Connect
MJA

Depression in young people: what causes it and can we prevent it?

Jane M Burns, Gavin Andrews and Marianna Szabo
Med J Aust 2002; 177 (7): S93. || doi: 10.5694/j.1326-5377.2002.tb04864.x
Published online: 7 October 2002

Abstract

  • Cumulative adverse experiences, including negative life events and early childhood adversity, together with parental depression and/or non-supportive school or familial environments, place young people at risk for developing depression.

  • Enhanced life skills and supportive school and family environments can mediate the effect of stressful life events.

  • Programs that enhance the school environment are associated with improved behaviour and wellbeing.

  • Interventions that teach cognitive skills are associated with a short-term reduction in depressive symptoms.

  • Current evidence suggests that for an intervention to be sustainable it must encompass multiple components across several levels: classroom, curriculum, whole school, and the school–community interface.

  • Teaching interpersonal skills, including cognitive and problem-solving skills, should be coupled with the promotion of positive school and family environments to prevent depression in young people.

The need to shift common and modifiable risk and protective factors in favourable directions in order to prevent mental health problems is recognised in the public health approach embraced by beyondblue: the national depression initiative.1 This approach may target individual factors, but usually aims to influence broader social determinants, specifically the settings in which people spend their time. As a recent child and adolescent survey demonstrated, depression has its peak incidence in mid-to-late adolescence.2 Although there are undoubtedly major opportunities for prevention and early intervention right across the life cycle, a focus on young people within the school environment is relevant. The introduction of evidence-driven, developmentally appropriate programs that have been designed to promote positive school environments and teach life skills can potentially decrease prevalence, reduce severity, and delay the onset of depression.3

As the causes of depression are complex, the identification of modifiable risk and protective factors, and understanding the processes through which they operate, is crucial. A protective factor may affect risk, either directly by operating on the antecedent risk factor itself, or indirectly by affecting the strength of the relationship between the risk factor and the development of depression.4

There has been a concerted effort in both health and education sectors to promote mental health and emotional wellbeing, reduce the incidence of depression in young Australians, and enhance the quality of care received. The education sector is overwhelmed with a choice of programs that target a broad range of risk-taking behaviours and poor health outcomes, including drug and alcohol use, early sexual activity, conduct disorders, depression and suicide. These programs, each between six and eight weeks long, are educationally based, or they promote resilience by teaching life skills, such as problem-solving, leadership, optimism, and communication. Anecdotal evidence suggests that schools struggle when faced with the task of choosing appropriate programs.

What causes depression?

The adversity young people experience increases dramatically during mid-to-late adolescence, especially for girls.5-7 Poor interpersonal skills, coupled with negative thought processes, can create difficulties for adolescents negotiating changing relationships with peers and families, searching for autonomy while trying to fit in, and simultaneously trying to succeed in a competitive academic and social environment.8 Cumulative adverse life events can lead directly to depression, poor academic achievement and increased risk-taking behaviour. Depressing life events can include exposure to family or community violence,9,10 chronic poverty,11 child physical and sexual abuse,12,13 bereavement,14,15 or parental divorce or separation.16

Life events involving loss are specifically associated with depression.17 Two explanations have been advanced. The first suggests that there may be a direct association between adversity and the onset of depression. Early adversity sensitises individuals to the effects of subsequent life stress,18 and depressed individuals are at greater risk of experiencing more stressors, which in turn lead to increased levels of depression.19,20

The second explanation aims to delineate the mechanisms that intervene between negative life events and depression to explain why many young people who experience adversity do not develop depression.21

Individual cognitive characteristics can influence a person's interpretation of negative life events. One theory is that individuals predisposed to depression perceive adverse experiences using "negative cognitive schemata" (stable memory structures that guide information processing). Following a negative life event, such as a relationship breakdown, an individual might describe him- or herself as inadequate, the world as unfair, and the future as hopeless.22-29

