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Addressing Adolescent Depression

April 10, 2019 by Tracy Vogel

A 20-year-old Hopkins program helps communities recognize a key driver of teen suicide

As a doctor, Karen Lee Swartz knows that data should come to mind first when she talks about the successes of the Adolescent Depression Awareness Program (ADAP). But what really stays with her are the stories.

The ninth-grader who sat on the phone for more than an hour each night with a friend who begged her to keep the suicidal thoughts she revealed secret — but who finally turned to an adult to get the friend help. The young girl who came up to Swartz after an ADAP class and said she had stopped taking her medication, but was going to talk to her mother about getting back into treatment.

“Teens have this instinct to try to handle things on their own and not bring in an adult,” says Swartz, ADAP’s founder and director, and an associate professor of psychiatry and behavioral sciences. “Can you imagine how dangerous it is to have your therapist be a 10th grade best friend? If the worst happens, the tragedy ruins multiple lives.”

A woman speaks, gesturing with her hands and surrounded by a half-dozen high-school-aged students in a classroom setting.
Under the leadership of Karen Swartz (second from left, speaking), ADAP has provided more than 100,000 high school students in Baltimore and beyond with evidence-based education about suicide, depression, and bipolar disorder.

Two decades ago, a trio of Baltimore-area teen suicides led to the birth of ADAP, a program that trains educators to deliver three hours of evidence-based information on suicide, depression, and bipolar disorder to their students. Today, more than 100,000 high school students in 20 states have taken the course.

ADAP conveys two key messages: First, depression is a treatable medical illness ― not a weakness. Second, if you’re worried about yourself or a friend, you need to tell a trusted adult.

Suicide rates are on the rise in the United States, including among teens. Psychological autopsy studies — which involve structured interviews of family members, relatives, friends, and health care personnel with relationships to a deceased person — have shown that more than 90 percent of suicides result from mental illness. Yet a lack of understanding remains pervasive, with popular culture emphasizing the risk factors for suicide over awareness of depression as a mood disorder.

ADAP strives to change that thinking. A study of ADAP’s effectiveness showed a significant increase in understanding of depression among students who participated in the program and noted that 46 percent of teachers were later approached by students with concerns about themselves or others.

“When you have a tragic death everyone wants to make sense of it, and the most honest response is that this person had a terrible illness and it wasn’t recognized or it didn’t respond to treatment,” Swartz says. “There’s a lot of storytelling about how these things happen that are about their life and relationships and breakups. But all those things are happening to thousands of kids this second. The difference is that some people can’t think through [those situations] because their reactions to things are heightened and distorted.”


A study of ADAP’s effectiveness showed a significant increase in understanding of depression among students who participated in the program and noted that 46 percent of teachers were later approached by students with concerns about themselves or others.

As ADAP enters its 20th year, it’s poised to leap into a new phase: converting the in-person training for teachers into an online platform featuring downloadable materials, video, and more. The goal is to reach every high school in the United States.

Mary Ellen Pease, a member of the Psychiatry and Behavioral Sciences Advisory Board, and her husband, university Trustee Charlie Scheeler, have agreed to match gifts up to $250,000 to help launch the online program. They were inspired by their experiences with their own daughter, Cecelia Scheeler, who was diagnosed at age four with obsessive-compulsive disorder (OCD). Now in law school, she has written about her experiences with OCD and her treatment in publications like Good Housekeeping and Self.

“In middle school there was a point where Cecelia just stopped hiding it and decided, ‘Look, I’m going to educate these people,’” Pease says.

Cecelia never struggled with clinical depression, but her efforts and successes drove home for her parents the importance of education on mood disorders, and especially eliminating the stigma around them.

“We want to pay forward our good fortune that we found treatment for our daughter early on,” Pease continues. “I cannot for a second imagine losing a child when there are treatments available.”

A man in a white lab coat stands behind a podium, smiling, as he hands a crystal plaque to a woman, dressed in a suit, standing beside him.
Johns Hopkins Medicine CEO Paul Rothman presents Swartz with a plaque during her installation as the Myra S. Meyer Professor in Mood Disorders during a 2018 ceremony. The chair honors Swartz’s two-decade stewardship of ADAP, as well as her excellence in teaching and research.

Pease and Scheeler’s generosity is the latest way philanthropy has fueled ADAP’s growth. Since Swartz began the program, about 250 donors have given approximately $2.5 million in support.

That funding is important, Swartz says, because federal agencies typically support established ideas. A multifaceted challenge like adolescent depression requires innovation and people willing to take chances on different approaches.

“No one was going to give me a federal grant to develop a program from scratch to do something that had never been done before ― which was a psychiatrist-written high school health program,” Swartz says. “This program never would have happened without philanthropy.”

Her longer-term goals include developing materials for parents and supplemental resources for students, and perhaps eventually a middle-school curriculum. For now, reaching as many high school students as possible remains Swartz’s top priority.

“We had the community say, ‘Do something.’ A few hundred students turned into a few thousand, and that turned into tens of thousands,” she says. “We’ve been ‘the little engine that could’ project.”

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Topics: Foundations, Friends of Johns Hopkins Medicine, Johns Hopkins Medicine, Promote and Protect Health, Strengthen Communities