Effects of a school-based intervention on levels of anxiety and depression: a cluster-randomized controlled trial of the MindPower program in ten high schools in Norway

Gry Anette Sælid, Nikolai Olavi Czajkowski, Leif Edvard Aarø, John Roger Andersen, Thormod Idsøe, Miguel Delgado Helleseter, Arne Holte, Gry Anette Sælid, Nikolai Olavi Czajkowski, Leif Edvard Aarø, John Roger Andersen, Thormod Idsøe, Miguel Delgado Helleseter, Arne Holte

Abstract

Background: The previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15-16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety.

Methods: We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData).

Results: According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData.

Conclusions: No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.

Keywords: Adolescent; Anxiety; CWD; Depression; Mental health promotion; Prevention; School; Universal.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
SCL-8 and RADS-2:SF across the seven measurement waves
Fig. 3
Fig. 3
Scores on SCL-8 and RADS-2:SF across the seven measurement points

References

    1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378(9801):1515–1525. doi: 10.1016/S0140-6736(11)60827-1.
    1. Key. State of Education Survey Report 2017: Rising to the challenge: examining the pressures of schools and how they are responding. . Accessed 12 Feb 2018.
    1. McLaughlin CL. International approaches to school-based mental health: intent of the Special Issue. Sch Psy Int. 2017;38(4):339–42.
    1. Sturgeon S. Promoting mental health as an essential aspect of health promotion. Health Prom Int. 2006;21(suppl_1):36–41.
    1. Tanner-Smith EE, Durlak JA, Marx RA. Empirically based mean effect size distributions for universal prevention programs targeting school-aged youth: a review of meta-analyses. Prev Sci. 2018;19:1091–1101. doi: 10.1007/s11121-018-0942-1.
    1. Hoare E, Collins S, Marx W, Callaly E, Moxham-Smith R, Cuijpers P, Holte A, Nierenberg AA, Reavley N, Christensen H, Reynolds CF, III, Carvalho AF, Jacka F, Berk M. Universal depression prevention: an umbrella review and meta-analysis. J Psychiatr Res. 2021;144:483–493. doi: 10.1016/j.jpsychires.2021.10.006.
    1. Bloom HS, Hill CJ, Black AR, Lipsey MW. Performance trajectories and performance gaps as achievement effect-size benchmarks for educational interventions. J Res Educ Effect. 2008;1:289328. doi: 10.1080/19345740802400072.
    1. Salazar de Pablo G, De Micheli A, Nieman DH, Correll CU, Vedel Kessing L, Pfennig A, Bechdolf A, Borgwardt S, Arango C, van Amelsvoort T, Vieta E, Solmi M, Oliver D, Catalan A, Verdino V, Di Maggio L, Bonoldi I, Vaquerizo-Serrano J, Baccaredda Boy O, Provenzani U, Ruzzi F, Calorio F, Nosari G, Di Marco BI, Famularo S, Molteni E, Filosi M, Mensi, U. Balottin, Politi PJI, Shin P, Fusar-Poli P. Universal and selective interventions to promote good mental health in young people: systematic review and meta-analysis. Eur Neuropsychopharmacol. 2020;41,pp. 28–39.
    1. Kavanagh J, Oliver S, Lorenc T, Caird J, Tucker H, Harden A, et al. School-based cognitive-behavioural interventions: A systematic review of effects and inequalities. Health Soc Rev. 2009;18(1):61–78. doi: 10.5172/hesr.18.1.61.
    1. Pinto TM, Laurence PG, Macedo CR, Macedo, EC. Resilience programs for children and adolescents: a systematic review and meta-analysis. 2021. Front Psychol. 10.3389/fpsyg.2021.754115
    1. Carsley D, Khoury B, Heath NL. Effectiveness of mindfulness interventions for mental health in schools: a comprehensive meta-analysis. Mindfulness. 2018;9(3):693–707. doi: 10.1007/s12671-017-0839-2.
    1. Galante J, Friedrich C, Dawson AF, Modrego-Alarcón M, Gebbing P, Delgado-Suárez I, Gupta R, Dean L, Dalgleish T, White IR, Jones PB. Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: a systematic review and meta-analysis of randomised controlled trials. PLoS Med. 2021;18(1):e1003481. doi: 10.1371/journal.pmed.1003481.
    1. Taylor RD, Oberle E, Durlak JA, Weissberg RP. Promoting positive youth development through school-based social and emotional learning interventions: a meta-analysis of follow-up effects. Child Dev. 2017;88(4):1156–1171. doi: 10.1111/cdev.12864.
