With treatment, 60 percent of people with eating disorders recover
- 20 percent make only partial recoveries and often relapse
- Remaining 20 percent do not recover and suffer chronic deterioration
- Treatment should include nutritional, medical, and psychiatric services, and psychotherapy with the patient and family
- Cognitive behavioral therapy has shown to be effective in reducing symptoms and increasing self-esteem
- Early detection and treatment result in improved outcomes
Sources:
- National Institute of Mental Health (NIMH)
- Eating Disorders Coalition for Research, Policy & Action (EDC)
- Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED)
- National Association of Anorexia Nervosa and Associated Disorders (ANAD)
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Introduction
Each year, drug and alcohol abuse contributes to the deaths of more than 120,000 Americans. Substance abuse costs taxpayers in excess of $294 billion each year in preventable health care costs, extra law enforcement, auto accidents, crime, and lost productivity.
An estimated 9 percent of the American population was dependent on or an abuser of substances in 2003. Nearly 15 million people were dependent on alcohol (1 in 13); nearly 4 million were addicted to illicit drugs; and 3 million were abusers of both drugs and alcohol.
Males are twice as likely as females to abuse or become dependent on substances except for the population of ages 12 to 17, when the abuse rates are nearly equal. The highest rate of substance abuse is in the age 18 to 25 population.
- Alcoholism lasts a lifetime and cannot be cured. However, it can be treated. A 2001-2002 survey showed that 36 percent of adults with alcohol dependence that began more than one year ago are now in full recovery.
- Alcohol problems are highest among young adults and lowest among adults over age 65.
- Teenagers who start drinking at age 14 or younger greatly increase their chances that they will develop alcohol problems at some point in their lives.
- Use of marijuana, LSD, methamphetamines, anabolic steroids, and cigarettes decreased significantly among high school students from 2003 to 2004, according to a National Institute on Drug Abuse study. However, abuse of inhalants increased for the second year. A single session of repeated inhalant abuse can disrupt heart rhythms and cause death from cardiac arrest or lowered oxygen levels that induce suffocation.
- Abuse of alcohol, heroin, crack cocaine, tranquilizers, and sedatives remained stable among teenagers from 2003 to 2004.
- Among adults, heroine is the substance of choice for 57 percent of substance abusers. Nearly 25 percent of users are dependent on cocaine, and 19 percent are addicted to sedatives.
- Prescription drug abuse is on the rise in the United States, particularly among older adults, teenagers, and women. An estimated 47 million Americans have used prescription drugs nonmedically during their lifetimes, and 15 million have done so in the past year.
- Women are more likely than men to be prescribed abusable prescriptions, particularly narcotics and anti-anxiety drugs. Women are also more likely to become addicted to sedatives, anti-anxiety drugs, and hypnotics.
- An increasing number of patients are treated in hospital emergency rooms and substance abuse treatment centers for nonmedical use of prescription drugs.
- Prescription drugs are often used in combination with other medications, illegal drugs, or alcohol. Reported combinations include potentially life-threatening mixtures of depressants and alcohol.
- The three classes of prescription drugs most commonly abused include narcotic analgesics used to treat pain, depressants for anxiety and sleep disorders, and stimulants.
- Vicodin is the drug of choice among high school seniors and OxyContin is the second most often abused prescription drug. Students who have used one of these drugs for nonmedical purposes are likely to use other drugs as well.
- Drug addiction is treatable with behavioral and medication therapies. Counseling, psychotherapy, support groups, and family therapy are often used. Medications block the effects of drugs and reduce drug cravings and withdrawal symptoms.
- In general, the more treatment given, the better the results. Medication therapies alone are not as effective as when combined with counseling. Likewise, patients who stay in treatment for three months or longer have better outcomes than those who are in treatment for a shorter period of time.
- The best drug treatment programs provide a combination of therapies and services, such as drug education, case management, and counseling.
- In 2003, 3.3 million Americans over age 12 received treatment for drug dependency. More than half participated in a self-help group. Drug abusers find assistance and treatment at rehabilitation facilities, mental health centers, hospitals, private doctor's offices, emergency rooms, and jails.
- Research shows that even the most severely addicted individuals can actively participate in treatment.