The "learned helplessness" theory of depression30 proposes that individuals are susceptible to depression because they have pessimistic attribution to neutral events. For example, during a basketball game a player might miss a shot. If they have a pessimistic attributional style, they may believe they missed the shot because they are hopeless. They have attributed this event to a cause that is internal (self-referent), stable (a personality characteristic), and global (likely to affect other situations). In contrast, a player who explains the missed goal as a result of being distracted attributes the failure to a cause that is external, unstable, and specific. Research indicates that a pessimistic attributional style interacts with subsequent negative life events to predict ensuing increases in depressed mood. In general, these findings are applicable to both males and females.31-33

Parental depression is a risk factor for adolescent depression. Children with a depressed parent are four times more likely to develop an affective disorder; they have a 40% chance of experiencing depression by age 20 years, and a 60% chance by age 25 years. Maternal depression is associated with depression in young people after controlling for other factors, including socioeconomic status.34-36 A history of parental depression also increases the risk of recurring depression37 and suicide attempts38 in adulthood. Prospective studies indicate that maternal depression may affect girls more significantly than boys.39-42 Parental psychopathology has strong support as a risk factor, but it is unclear whether this risk is mediated through a biological vulnerability,35,43 the effects of poor parenting caused by that psychopathology,34,40,43-45 or the transmission of attitudes and values which predispose an individual to later psychiatric disorder.45,46

Low self-esteem is often flagged as a predictor of adolescent depression. This claim is supported by longitudinal research which shows that children who perceive themselves as academically, socially, or physically incompetent are more vulnerable to subsequent depression than are children who perceive themselves as competent.47,48 Such beliefs develop during middle childhood and early adolescence, and arise from evaluations children receive from their peers, teachers or parents,49 and from the experience of negative events.48,50 Moderating influences which affect negative beliefs may not emerge until late adolescence or young adulthood.48,51,52

Social-skills deficits are associated with concurrent depression and with a wide range of other psychological problems, both in adults and in children.53 Recent prospective studies have shown that negative perceptions about social competence, self-efficacy or peer acceptance predict symptoms of depression.54,55 In contrast, high self-perceived social competence acts as a protective factor in young people who are at increased risk of depression as a result of negative life events or parental psychopathology.56,57

School is an important arena for social and emotional development; however, it can also be a source of negative life events. Poor academic achievement and beliefs about academic ability, coupled with depression, result in poor school engagement, enhanced perceptions of school-related stress, and increased problem behaviours.54,58 Children aged 5–9 years whom teachers believe are unpopular and who are rejected or neglected by their peers are more likely to become depressed during adolescence.14,59,60 Recurrent bullying or victimisation in Year 8 predicts symptoms of depression and anxiety in Year 9, especially for girls.61

In short, adversity and deprivation are risk factors for depression, either directly or because they engender the negative and pessimistic thinking that turns surmountable negative happenings into the defeats that produce depression.

Can we prevent depression by improving the school environment?

Although there is no evidence that a nurturing school environment prevents depression, one of the primary aims of any prevention program is to reduce known and modifiable risk factors. It is equally important to increase protective factors that reduce the likelihood of poor outcomes in the presence of risk.62 Children with high intelligence, good problem-solving and social skills,56,63,64 high self-esteem, a sense of control and positive expectations for the future57,65,66 are less likely than others to become depressed when environmental risk factors are present. A positive attributional style provides protection against stressful life events.67 In addition to such individual characteristics, the presence of social support plays an especially important protective role.57,68,69 Such support includes good peer relations, support from teachers,70 and a warm and stable relationship with at least one parent.65 Children who grow up in a negative family situation are less likely to become depressed if they have a confiding relationship with at least one adult outside the family, or if they are involved in and obtain positive recognition for school or community activities outside the family.63,71,72

School-based programs

School-based programs generally fall under three main intervention types: universal (involving all members of a population group), selective (focusing on a subgroup at high risk), or indicated (targeting those with subclinical disturbances).4 Andrews and Wilkinson73 (page S97) list the nine randomised controlled trials (RCT) of prevention of depression in young people at risk. Five trials, all of which used cognitive approaches to strengthen the child's interpretation of adversity, were successful. In some, the reduction of major depressive disorder approached 50%. But these were small studies — none involved a whole-school system approach.

