Program Helps Hispanic Teens Through Depression

February 6, 2007
BY MARINA PISANO

It started last fall, feelings of sadness, helplessness and anger as black as the clothing she wore to feel protected and conceal the cuts on her arm.

Already thin, she couldn't eat, couldn't sleep. At school, she withdrew from friends. At home, she screamed with rage at the slightest provocation. Still, as bad as she felt, there were no tears.

"I never cry. If you cry, people know you're vulnerable, and they take advantage," says Kira, 15, a 10th-grader at Harlandale High School here, who doesn't want her real name used.

Kira's depressive symptoms surfaced a few months ago, when a letter arrived from her stepfather -- the man she hadn't seen in years, the man who had sexually abused her when she was a child.

Looking back, the symptoms were there in elementary school, too, starting at 8 when she was first abused. Experts say child abuse and trauma can raise the risk of depression and other disorders.

"Nobody knew. She never told anyone about (the abuse), not even her mother, until she told me," says Renee Blakeney, a school social worker with mental-health-care experience.

Kira was spotted and steered to Blakeney in late November by Joy Gonzales, a peer facilitator in Talk It Up, Texas, a depression awareness program aimed at Hispanics that is now in its second year at Harlandale.

The girl and her mother were connected to several agencies and began individual and family counseling. But Kira's depression worsened, and she started having flashbacks of the abuse, a symptom of post-traumatic stress disorder.

Angry with her mother for allowing the abuse and not protecting her, Kira began cutting herself more often.

"It takes away the pain," she explains.

Although the family was wary of medication and resisted it at first, Kira recently started taking an antidepressant. "If it helps, I'll take it," she says with more resignation than hope in her voice. She also sees a therapist.

Developed and funded by the South Texas Health Research Center at the

University of Texas Health Science Center at San Antonio, the idea for Talk It

Up goes back three years to a growing awareness among clinicians and other experts in the community that teenage depression is on the rise and that early intervention and treatment is key to limiting the harm it can do in teens and adults.

Depression can be a factor in heart disease, diabetes, cancer and other medical problems.

Research also showed that when teens are depressed, they often first turn to their peers for advice. Talk It Up peer facilitators go through a six-session training program to learn how to recognize symptoms of depression and how to approach a student who appears to have symptoms and get them help from an adult. Facilitators meet weekly to discuss their work.

Directed by physician Robert Villarreal, Talk It Up has a scientific advisory panel made up of experts from the health science center, the Center for Health Care Services and mental-health providers in the city.

Teens who appear to be a danger to themselves or others are referred to mental-health professionals. Parents are alerted, although when families are dysfunctional, Blakeney says that presents challenges.

Talk It Up is based in Harlandale because it was the one school district that agreed to implement it. The hope is that more area school districts will get involved.

As project coordinator Laura Fornos points out, depression cuts across all economic and cultural barriers. At any given time, 10 percent to 15 percent of children and adolescents have some symptoms of depression.

The great majority of the high school's almost 1,900 students are Hispanic, and Fornos notes that Hispanic youth experience more depression than young non-Hispanic whites. In 2001, suicide, which is strongly linked to depression, was the third-leading cause of death among young Hispanics nationwide.

In San Antonio and surrounding Bexar County, with its large Hispanic population, suicide was the second-leading cause of death for ages 15 to 24.

Fornos believes Talk It Up is the only program in the country that focuses on depression in Hispanics. Special cultural issues come up with these teens.

The stigma surrounding all mental illnesses affects all cultures, but for Hispanic families, already struggling with assimilation, Fornos says, it's more complicated.

"They have the idea that it (mental illness) doesn't happen in their family. It's a culture where things are handled inside the family, not outside," Fornos says.

As a result, Hispanics underutilize treatment services, although once in treatment, their recovery rate is equal to that of other ethnic groups.

The kids helped by Talk It Up -- more than 200 so far -- have had everything from mild, short-term depressive symptoms, such as irritability and loss of interest in activities, to severe clinical depression.

Five students have needed hospitalization. Blakeney says that in some cases teens didn't share their symptoms with parents, and the program has helped family members connect in a positive way.

The Talk It Up, Texas Web site is open to all teens, with information about depression and where to get help, along with resources, a message board and photos of teens.

Ask-a-Friend fields questions from teens, with about 60 percent of them involving relationships. Fornos supervises answers.

The big message for teens and parents is that depression is treatable, often most successfully with a combination of cognitive behavioral therapy, counseling and medication.

Nineteen students have received certificates as peer facilitators, and Blakeney recruited them from every peer group -- goths, jocks, "good girls," even so-called problem kids.

Lillie Fuentes, 15, who is in the 10th grade, says training helped students recognize depressive symptoms and, through role-playing, how to make contact and build trust.

"Maybe you notice someone who is usually outgoing and they start getting quiet," she said. "They stop playing sports. You take them somewhere private to talk to them. You ask them how they're feeling. Some don't want to talk. Some can't stop talking. Some break down."

Source: The Ledger Online