Sources: National Institute on Alcohol Abuse and Alcoholism National Institute on Drug Abuse Substance Abuse and Mental Health Services Administration
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Peer educators are addressing campus alcohol abuse and students are listening.
The stories are increasingly familiar:
- At the University of Oklahoma, a 19-year-old freshman died after binge drinking at a fraternity party. He consumed so much alcohol—more than 15 drinks in two hours—that his blood level was five times the legal limit.
- A 19-year-old woman, described by police as having as many as 40 drinks at a fraternity party at Colorado State University, died less than two weeks before a freshman pledge—also under the legal drinking age—died of alcohol poisoning at the University of Colorado.
- A Virginia Tech student—a general engineering major—spent a night drinking and never woke up the next morning.
- A 20-year-old fell to her death from a dormitory window at Colorado College in Colorado Springs. Her blood alcohol level was 0.22%.
Similar tragedies are making headlines in papers across the nation in alarming numbers. College students are dying to drink, and campuses are desperate for a solution. Numerous efforts are being taken to combat alcohol poisoning and abuse, and while a broad range of tactics is essential, one of the most effective strategies is also one of the simplest: peer education.
In a sense, it's a strategy of fighting peer pressure with peer pressure. Students trained as peer educators can get through to students who turn a deaf ear to messages delivered by individuals outside of their social environment. In the tragic instances of alcohol poisoning described above, peer educators could have been the vanguard that saved lives. Imagine a campus party that's gotten out of control. A well-trained peer educator who is both able to recognize alcohol poisoning and isn't afraid to call for help can prevent a tragedy. That, says David Hellstrom, MA, education director of the BACCHUS (Boost Alcohol Consciousness Concerning the Health of University Students) and GAMMA (Greeks Advocating Mature Management of Alcohol) Peer Education Network, is "education translated into real action."
Among the numerous solutions proposed, peer education has been acknowledged by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), which, says Drew Hunter, MPA, president and CEO of the BACCHUS and GAMMA Peer Education Network, is now funding research to look at how peer education works and how it impacts student behaviors.
A Movement Is Born
It's a hot topic at the moment, but the peer education movement is more than a quarter-century old. Gerardo Gonzalez and Tom Goodale, students at the University of Florida, recognized a growing need on campus for alcohol awareness and abuse prevention and forged an effective response by founding BACCHUS, a first-of-its-kind student leadership organization that catalyzed the peer education movement.
The program captured the attention of campuses across the country, and in 1980 the organization, which became known as BACCHUS of the United States, Inc., began offering the peer education training and educational materials for which it is now known. Five years later, fraternity and sorority students were addressed by a new branch, GAMMA, sparking the organization of peer education efforts in campuses nationwide. As the organization grew in scope, its geographic boundaries expanded beyond the United States, and in 1990 a new name reflected this evolution: The BACCHUS and GAMMA Peer Education Network.
Now, more than 1,000 active affiliates in the United States not only provide peer education about alcohol abuse prevention but also offer programs pertaining to problems that may sometimes exist separately but are often linked to alcohol abuse. The scope of the organization grew, says Hunter, largely in recognition of the impact alcohol abuse has on so many other aspects of a young person's life, hence the inclusion of comprehensive programs aimed at preventing violence and ensuring sexual health and safety. The organization provides the educational materials and training, and the campuses take that information and tailor it to whatever specific issues they want to address at the campus level, explains Hunter. That, he adds, can be done very formally by trained peer educators who provide structured programs or in a less formal manner by peers who engage other students about the issues in everyday settings and activities and provide a forum for discussion.
The organization's members are primarily college- and university-based peer education programs whose strategies vary from campus to campus. There's no formula for the programs, explains Hunter. "It would be hard to find two that do the same thing or even call themselves by the same name." In all cases, however, he says, it's students getting together out of a desire to create a healthier and safer campus and community. For a student group to be recognized by the national organization, a campus must provide a faculty or staff advisor and officially recognize the student group. The network provides a leadership structure for these academic organizations, offering a national conference, workshops, educational materials, a monthly publication, and a variety of resource publications and training materials.
Its goal is to help students do a better job addressing critical issues. To meet that objective, it offers an accredited training program called Certified Peer Educator training, a 13-hour skills-based program used to develop effective peer support skills. It teaches what Hellstrom describes as the core skills involved in peer support: educational, listening, and confrontation skills; referral strategies; and cultural competency.