Although not specifically designed to prevent depression, several "whole-school system" programs have shown positive results (see Box).74 In practice, many school-based programs designed to promote emotional wellbeing have focused on younger children in an attempt to prevent academic failure and reduce the school drop-out rate. For example, one study evaluated a transition program for "high risk" students transferring from primary to secondary school.78 Elements included the restructuring of home rooms to allow more continuity with peers, and expanding the role of home room teachers to assume advisory and counselling roles for students. Students participating in the program reported lower levels of depression and anxiety symptoms, and fewer behavioural problems. School drop-out rates after four years were reduced by more than 50% in the intervention group.

The Mastery Learning and Good Behaviour Games (MLG and GBG, respectively) are examples of classroom-level interventions teaching skills to six- and seven-year-old students.79 The MLG was introduced to promote academic achievement with the aim of preventing later depressive symptoms. The GBG was designed to prevent the development of aggressive behaviour. The project used a novel randomisation design with schools allocated to one of three groups: control, MLG or GBG. Within intervention schools, classes were randomised to intervention or control status. The GBG had a strong effect in Year 1 in reducing aggressive behaviour and the effect was still present at Year 6, with the greatest improvement in the most aggressive males. The introduction of MLG improved achievement. Interestingly, this was accompanied by reduced reports of depressive symptoms in girls. Unfortunately, there were insufficient data to calculate effect sizes, and there is the possibility that teachers who made ratings were influenced by their participation in the program.

Conclusion

beyondblue is committed to strategies that prevent or minimise the impact of depression. We have concluded that the risk factors for depression in young people lie in part in their environment, and in part in their interpretation of that environment. Previous reports on prevention show that the school environment can be made less aversive and punitive and that the cognitive and behavioural styles of at-risk children can be changed. Now that we know what to do — improve the school environment and teach cognitive skills to children at risk — we need to plan how to implement this on a national basis while sustaining some ability for ongoing evaluation. Andrews and Wilkinson (page S97) describe one method to evaluate the roll-out of such programs. 73

Examples of "whole school" programs with positive results

Reducing bullying75

This study in Scandinavia involved a universal prevention program focusing on the whole-school climate, with subsequent benefit to school attachment and retention. The intervention targeted 11–14-year-old children and consisted of a nationwide campaign to tackle the problems of victimisation and bullying in Norwegian and Swedish schools.

Schools and families were given a folder and instruction booklet, a video on bullying and questionnaire data. The program was designed to target aggressive behaviour, poor family management, and attitudes to bullying. Information was collected from students at baseline, eight months and 20 months.

There was a 50% reduction in the reported levels of victimisation and a substantial reduction in self-reports of antisocial behaviours (vandalism, theft, truancy). Furthermore, there was a considerable increase in reports of satisfaction with school life, with increased retention rates being the best indicator. The absence of significance testing and the reliance on self-report data are notable limitations of the study.

Preventing antisocial behaviour76

This study in the US, targeting the social climate of the classroom, aimed to improve commitment to school, increase academic performance, and reduce peer rejection and disruptive behaviour.

Teachers received initial training, followed by an average of two hours of supervision per month for the duration of the year. Randomisation occurred at the teacher level, and students identified as low achievers in Year 6 were randomised into experimental or comparison groups.

At one-year follow-up, substantial differences were noted in the strategies used by the intervention teachers. Although differences were not found on academic achievement or self-reported levels of delinquency, the number of suspensions was almost halved in the experimental group. Furthermore, there were significant gains in attachment and commitment to school.

Helping socially disadvantaged children77

The Cromer program in the US targeted school organisation in demoralised inner city elementary schools.

