Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Psychological and Social Foundations

Major Professor

Shannon M. Suldo

Keywords

internalizing, middle school, psychopathology, school-based mental health, teacher nomination

Abstract

Schools need accurate and efficient ways to identify youth with mental health problems, in part to provide services to such students whose mental health concerns pose barriers to learning. The present study involved an investigation of the accuracy of one method--relying on educators (teachers, a team of school-based mental health professionals, and a school nurse) to identify early adolescents who self-report elevated levels of anxiety or depression. With respect to teachers as screening agents, the possible variability in rates of accurate identification as a function of number of teachers involved in the process (i.e., pooling nominations from multiple subject area teachers for a single student rather than from a single subject area teacher) was examined. The present study also included an examination of the demographic and psychological features of students who are more likely to be missed (i.e., self-report elevated symptoms but are not detected) or misidentified (i.e., self-reported symptoms in the typical range but were incorrectly identified as symptomatic) by educators. Participants included 233 middle school students in grades 7 to 8, 19 teachers, and 6 school-based mental health professionals. Approximately 15.5% and 12% of student participants twice-reported at-risk levels of anxiety and depression, respectively. At-risk was defined as T-scores more than one standard deviation from the norm group mean on psychometrically sound narrowband measures of anxiety and depression. Teachers correctly identified 58.33% of these anxious students and 32.14% of the students with elevated depression, but misidentified 34.52% of non-symptomatic students for anxiety and 23.41% for depression. The school-based mental health staff was largely less accurate than the teachers. The team of school-based mental health professionals accurately identified 12.50% of students for anxiety and 26.32% for depression, and falsely identified 10.31% for anxiety and 25.49% for depression. The school nurse correctly identified 14.81% of students for anxiety and 14.29% for depression, and misidentified 16.26% for anxiety and 17.83% for depression. Taken together, the use of educator nominations in identification of internalizing middle school students appears most defensible when relying on teacher judgments to identify youth with elevated anxiety. The combined group of core subject area teachers (language arts, math, and social studies) was more accurate than teachers from a single subject area, suggesting that teacher nominations should be elicited from multiple groups of core subject area teachers, particularly math and language arts. Rather than nominating students themselves, school-based mental health professionals may be better situated to deliver professional development to teachers regarding the identification of anxiety and depression. Additionally, although several demographic (i.e., gender, race/ethnicity, socioeconomic status) and psychological features (i.e., symptom severity, symptom type; also socially desirable responding and life satisfaction) were examined for students who were missed and misidentified, few differences emerged between the pairs of groups with similar self-reported levels of symptoms. Exceptions included that students who were misidentified reported higher levels of depressive symptoms (albeit still in the typical range) and less satisfaction with their lives than students who were not nominated by teachers. Thus, teachers may detect some mild mood or quality of life differences among students that do not align with students' self-report of symptoms. The practical implications of all study findings, as well as directions for future research, are discussed

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