In addition, several times per year the network sends campuses campaigns with programming manuals and other educational materials they can use and adapt to their own needs. Early in the year, it disseminates Alcohol Awareness Week materials, runs the Great American Smokeout for colleges and universities, and distributes an impaired-driving prevention program. In the second semester, it organizes activities for Sexual Responsibility Week, and later in the year offers a Safe Spring Break program. And in recognition of the headline-grabbing issue of alcohol poisoning, it's developed special educational materials addressing prevention efforts, both for general student bodies and specifically for fraternities and sororities. The organization operates three different Web sites from which affiliate members can download easy-to-duplicate programs and activities, as well as programming manuals. For every topic, numerous examples are provided of programs successfully used by a variety of campuses.
The network's programs are based on original research as well as principals of research efforts sponsored and carried out by well-respected groups such as the NIAAA. To capture the attention of its prime audience, it presents this research in a manner most palatable to students.
"We target the hardcore educational materials that are needed but write them in a manner that's appealing to the young adult population," says Hunter. Educational materials typically are either very technical or much too basic, so the college audience can extract little that's useful, he says. "We write our materials with the idea that the audience is intelligent, engaged college students." Because these programs challenge students, he believes they're more effective and are thus the most widely used in higher education.
The Peer Concept
The concept behind peer education is based on a simple truth: People tend to accept information best from people like themselves. Research, says Hunter, has shown that students respond well to information provided by their peers. Furthermore, adds Hellstrom, studies have shown that they also tend to retain and use information more when it's brought to them by people considered to be peers. It's an approach that's well-suited to target high-risk populations and can be used to engage and influence special interest groups.
"Whether it's student athletes, fraternities and sororities, students with disabilities, or gay and lesbian students, or any other group the campus wants to embrace, it can recruit and train students from within those special populations to address the special needs and concerns of the individual groups," Hellstrom explains. "If you put trained students who are involved with and representative of the students they're serving, they can have a much greater impact in those groups than can outsiders."
Do as I Say and as I Do
Part of the job of an effective peer educator is to be a stellar role model. "We hope that our peers take the information that we try to teach and promote and incorporate it into their own lives so that the positive messages that we want our students to have can be seen in action in the lives of their peers around them," says Hellstrom. The approach, then, is dynamic rather than static. "Instead of having education provided in the classroom or through posters, for example," he says, "now we have peers who are in social situations at parties or in different groups with their friends and fellow students who are making positive choices themselves. That message then becomes something that's lived as opposed to just heard." In this way, he observes, through role modeling, students take on the positive and healthy behaviors that are modeled.
What makes a good peer educator? "The role modeling aspect is of the utmost importance," explains Hellstrom. "They can't merely teach the issues without living them themselves, so our first step is to make sure that people who call themselves peers are in fact making healthy choices themselves." Also important, he says, is to have strong social networks such as those created through participation on athletic teams or in Greek organizations and, of course, strong communication skills.
Peer educators are not to be confused with counselors—they don't attempt to analyze or assess other students. Instead, they provide education and perspective, engage students on the issues, and, when necessary, provide referrals for counseling. "When they come across students whose issues are clearly leading them toward addiction, our students are trained to be referral agents to get at-risk students to seek the help of the campus counselor or community-based resources," says Hellstrom. "We do not expect our students to be junior counselors because clearly they're not adequately trained for that role. They'll do some confrontation and many of the presteps to counseling, but their goal is to get people in for help, not to counsel them."
Part of knowing one's role as a peer educator, says Laurel Okasaki, the network's National Highway Traffic Safety Administration Impaired Driving Prevention Initiatives intern, is knowing when an issue is beyond the scope of your knowledge and knowing when to ask for help from your advisors.
Peer education isn't meant to be a total solution but rather part of a broader approach to alcohol abuse prevention. It's not a single magic bullet, says Hunter, but a highly effective tool. In addition, he notes, there need to be additional weapons such as campus environmental policies and judicial sanctions for bad behavior. The network is also a forceful advocate for strong campus policies and efforts to reduce underage students' access to alcohol.