This program included the introduction of a social calendar, a parent program, visits from a multidisciplinary mental health team, and development of a more democratic and participatory system of school governance.

The intervention schools had significantly higher middle school grades, academic achievement on external tests, and self-perceived social competence.

  • Jane M Burns1
  • Gavin Andrews2
  • Marianna Szabo3

  • 0 beyondblue: the national depression initiative, Melbourne, VIC.
  • 1 Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Sydney, NSW.


  • 1. Rose G. The strategy of preventive medicine. Oxford: Oxford University Press, 1995.
  • 2. Sawyer MG, Koski RJ, Graetz BW, et al. National survey of mental health and well-being: the child and adolescent component. Aust N Z J Psychiatry 2000; 34: 214-220.
  • 3. Burns J, Hickie I. Depression in young people: a national school-based initiative for prevention, early intervention and pathways for care. Australas Psychiatry. In press, 2002.
  • 4. Committee on Prevention of Mental Disorders. Reducing the risks for mental disorders: frontiers for preventive intervention research. 1st ed. Washington DC: National Academy Press, 1994.
  • 5. Ge X, Lorenz FO, Conger RD, Elder GH. Trajectories of stressful life events and depressive symptoms during adolescence. Dev Psychol 1994; 30: 467-483.
  • 6. Hankin BL, Abramson LY. Development of gender differences in depression: description and possible explanations. Ann Med 1999; 31: 372-379.
  • 7. Grant KE, Compas B. Stress and anxious-depressed symptoms among adolescents: searching for mechanisms of risk. J Consult Clin Psych 1995; 63: 1015-1021.
  • 8. Patton GC. Meeting the challenge of adolescent mental health [editorial]. Med J Aust 1997; 166: 399-400.
  • 9. Straus MA, Kantor GK. Corporal punishment of adolescents by parents: a risk factor in the epidemiology of depression, suicide, alcohol abuse, child abuse, and wife beating. Adolescence 1994; 29: 543-561.
  • 10. Gorman-Smith D, Tolan P. The role of exposure to community violence and developmental problems among inner-city youth. Dev Psychopathol 1998; 10: 101-116.
  • 11. Conger RD, Conger KJ, Matthews LS, Elder GH Jr. Pathways of economic influence on adolescent adjustment. Am J Community Psychol 1999; 27: 519-541.
  • 12. Calam R, Horne L, Glasgow D, Cox A. Psychological disturbance and child sexual abuse: a follow-up study. Child Abuse Negl 1998; 22: 901-913.
  • 13. Toth SL, Cicchetti D. Patterns of relatedness, depressive symptomatology, and perceived competence in maltreated children. J Consult Clin Psychol 1996; 64: 32-41.
  • 14. Reinherz HZ, Giaconia RM, Hauf AM, et al. Major depression in the transition to adulthood: risks and impairments. J Abnormal Psychol 1999; 108: 500-510.
  • 15. Frost AK, Reinherz HZ, Pakiz-Camras B, et al. Risk factors for depressive symptoms in late adolescence: a longitudinal community study. Am J Orthopsychiatry 1999; 69: 370-381.
  • 16. Grych J, Fincham F. Children of single parents and divorce. In: Silverman WK, Ollendick TH, editors. Developmental issues in the clinical treatment of children. Boston, MA: Allyn and Bacon, 1999; 321-341.
  • 17. Maughan B, McCarthy G. Childhood adversities and psychosocial disorders. Br Med Bull 1997; 53: 156-169.
  • 18. Hammen C, Henry R, Daley SE. Depression and sensitization to stressors among young women as a function of childhood adversity. J Consult Clin Psychol 2000; 68: 782-787.
  • 19. Rudolph KD, Hammen C. Age and gender as determinants of stress exposure, generation, and reactions in youngsters: a transactional perspective. Child Dev 1999; 70: 660-677.
