Helping youth cope with anxiety, depression, and suicidal thoughts

"I said to my wife that this is probably the most important thing I'll ever do in my life, if I can get this going and make a difference."

Silverstone, a professor in the University of Alberta's Department of Psychiatry, is the creator of EMPATHY, a pilot program that has been used in Red Deer Public Schools since 2013 to help lessen incidents of youth anxiety, depression and suicide. Now, new research published in the May edition of the journal PLOS ONE gives definitive proof the program is having an impact.

"We have had a significant decrease in suicidal thinking. Kids are not thinking about harming themselves as much. It's quite profound," says Silverstone. "We've also had a decrease in the entire school ratings for anxiety and depression, and this occurred in every school, in every grade."

The program began with a phone call in 2013. Silverstone remembers watching the news one night and seeing an interview with the superintendent of Red Deer Public Schools in which he spoke of a crisis due to several recent teenage suicides. Silverstone immediately called school administrators, describing a program he had in mind to introduce interventions to reduce suicidality, depression and anxiety.

The conversation quickly led to the start of a pilot study involving all students at Red Deer Public Schools between the ages of 11 and 18. At the beginning of the school year, more than 3,000 students in grades 6 through 12 were screened for mental health issues and assigned an EMPATHY scale score. Following screening there were rapid interventions for the four per cent of youth identified as being actively suicidal or at high risk of self-harm. Within a few hours they had met with a resiliency coach, their parents were informed and they were offered a guided Internet program to help them address their problems. After taking part in the program, they were re-assessed, and if needed, referred to primary or specialist care.

In addition, junior high students were also offered a 16-week resiliency program aimed at building their ability to interact with other youth and to deal with day-to-day stress in a way that didn't lead to low mood or anxiety.

After 12 weeks the program saw significant decreases in depression and suicidality. The number of students who were actively suicidal dropped from 125 to 30. Of the 503 students offered guided Internet-based interventions, 30 per cent took part, significantly lowering their scores for depression (28 per cent decrease) and anxiety (12 per cent decrease). Overall, depression scores for all students dropped by 15 per cent, while scores for anxiety dropped by 11 per cent.

"In our school alone, the screening has identified a significant number of students who were not on our radar for having mental health issues," says Mark Jones, a principal with Central Middle School. "What's really important to me is students are recognizing they are not alone and that others are also dealing with many of the struggles associated with mental health and wellness.

"Because of the program, the students are implementing resiliency strategies that they've learned in the classroom. The transfer of these skills has had a positive impact on student's daily lives and their ability to cope with issues that arise."

"This study is truly world leading," says Silverstone. "There are no studies like this around the world that have had these kinds of results. There just aren't."

Pieter Langstraat, superintendent of Red Deer Public Schools, adds, "We are pleased to be partners in this important and valuable program and appreciate the strong research component that is part of it. The results show real promise with the potential to have positive impact in supporting mental wellness of students."

Silverstone cautions that while early results are encouraging, more study is needed to see if the improvements are sustainable over the long term. With the EMPATHY program just finishing its second year in Red Deer Public Schools, Silverstone hopes to continue evaluating the program but worries for its future. He says it had received a public promise of funding in April from then Premier Jim Prentice, but with the change in government and the budget going unpassed, the short-term funding needed to keep EMPATHY running in the fall is no longer certain.

"The current funding runs out on June 30. My concern is that this will fall through the cracks," he says.

Despite the challenges, Silverstone believes in the future of EMPATHY, and hopes to see it soon in schools across the province.

"Approaches like this can reduce the risk of kids getting depressed or anxious, they can identify kids that have problems, and they can intervene early to stop problems," says Silverstone. "As a parent, who wouldn't want that for their kids?"