"We view the students as educators, activists, and change agents on the campus," says Hunter. Highly trained peer educators, he observes, are a first line of defense. They're able to help other students recognize that they may be at risk for or may already have a problem with alcohol and work with them to acknowledge the problem or potential hazard. Because peer support aims to stem problems before they happen, he says, it's one of the more proactive approaches available.
Okasaki, a student in the Graduate School of Social Work at the University of Denver, became involved in peer support as a sophomore at the University of Northern Colorado Center for Peer Education as a student coordinator and peer educator. She was involved for three years and came to work as an intern for National BACCHUS and GAMMA last spring. Peer education, she explains, provides a unique opportunity, giving students access to someone they can relate to who has been trained and has skills with which to dispense important information about campus issues.
"Information, when shared with someone who is like you who's in a similar circumstance, can have a more profound impact than that delivered by someone who comes into your world claiming to be an expert on the matter," she says. Part of the important message peer educators can provide, she explains, is that most college students are making responsible choices and are engaging in healthy behaviors. By delivering that message and communicating information about ways students can protect themselves, they can help play an important role in preventing the kinds of tragedies that have made headlines in recent years.
An Open Door to the Helping Professionals
Not only do peer education programs help keep students on a straight and narrow path toward healthier lifestyles, but they also appear to steer many into careers in the helping professions. Peer education, says Hunter, is often the breeding and training ground for people entering the social service fields. "Time and again students get their first taste for the social work profession by being involved in a peer education program," he says. It fuels a desire to help and provides a base set of skills that serve students well when they enter the profession. "Peer support programs are a perfect way to encourage and reinforce the same skills that are desirable in social workers."
Says Okasaki, "The skills I gained as a peer educator—learning how to relate to my peers and to dispense important information about taking care of yourself and taking care of the people you love—is something that will definitely have an impact on my role in social work. I hope to carry those tenets into whatever I do."
— Kate Jackson is a staff writer for Social Work Today.
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Introduction
Social workers, in general, have always treated their clients fairly and with respect. School social workers have been no different. They have always worked to help young children and teenagers become better students and better young people. Currently, school social workers are helping students by taking a broader view of the student and his environment than they have done in the past.
In the past, school social workers were trained to look at a troubled student's emotional issues and without taking into account the student's home life. But, school social workers abandoned this approached because so many of the children they saw were underprivileged and neglected and this could not be ignored. So, social workers began looking at the way a child's environment including their home and neighborhood might influence their behavior.
Over the years, school social workers and researchers discovered many new methods to help students. Each new method of helped guide the practice of school social work in the United States during the 1970s.
Things changed again in the 1980's and 1990's. Social workers took on more duties in part because of new laws that gave all children the right to a free and appropriate education. During this time school social workers became advocates for students supporting programs and polices to help students and their families. During this time school social workers began working with teachers, special education teachers, and administrative staff to help the students.
Even now the role of school social workers continues to change. Issues like health care reform, changes in the law, decreasing school budgets, increased poverty among children and families, and the increase in school violence are forcing these changes.
A recent law that gives disabled students the right to an education has caused the role of school social workers to change even more. And, now school social workers are looking at the way a student's particular culture influences their behavior.
The latest trend in school social work involves looking at the school as part of the community, not separate from it. Students, their family, and school personnel are seen as part of this larger community that is constantly changing. The challenge for school social workers in the 21st century will be to work within this model.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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According to the prestigious Mayo Clinic, it is estimated that 7.5 percent of school-aged children have Attention-Deficit Hyperactivity Disorder (ADHD). The great majority of these children grow up to be adults with ADHD. This means there are between 4.5 and 5.5 million women in the United States alone with ADHD.
If one thinks of the core symptoms of ADHD (distractibility, impulsivity and hyperactivity), it is no wonder that women struggle with seemingly simple tasks such as picking out their clothes, keeping their home in order, handling paperwork at the jobs, maintaining healthy relationships, etc? And, we often forget that many ADHD symptoms aren't usually described in clinical journals and books, but have been observed in countless women.
Not everyone with ADHD shows the same symptoms. Some people are hyperactive. Others are sluggish. Some love having a lot of commotion and stimulation in their lives. Others need to retreat to a quiet place to re-charge.