  • 20. McKenna ER. The relationship between parenting style, level of culture change and depression in Chinese living in the United States [dissertation]. Dissertation Abstracts International 1999.
  • 21. Goodyer IM. The influence of recent life events on the onset and outcome of major depression in young people. In: Essau CA, Petermann F, editors. Depressive disorders in children and adolescents: epidemiology, risk factors, and treatment. Northvale, NJ: Jason Aronson Inc, 1999; 237-260.
  • 22. Gotlib IH, Krasnoperova E. Biased information processing as a vulnerability factor for depression. Behav Ther 1998; 29: 603-617.
  • 23. Marton P, Connolly J, Kutcher S, Korenblum M. Cognitive social skills and social self-appraisal in depressed adolescents. J Am Acad Child Adolesc Psychiatry 1993; 32: 739-744.
  • 24. Rudolph KD, Clark AG. Conceptions of relationships in children with depressive and aggressive symptoms: social–cognitive distortion or reality? J Abnorm Child Psychol 2001; 29: 41-56.
  • 25. Dalgleish T, Neshat-Doost H, Taghavi R, et al. Information processing in recovered depressed children and adolescents. J Child Psychol Psychiatry 1998; 39: 1031-1035.
  • 26. Dalgleish T, Taghavi R, Neshat-Doost H, et al. Information processing in clinically depressed and anxious children and adolescents. J Child Psychol Psychiatry 1997; 38: 535-541.
  • 27. Cole DA, Jordan AE. Competence and memory: integrating psychosocial and cognitive correlates of child depression. Child Dev 1995; 66: 459-473.
  • 28. Turner JE, Cole DA. Developmental differences in cognitive diatheses for child depression. J Abnorm Child Psychol 1994; 22: 15-32.
  • 29. Weisz JR, Southam-Gerow MA, McCarty CA. Control-related beliefs and depressive symptoms in clinic-referred children and adolescents: developmental differences and model specificity. J Abnorm Psychol 2001; 110: 97-109.
  • 30. Abramson LY, Seligman ME, Teasdale JD. Learned helplessness in humans: critique and reformulation. J Abnorm Psychol 1978; 87: 49-74.
  • 31. Gladstone TR, Kaslow NJ. Depression and attributions in children and adolescents: a meta-analytic review. J Abnorm Child Psychol 1995; 23: 597-606.
  • 32. Hilsman R, Garber J. A test of the cognitive diathesis-stress model of depression in children: academic stressors, attributional style, perceived competence, and control. J Pers Soc Psychol 1995; 69: 370-380.
  • 33. Joiner TE Jr. A test of the hopelessness theory of depression in youth psychiatric inpatients. J Clin Child Psychol 2000; 29: 167-176.
  • 34. Beardslee WR, Versage EM, Gladstone TRG. Children of affectively ill parents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1998; 37: 1134-1141.
  • 35. Gotlib IH, Goodman SH. Children of parents with depression. In: Silverman WK, Ollendick TH, editors. Developmental issues in the clinical treatment of children. Boston, MA; Allyn and Bacon, 1999; 415-432.
  • 36. Essex M, Klein M, Miech R, Smider N. Timing of initial exposure to maternal major depression and children's mental health symptoms in kindergarten. Br J Psychiatry 2001; 179: 151-156.
  • 37. Wickramaratne PJ, Warner V, Weissman MM. Selecting early onset MDD probands for genetic studies: results from a longitudinal high-risk study. Am J Med Genet 2000; 96: 93-101.
  • 38. Weissman MM, Fendrich M, Warner V, Wickramaratne P. Incidence of psychiatric disorder in offspring at high and low risk for depression. J Am Acad Child Adolesc Psychiatry 1992; 31: 640-648.
  • 39. Duggal S, Carlson EA, Sroufe LA, Egeland B. Depressive symptomatology in childhood and adolescence. Dev Psychopathol 2001; 13: 143-164.
