Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Depression

Summer 2004

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Size of the Problem

According to the National Survey of Children with Special Health Needs, there are an estimated 56,280 (12.5%) 6 to 11 year olds with special health needs in Minnesota and 78,485 (17.4%) 12 to 18 year olds with special health needs.

In 2001, The National Health Interview Survey found that 35% of children and adolescents with disabilities age 4 to 17 years are reported to be unhappy, sad or depressed.[1] Analysis of the 1994-95 National Health Interview Survey Disability Supplement revealed that 40% of children with disabilities with poor psycho-social adjustment received treatment.[2]

In the 2001 Minnesota Student Survey of 6 th, 9 th and 12 th graders, 13.96% were identified as having a special health need. [NOTE: This analysis excluded students who are in alternative education settings. In addition, due to the required reading level of the survey, student who were clearly not proficient at the 5 th grade level, were likely not surveyed.]

  • More than 20% of the students with special health needs in grades 6, 9, and 12 had a history of suicide attempt.
  • Depending on grade and gender, anywhere from 34% to 65% of the students with special health care needs, had thought about committing suicide.

Seriousness

A disproportionate number of students with special health needs have considered suicide when compared to same aged peers:

  • 48% of the students with special health needs overall had thought about suicide in the year preceding the survey compared to approximately 26% of peers without special needs.
  • More than 20% of students with special health needs revealed a history of attempted suicide compared to 7% of their peers without special health needs.
  • 27% of non-white students with special health needs had attempted suicide compared to 10% of non-white students without special health needs.
  • Regardless of health status, beyond sixth grade, females are more likely than males to have considered suicide.
  • Disparities by both health status and gender continue in relation to actual suicide attempts.
Children and Adolescents Aged 4 to 11 Years, 1997 Reported to Be Sad, Unhappy, or Depressed
With disabilities
Without Disabilities
Percent
TOTAL
31
17
Gender
    Female
32
16
    Male
30
18
Family income level
    Poor
37
20
    Near Poor
31
17
    Middle / high income
27
17
Geographic location
    Urban
27
17
    Rural
39
16

The National Health Interview Survey completed in 1997 identified economic and geographic disparities in children aged four to eleven in children with and without disabilities who were reported to by sad, unhappy or depressed.[3]

Poor self-esteem has been identified as a risk factor for depression.[4][5] Self-esteem and hopefulness are essential to children's health and well being, impacting their behaviors and accomplishments throughout life. Depression, low self-esteem and emotional distress are associated with adverse outcomes including smoking, alcohol and other drug use and suicide attempts among adolescents.[6] The adverse outcomes of untreated depression in children and youth with special health needs impact the individual, the family, school, community and society as a whole.

Interventions

Primary care providers, school counselors, teachers and parents should be made aware of the association between depression and the presence of a special health care need. The National Center on Birth Defects and Developmental Disabilities of the Centers for Disease Control and Prevention provides guidance in the area of health communication that will be useful in raising awareness of this issue and changing current practice.[7]

School-connectedness, family-connectedness, and religious identity were identified as protective factors in reducing risk for suicide, emotional distress and violence among students with learning disabilities[8] and may be applicable children and youth chronic conditions generally.

Health care providers should be screening for depression in this group of children and youth at regular intervals.

Once depression or other mental health issue is identified, education regarding the condition; cognitive-behavioral strategies to reduce the impact of stress and individual response to it; social skills training; and family therapy and group work should be employed as interventions.[9]

A randomized controlled community-based intervention that paired mothers of older children with chronic illnesses and a child life specialist with chronically ill children aged 7 - 11 years and their mothers was designed to reduce risk for poor adjustment and mental health problems in the children. The intervention included telephone contacts, face-to-face visits and special family events. The maladjustment range was measured by the Personal Adjustment and Role Skills Scale III, the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, and the Self-Perception Profile for Children. The range fell from 19% to 10% in the experimental group over a 15-month period and rose in the control group from 15% at baseline to 21%.[10]

A number of school-based suicide and depression prevention programs have been evaluated and were effective in the adolescent population in general.[11][12][13] None of those studies clearly delineated the presence or absence of children and youth with special health needs.

Status

Mental health and well-being is among the highest of public health concerns at the local and state levels in Minnesota and at the Federal level. As such, a number of financial resources are currently being directed toward the issue.

Efforts within the state directed to this specific high-risk population appear limited, however, possibly due to lack of awareness of the issue.


1. United States Department of Health and Human Services. Data 2010. Healthy People 2010 Database. October 2003 Edition. 11/21/03.
2. Witt, W., Kasper, J., Riley, A. "Mental Health Services Use among School-Aged Children with Disabilities: The Role of Sociodemographics, Functional Limitations, Family Burdens and Care Coordination". HSR: Health Services Research 38:6, Part 1. December 2003.
3. United State Department of Health and Human Services Healthy People 2010. Baseline Data.
4. Park J., Adolescent Self-concept and Health into Adulthood., Health Rep. 2003;14 Suppl:41-52
5. Purper-Ouakil D, Michel G, Mouren-Simeoni MC., Vulnerability to depression in children and adolescents: update and perspectives] Encephale. 2002 May-Jun;28(3 Pt 1):234-40. (ABSTRACT)
6. Borowsky, I., Resnick M., "Environmental Stressors and Emotional Status of Adolescents Who Have Been in Special Education Classes." Archives of Pediatric and Adolescent Medicine 152: 377-382. April 1998
7. Lyon-Daniel, KL., "Health Communication Research: How To Get Your Message Across." Power Point Presentation. http://www.cdc.gov/ncbddd. [Attn: Non-MDH Link] Accessed 6/19/2004.
8. Svetaz, M., Ireland, M., Blum, R. "Adolescents with Learning Disabilities: Risk and Protective Factors Associated With Emotional Well-being: Finding From the National Longitudinal Study of Adolescent Health". Journal of Adolescent Health 2000;27:340-348.
9. Child Study Center Letter. New York University School of Medicine. Vol 5 Number 4. March/April 2001
10. Chernoff, R., Ireys, H., DeVet, K., Kim, Y. "A Randomized Controlled Trial of a Community-Based Support Program for Families of Children with Chronic Illness: Pediatric Outcomes". Archives of Pediatric and Adolescent Medicine. 2002; 156: 533-539.
11. Aseltine, RH., Demartino, R. "An Outcome Evaluation of the SOS Suicide Prevention Program." Journal of the American Academy of Child and Adolescent Psychiatry. 2004 May;43(5):538-547.
12. McDowell, M., Bir, W., Cunliffe, R. "A Randomized Placebo-Controlled Trial of a School-Based Depression Prevention Program." Journal of Clinical Child Psychology. 2001 Sep; 30(3):303-315.
13. Shochet, I., Dadds, M., et al. "The Efficacy of a Universal School-Based Program to Prevent Adolescent Depression." Journal of Child and Adolescent Psychiatric Nursing. 2003 Apr-Jun; 16(2): 71-80.