Some symptoms of ADHD but not commonly described in articles about ADHD include:
- Hypersensitivity to noise, touch, and smell
- Low feeling of self-worth
- Easily overwhelmed
- Hypersensitive to criticism
- Poor sense of time – often runs late
- Starts projects but can't seem to finish them
- Takes on too much
- Difficulty remembering names
- Says things without thinking, often hurting others' feelings
- Appears self-absorbed
- Poor math and/or writing skills
- Doesn't seem to hear what others are saying
- Addictive behaviors: shopping, eating
- Problems with word retrieval
- Poor handwriting
- Difficulty with boring, repetitive tasks
- Thinks things over and over
- Difficulty making decisions
- Clumsy, poor coordination
- Tires easily or conversely, can't sit still
- Has problems falling asleep and difficulty waking up the next morning
For some women, just holding their own in a conversation can be a real challenge. Others avoid social gatherings because they miss social cues. This makes them feel out of step and they shut down to avoid embarrassing themselves.
Many women feel unable to entertain at home because the piles of clothes, papers and assorted knick-knacks keep them away from inviting people over.
Relationships, work situations, and parenting can all become huge challenges for women living with undiagnosed and untreated ADHD. The result of living for years with these difficulties often produces depression, anxiety, low self-esteem, substance abuse, and other difficulties.
Much of the treatment used for ADHD in children is often the treatment of choice for adults too. Studies have shown that a combination of counseling, psycho education (learning more about ADHD and how it impacts one's life), coaching, support groups and medication (if recommended by a physician), is the most successful treatment approach for women.
The most common medications used are the stimulants (Ritalin, Adderall, Dexedrine, and Concerta are currently the most popular) and a newer non-stimulant medication, Strattera.
However, many women because of their life-long struggle with ADHD may find themselves anxious, depressed or both. Approximately 50 percent of ADHD adults experience a co-morbidity, which then needs to be addressed by adding perhaps an anti-depressant or anti-anxiety medication to their regime.
Research is beginning to show that ADHD women have special issues throughout their life that can extra difficulties in living with this disorder. As hormonal changes shift, so do their ADHD symptoms.
On the one hand, some girls may find that their hyperactivity improves during puberty, yet they may experience an increase in mood instability before and during their menstrual cycles.
Peri-menopause and menopause can create it's own set of problems. Women often report an increase in ADHD symptoms, particularly memory loss and difficulty with word retrieval. Some notice an increase in depressive symptoms. It's important for women to work closely with their physicians during these times, so that changes in medications can be discussed. Often, hormonal treatment can alleviate these aggravated symptoms.
Whether you are a teenager, or a post-menopausal woman, it's important to regularly check your "ADHD temperature" and discuss any changes in your symptoms with your health care provider.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Help from a Primary Care Physician and a Social Worker Make a Difference
Although it may not be commonly known, senior citizens have the highest suicide rate of any group of Americans. That's the bad news. The good news is that when the depressed elderly are by a doctor and receives depression care management from a social worker, their chances of improving are better than when they receive care from a doctor alone. These are the results of a resent study published in the Journal of the American Medical Association in 2004.
Martha Bruce of Cornell University, Charles Reynolds III of the University of Pittsburgh and colleagues conducted the study to tackle the issue of elderly suicides.
Called PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), the trial recruited patients from 20 primary care physician practices in New York City, Philadelphia, and Pittsburgh.
Nearly 600 patients suffering from depression ranging in age from 60 to 94 years were studied. Social workers, nurses, and psychologists were depression care managers for these patients.
The study revealed that patients who receive depression care management services in addition to a physician's care improved more quickly than those under the care of only a physician. After four months, 56 percent of patients who initially experienced suicidal thoughts no longer suffered from them, compared to 30 percent of usual-care patients.
Another benefit was that the patients in this study saw a reduction in the number of symptoms of depression they had been experiencing. They also responded better to treatment. These positive results led the study's authors to conclude that routine depression screening of elderly people in primary care can be very beneficial if it is followed with treatment and care management.
Treatment guidelines provided to doctors in the study recommended a trial of antidepressant medication. If a patient declined medication therapy, the physician could recommend interpersonal therapy from the care manager. Care managers had backup, weekly supervision by psychiatrist investigators and monthly supervision of interpersonal therapy.