  • 40. Fergusson DM, Horwood LJ, Lynskey MT. Maternal depressive symptoms and depressive symptoms in adolescents. J Child Psychol Psychiatry 1995; 36: 1161-1178.
  • 41. Boyle MH, Pickles A. Maternal depressive symptoms and ratings of emotional disorder symptoms in children and adolescents. J Child Psychol Psychiatry 1997; 38: 981-992.
  • 42. Crawford TN, Cohen P, Midlarsky E, Brook JS. Internalizing symptoms in adolescents: gender differences in vulnerability to parental distress and discord. J Res Adolesc 2001; 11: 95-118.
  • 43. Essau CA, Merikangas KR. Familial and genetic factors. In: Essau CA, Petermann F, editors. Depressive disorders in children and adolescents: epidemiology, risk factors, and treatment. Northvale, NJ: Jason Aronson Inc, 1999; 261-285.
  • 44. Dadds MR, Barrett PM. Family processes in child and adolescent anxiety and depression. Behav Change 1996; 13: 231-239.
  • 45. Lyons-Ruth K, Wolfe R, Lyubchik A. Depression and the parenting of young children: making the case for early preventive mental health services. Harv Rev Psychiatry 2000; 8: 148-153.
  • 46. Taylor L, Ingram RE. Cognitive reactivity and depressotypic information processing in children of depressed mothers. J Abnorm Psychol 1999; 108: 202-210.
  • 47. Cole DA, Jacquez FM, Maschman TL. Social origins of depressive cognitions: a longitudinal study of self-perceived competence in children. Cognit Ther Res 2001; 25: 377-395.
  • 48. Tram JM, Cole DA. Self-perceived competence and the relation between life events and depressive symptoms in adolescence: mediator or moderator? J Abnorm Psychol 2000; 109: 753-760.
  • 49. Cole DA, Martin JM, Powers B. A competency-based model of child depression: a longitudinal study of peer, parent, teacher, and self-evaluations. J Child Psychol Psychiatry 1997; 38: 505-514.
  • 50. Cole DA. Relation of social and academic competence to depressive symptoms in childhood. J Abnorm Psychol 1990; 99: 422-429.
  • 51. Cole DA, Martin JM, Peeke LA, et al. Children's over- and underestimation of academic competence: a longitudinal study of gender differences, depression, and anxiety. Child Dev 1999; 70: 459-473.
  • 52. McCauley Ohannessian C, Lerner RM, Lerner JV, von Eye A. Does self-competence predict gender differences in adolescent depression and anxiety? J Adolesc 1999; 22: 397-411.
  • 53. Segrin C. Social skills deficits associated with depression. Clin Psychol Rev 2000; 20: 379-403.
  • 54. Bandura A, Pastorelli C, Barbaranelli C, Caprara GV. Self-efficacy pathways to childhood depression. J Pers Soc Psychol 1999; 76: 258-269.
  • 55. Kistner J, Balthazor M, Risi S, Burton C. Predicting dysphoria in adolescence from actual and perceived peer acceptance in childhood. J Clin Child Psychol 1999; 28: 94-104.
  • 56. Conrad M, Hammen C. Protective and resource factors in high- and low-risk children: a comparison of children with unipolar, bipolar, medically ill, and normal mothers. Dev Psychopathol 1993; 5: 593-607.
  • 57. Seifer R, Sameroff AJ, Baldwin CP, Baldwin A. Child and family factors that ameliorate risk between 4 and 13 years of age. J Am Acad Child Adolesc Psychiatry 1992; 31: 893-903.
  • 58. Rudolph KD, Lambert SF, Clark AG, Kurlakowsky KD. Negotiating the transition to middle school: the role of self- regulatory processes. Child Dev 2001; 72: 929-946.
  • 59. Steele RG, Armistead L, Forehand R. Concurrent and longitudinal correlates of depressive symptoms among low-income, urban, African American children. Family Health Project Research Group. J Clin Child Psychol 2000; 29: 76-85.