    1. Stockings E, Degenhardt L, Dobbins T, Lee Y, Erskine H, Whiteford H, et al. Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention. Psychol Med. 2016;46(1):11–26. doi: 10.1017/S0033291715001725.
    1. Weare K, Nind M. Promoting mental health of children and adolescents through schools and school based interventions: Evidence outcomes: School based interventions. Health Promot Int. 2011;26(Suppl. 1):i29–i69. doi: 10.1093/heapro/dar075.
    1. Werner-Seidler A, Perry Y, Calear AL, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:30–47. doi: 10.1016/j.cpr.2016.10.005.
    1. Weissberg RP, Caplan M, Z., Sivo PJ. A new conceptual framework for establishing school-based social competence promotion programs. In: L.A. B, Compas BE, editors. Primary prevention and promotion in schools (pp. 255–296). Newbury Park: CA: Sage; 1989.
    1. World Health Organication: General life skills education for children and adolescents in schools. Introduction and guidelines to facilitate the development and implementation of life skills programmes. Programme on Mental Health. ; 1997. Accessed Apr 14 2021.
    1. Atkins MS, Hoagwood KE, Kutash K, Seidman E. Toward the integration of education and mental health in schools. Adm Policy Ment Health Ment Health Serv Res. 2010;37(1):40–47. doi: 10.1007/s10488-010-0299-7.
    1. Government S. Mental Health Strategy 2017–2027. In: care Has, editor. . Accessed Nov 12 2020.
    1. Government W. Written Statement - Providing for the Emotional and Mental Health Needs of Young People in Schools. In: Cabinet Secretary for Health WBS, editor. . Accessed Feb 21 2021.
    1. Clarke GN, Hawkins W, Murphy M, Sheeber L. School-based primary prevention of depressive symptomatology in adolescents: Findings from two studies. J Adol Research. 1993;8(2):183–204. doi: 10.1177/074355489382004.
    1. Cuijpers P, Muñoz RF, Clarke GN, Lewinsohn PM. Psychoeducational treatment and prevention of depression: the “Coping with Depression” course thirty years later. Clin Psychol Rev. 2009;29(5):449–458. doi: 10.1016/j.cpr.2009.04.005.
    1. Lewinsohn PM, Weinstein MS, Alper T. A behavioral approach to the group treatment of depressed persons: a methodological contribution. J Clin Psychol. 1970;26:525–532. doi: 10.1002/1097-4679(197010)26:4<525::AID-JCLP2270260441>;2-Y.
    1. Lewinsohn PM, Steinmetz JL, Antonuccio D, Teri L. Group therapy for depression: the coping with depression course. Int J Ment Health. 1984;13(3–4):8–33. doi: 10.1080/00207411.1984.11448974.
    1. Dalgard OS: A randomized controlled trial of a psychoeducational group program for unipolar depression in adults in Norway (NCT00319540). Clin Pract Epidemol Ment Health. 2006, 2: 15-10
    1. Keles S, Idsoe T. Six-and twelve-month follow-up results of a cluster randomized controlled trial of a CBT-based group course. Prev Sci. 2021;22(4):409–418. doi: 10.1007/s11121-020-01160-0.
    1. Sælid GA, Czajkowski NO, Holte A, Tambs K, Aarø LE. Positive mental health effects of the coping with strain (CWS) course on employees: a four-year longitudinal randomized controlled trial. Int J Ment Health Promot. 2016;18(3):158–175. doi: 10.1080/14623730.2016.1196231.
    1. Saelid GA, Czajkowski NO, Holte A, Tambs K, Aarø LE. Coping With Strain (CWS) course–its effects on depressive symptoms: A four-year longitudinal randomized controlled trial. Scand J Psych. 2016;57(4):321–327. doi: 10.1111/sjop.12289.
    1. Rose GA, Khaw K-T, Marmot M. Rose's strategy of preventive medicine (Oxford Medical Publications). Oxford University Press, USA; 1992.
    1. Mackenbach JP, Lingsma HF, van Ravesteyn NT, Kamphuis CB. The population and high-risk approaches to prevention: quantitative estimates of their contribution to population health in the Netherlands, 1970–2010. Eur J Publ Health. 2013;23(6):909–915. doi: 10.1093/eurpub/cks106.
    1. Mrazek PB, Haggerty RJ. Reducing risks for mental disorders: Institute of Medicine Committee on Prevention of Mental Disorders; 1994.
    1. van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF, III, Beekman AT, et al. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol. 2014;43(2):318–329. doi: 10.1093/ije/dyt175.