Care managers helped the primary care physicians recognize depression and offered guideline-based treatment recommendations, monitored clinical status and provided follow up. Research associates introduced the depression care manager to patients immediately after the baseline review. Care managers interacted with patients at scheduled intervals or when clinically necessary either by telephone or in person.
The comparison treatment was the usual primary care with the addition of initial education of physicians about the treatment guidelines and notification when a patient met criteria for depression. These were added to usual care to protect patients and keep the study focused on depression treatment and management rather than recognition.
The study's results varied based on the level of depression severity and the presence of suicidal ideas. The authors said it is important to build on the success of these trials by developing effective strategies for implementing successful interventions in routine practice, increasing the efficacy and disseminating them more broadly.
Source: NASW News, May 2004
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Introduction
An estimated 17 million adults ages 18 and older (8.0 percent) reported having experienced at least one major depressive episode during the past year, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported today. Around two thirds of them reported receiving treatment for that depression in the past year, according to the new report, "Depression among Adults".
SAMHSA extracted the data from the 2004 National Survey on Drug Use and Health, which for the first time asked adults in the survey ages 18 and older questions reflecting the criteria for major depressive episodes in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). That manual, by the American Psychiatric Association, specifies that a major depressive episode is two weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change of functioning, such as problems with sleep, eating, energy, concentration or self-image.
During the 12 months prior to the interview, 65.1 percent of adults who had experienced a major depressive episode in the past year reported seeing or talking to a medical doctor or other health professional, or taking prescription medications for depression. This is the first time that questions about depression were asked in the National Survey on Drug Use and Health.
"The good news is almost two thirds of people with depression are seeking help," SAMHSA Administrator Charles Curie said. "Clearly, we are making progress in overcoming the stigma that has prevented people from seeking help. Mental illness is not a scandal. It is an illness. It is a treatable illness. And most important, we need to send the message that with help there is hope, and recovery is the expectation."
Past month illicit drug use was nearly twice as high among adults who had experienced a major depressive episode (14.2 percent) compared with adults who had not experienced such an episode (7.3 percent), and cigarette use was much more likely. The data show 39.7 percent of adults who suffered a major depressive episode in the past year smoked cigarettes during the past month compared to 25.9 percent of adults 18 and older who did not have a major depressive episode.
Women were almost twice as likely as men to report a major depressive episode in the past year (10.3 percent versus 5.6 percent) and women who experienced a major depressive episode were more likely to receive treatment for depression (70.1 percent) than their male counterparts (55.2 percent). Major depressive episodes are more prevalent among adults ages 18-49, approximately 9-10 percent, than among adults ages 65 or older (1.3 percent).
SAMHSA defines illicit drugs as marijuana, cocaine, inhalants, hallucinogens, heroin or non medical use of prescription drugs. The National Survey on Drug Use and Health surveys close to 70,000 people ages 12 and older in their homes each year.
The report and the complete survey are available on the web at http://www.oas.samhsa.gov/2k5/depression/depression.cfm.
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Introduction
In traditional societies the world over, young people growing into adulthood have had valued, secure roles in their societies. Contemporary U.S. culture, however, prolongs adolescence for some and deters youth from finding fulfilling and contributing roles.
Major cultural movements—consumerism, mass media messages about sex, disturbing lyrics in music, accepted use of drugs, unsupervised mobility, premature sexual behavior, and societal violence, including unethical adult behavior affect us all. Youth are especially vulnerable to the risks these experiences pose. Many youth live in environments that encourage problem behaviors and offer limited opportunities for growth and participation. Even in relatively stable communities, many young people live in environments of emotional violence and harassment that can have lifelong negative consequences.
Yet the outlook for youth remains promising. Youth development research indicates that all youth are resilient, and that young persons who experience high levels of known protective factors are much less likely to become involved in problem and antisocial behavior. They are also much more likely to achieve their personal potential and contribute to community life. Even young people faced with multiple risk factors are likely to have successful life outcomes if risks are buffered by protective experiences.
Among the protective factors known to be important are the following:
- strong coping and relationship skills
- a stable, committed relationship with an adult
- adult models of coping with challenges
- strong networks of family or friends
- opportunities for real community participation and involvement in decision-making
- strong connections to community institutions (for example, schools, religious communities, or service agencies)
Effective youth development supports are designed to strengthen these protective factors and reduce exposure to risk factors like violence and abuse.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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