  • 60. Jaffee SR, Moffitt TE, Caspi A, et al. Differences in early childhood risk factors for juvenile-onset and adult-onset depression. Arch Gen Psychiatry 2002: 59: 215-222.
  • 61. Bond L, Carlin JB, Thomas L, et al. Does bullying cause emotional problems? A prospective study of young teenagers. BMJ 2001; 323: 480-484.
  • 62. Cowen EL. Now that we all know that primary prevention in mental health is great, what is it? J Community Psychol 2000; 28: 5-16.
  • 63. Bonde E, Dehlholm-Lambertsen B, Nielsen N, Justesen EM. Life circumstances for children of mentally ill parents. Nord J Psychiatry 1997; 51: 467-474.
  • 64. Downey G, Walker E. Distinguishing family-level and child-level influences on the development of depression and aggression in children at risk. Dev Psychopathol 1992; 4: 81-95.
  • 65. Herman-Stahl M, Petersen AC. Depressive symptoms during adolescence: direct and stress-buffering effects of coping, control beliefs, and family relationships. J Appl Dev Psychol 1999; 20: 45-62.
  • 66. Zimmerman MA, Ramirez-Valles J, Maton KI. Resilience among urban African American male adolescents: a study of the protective effects of sociopolitical control on their mental health. Am J Community Psychol 1999; 27: 733-751.
  • 67. Abramson LY. Optimistic cognitive styles and invulnerability to depression. In: Gillham J, editor. The science of optimism and hope: research essays in honor of Martin E. P. Seligman. Philadelphia, PA: Templeton Foundation Press, 2000; 75-98.
  • 68. Gore S, Farrell F, Gordon J. Sports involvement as protection against depressed mood. J Res Adolesc 2001; 11: 119-130.
  • 69. Gore S, Aseltine RH Jr. Protective processes in adolescence: matching stressors with social resources. Am J Community Psychol 1995; 23: 301-327.
  • 70. Cheung SK. Life events, classroom environment, achievement expectation, and depression among early adolescents. Soc Behav Pers 1995; 23: 83-91.
  • 71. Beardslee WR. Prevention and the clinical encounter. Am J Orthopsychiatry 1998; 68: 521-533.
  • 72. Hakim-Larson J, Essau CA. Protective factors and depressive disorders. In: Essau CA, Petermann F, editors. Depressive disorders in children and adolescents: epidemiology, risk factors, and treatment. Northvale, NJ: Jason Aronson Inc, 1999; 319-337.
  • 73. Andrews G, Wilkinson DD. The prevention of mental disorders in young people. Med J Aust 2002; 177 Suppl Oct 7: S97-S100. <eMJA full text>
  • 74. Burns JM, Patton GC. Preventive interventions for youth suicide: a risk factor-based approach. Aust N Z J Psychiatry 2000; 34: 388-407.
  • 75. Olweus D. Bullying at school: basic facts and effects of a school based intervention program. J Child Psychol Psychiatry 1994; 35: 1171-1190.
  • 76. Hawkins JD, Catalano RF, Morrison DM, et al. The Seattle Social Development Project: effect of the first four years on protective and problem behaviours. In: McCord J, Tremblay RE, editors. Preventing antisocial behaviour: interventions from birth through to adolescence. New York: Guilford Press, 1992.
  • 77. Comer JP. Educating poor minority children. Sci Am 1988; 259: 42-48.
  • 78. Felner RD, Brand S, Adan AM, et al. Restructuring the ecology of the school as an approach to prevention during school transitions: longitudinal follow-ups and extensions of the School Transitional Environment Project (STEP). Prev Hum Serv 1993; 10: 103-136.
  • 79. Kellam SG, Rebok GW. Building developmental and etiological theory through epidemiologically based preventive intervention trials. In: McCord J, Tremblay RE, editors. Preventing antisocial behaviour: interventions from birth through adolescence. New York: Guilford Press, 1992; 162-195.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.