    1. Roberts C, Freeman J, Samdal O, Schnohr CW, De Looze ME, Gabhainn SN, Iannotti R, Rasmussen M. The Health Behaviour in School-aged Children (HBSC) study: methodological developments and current tensions. Int J Public health. 2009;54(2):140–150. doi: 10.1007/s00038-009-5405-9.
    1. Campbell MK, Thomson S, Ramsay CR, MacLennan GS, Grimshaw JM. Sample size calculator for cluster randomised trials. Comput Biol Med. 2004;34:113–125. doi: 10.1016/S0010-4825(03)00039-8.
    1. Tambs K, Røysamb E. Selection of questions to short-form versions of original psychometric instruments in MoBa. Norsk Epidemiologi. 2014;24(1–2):195–201.
    1. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Bev Sci. 1974;19(1):1–15. doi: 10.1002/bs.3830190102.
    1. Strand BH, Dalgard OS, Tambs K, Rognerud M. Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36) Nor J Psychiatry. 2003;57(2):113–118. doi: 10.1080/08039480310000932.
    1. Sund AM, Larsson B, Wichstrøm L. Prevalence and characteristics of depressive disorders in early adolescents in central Norway. Child Adolesc Psychiatry Mental Health. 2011;5(1):1–13. doi: 10.1186/1753-2000-5-28.
    1. Wichstrøm L. The emergence of gender difference in depressed mood during adolescence: the role of intensified gender socialization. Dev Psychol. 1999;35(1):232. doi: 10.1037/0012-1649.35.1.232.
    1. Abebe DS, Frøyland LR, Bakken A, Von Soest T. Municipal-level differences in depressive symptoms among adolescents in Norway: results from the cross-national Ungdata study. Scand J Public Health. 2016;44(1):47–54. doi: 10.1177/1403494815604764.
    1. Reynolds WM. Reynolds adolescent depression scale – 2nd Edition. In M. Hersen, D. L. Segal & M. Hilsenroth (Eds.). Comprehensive handbook of psychological assessment, Volume 2: Personality assessment and psychopathology (pp 224–236). New York: John Wiley & Sons. 2004.
    1. Milfont TL, Merry S, Robinson E, Denny S, Crengle S, Ameratunga S. Evaluating the short form of the Reynolds Adolescent Depression Scale in New Zealand adolescents. Aust N Z J Psychiatry. 2008;42(11):950–954. doi: 10.1080/00048670802415343.
    1. Sælid GA, Czajkowski NO, Aarø LE, Idsøe T, Helleseter MD, Holte A. Challenges in establishing positive mental health effects of a school-based intervention: a cluster-randomized controlled trial of a life skill program in ten public high schools in Norway. Sch Mental Health. [Manuscript submitted for publication]. 2021.
    1. Core Team R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.2013. . Accessed Des 5 2020.
    1. Spss I. IBM SPSS statistics for Windows, version 20.0. New York: IBM Corp. 2011.
    1. Jackson DL. Reporting results of latent growth modeling and multilevel modeling analyses: some recommendations for rehabilitation psychology. Rehabil Psychol. 2010;55(3):272–285. doi: 10.1037/a0020462.
    1. Kwok O-M, Underhill AT, Berry JW, Luo W, Elliott TR, Yoon M. Analyzing longitudinal data with multilevel models: an example with individuals living with lower extremity intra-articular fractures. Rehabil Psychol. 2008;53(3):370. doi: 10.1037/a0012765.
    1. Tasca GA, Maxwell H, Faye M, Balfour L. Feeling worse before feeling better: a case of increased disorganized mental states following group psychotherapy. Int J Group Psychother. 2017;67(2):240–258. doi: 10.1080/00207284.2016.1260461.
    1. Cheng S, Ihlebæk C, Sælid GA. Implementation of a life-skill and health promoting program in High school - A qualitative study of teacher’s experiences. [Unpublished Manuscript]. 2021.
    1. Feiss R, Dolinger SB, Merritt M, Reiche E, Martin K, Yanes JA, et al. A systematic review and meta-analysis of school-based stress, anxiety, and depression prevention programs for adolescents. J Youth Adoles. 2019;48(9):1668–1685. doi: 10.1007/s10964-019-01085-0.
    1. O’Reilly M, Svirydzenka N, Adams S, Dogra N. Review of mental health promotion interventions in schools. Soc Psychiatry Psychiatr Epidemiol. 2018;53(7):647–662. doi: 10.1007/s00127-018-1530-1.
    1. Caldwell DM, Davies SR, Hetrick SE, Palmer JC, Caro P, López-López JA, et al. School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis. Lancet Psychiatry. 2019;6(12):1011–1020. doi: 10.1016/S2215-0366(19)30403-1.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren