Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE): a protocol for a cluster randomised trial testing a school teacher training programme to teach mindfulness (".b")

Lise Juul, Morten Frydenberg, Michelle Sand Beck, Lone Overby Fjorback, Lise Juul, Morten Frydenberg, Michelle Sand Beck, Lone Overby Fjorback

Abstract

Background: There is a call for sustainable, evidence-based interventions in schools to promote mental health in schoolchildren. Our primary aim of this trial is to evaluate the effectiveness in vulnerable pupils of a school teacher training programme to teach mindfulness (".b" programme) as a part of compulsory class room teaching in Danish schools on the pupils' self-reported mental health at 6-month follow-up. Our secondary aim is to evaluate the effectiveness of the school teacher training programme to teach the ".b"-programme as a part of compulsory class room teaching among the total pupil population on the pupils' self-reported mental health at 3 and 6 months after baseline.

Methods: The pragmatic cluster two-armed randomised controlled trial includes 110 municipal or private schools from all five regions in Denmark; 191 school teachers and approximately 2000 pupils at 11-15 years of age. Exclusion criteria; for schools: < 100 pupils; for pupils: parental opt out. Our intervention consists of (A) a school teacher training programme and (B) the ".b"-programme delivered as part of compulsory class room teaching in schools to pupils at the age of 11-15 years. The pupils in the control schools receive education as usual. Our primary study population is the vulnerable subgroup with a Strengths and Difficulties Questionnaire (SDQ) total difficulties score > 80% percentile at baseline (approximately 400 pupils). The primary outcome is change in the SDQ total score by the pupils. We also evaluate the effectiveness among the total pupil study population and in girls and boys, respectively and use other measures on mental health. Data will be analysed with repeated measurement models taken clusters into account.

Discussion: This large-scale trial will estimate the effectiveness of a population-based strategy on mental health in Danish schoolchildren. The trial evaluates the effect of a school teacher training programme, where teachers are trained in teaching the ".b" programme. The ".b" programme will be taught as a part of compulsory class room teaching. The intervention takes implementation issues into account. Effectiveness will be evaluated both in a vulnerable subgroup and among the total population. Trial registration number ClinicalTrials.gov Identifier: NCT04208113, registered December 23 2019, https://ichgcp.net/clinical-trials-registry/NCT04208113 .

Keywords: Community mental health services (MeSH); Effectiveness; MBSR; Mindfulness; Mindfulness-based stress reduction; Pragmatic clinical trial (MeSH); Psychological (MeSH); Schoolbased intervention (MeSH); Stress.

Conflict of interest statement

Aarhus University offers revenue-funded MBSR teacher training education and MBSR courses. The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A brief overview of the SELFCARE project
Fig. 2
Fig. 2
Timeline and description of research activities and intervention contents in the SELFCARE project. A cluster randomised trial testing a school teacher training programme to deliver the “.b” programme in 110 schools from all five regions in Denmark. (Squares reflect fixed elements and circles reflect that some factors e.g. relational dynamics in groups are never fixed.)
Fig. 2
Fig. 2
Timeline and description of research activities and intervention contents in the SELFCARE project. A cluster randomised trial testing a school teacher training programme to deliver the “.b” programme in 110 schools from all five regions in Denmark. (Squares reflect fixed elements and circles reflect that some factors e.g. relational dynamics in groups are never fixed.)
Fig. 2
Fig. 2
Timeline and description of research activities and intervention contents in the SELFCARE project. A cluster randomised trial testing a school teacher training programme to deliver the “.b” programme in 110 schools from all five regions in Denmark. (Squares reflect fixed elements and circles reflect that some factors e.g. relational dynamics in groups are never fixed.)
Fig. 2
Fig. 2
Timeline and description of research activities and intervention contents in the SELFCARE project. A cluster randomised trial testing a school teacher training programme to deliver the “.b” programme in 110 schools from all five regions in Denmark. (Squares reflect fixed elements and circles reflect that some factors e.g. relational dynamics in groups are never fixed.)

References

    1. World Health Organization: Mental health Action Plan 2013–2020. . Accessed 27 Aug 2019.
    1. Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302–1313. doi: 10.1016/S0140-6736(07)60368-7.
    1. Rasmussen Mette ea. Health Behaviour in School-aged Children, Denmark 2018. SDU; 2019.
    1. World Health Organization. Depression. . Accessed 26/05 2020.
    1. Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet. 2018;392(10157):1553–1598. doi: 10.1016/S0140-6736(18)31612-X.
    1. Larsen FB PM, Lasgaard M, Sørensen JB, Christiansen J, Lundberg A, Pedersen SE, Friis K. Hvordan har du det? 2017 – Sundhedsprofil for region og kommuner (Bind 2). Udviklingen 2010–2013–2017. Aarhus: DEFACTUM, Region Midtjylland; 2018.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Skovlund CW, Kessing LV, Morch LS, Lidegaard O. Increase in depression diagnoses and prescribed antidepressants among young girls. A national cohort study 2000–2013. Nord J Psychiatry. 2017:1–8.
    1. OECD. Health at a Glance: Europe 2018: State og Health in the EU Cycle. 2018. . Accessed 05/11 2019
    1. de Vibe M BA, Fattah S, Dyrdal GM, Halland E, Tanner-Smith EE. . Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults:a systematic review and meta-analysis. Campbell Systematic Reviews. 2017.
    1. Rose G. Rose’s strategy of preventive medicine. New York: Oxford University Press; 2008.
    1. O'Connor CA, Dyson J, Cowdell F, Watson R. Do universal school-based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review. J Clin Nurs. 2018;27(3–4):e412–e426.
    1. Meilstrup C, Holstein BE, Nielsen L, Due P, Koushede V. Self-efficacy and social competence reduce socioeconomic inequality in emotional symptoms among schoolchildren. Eur J Public Health. 2019.
    1. Dunning DL, Griffiths K, Kuyken W, Crane C, Foulkes L, Parker J, et al. Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents—a meta-analysis of randomized controlled trials. J Child Psychol Psychiatry. 2019;60(3):244–258.
    1. Kabat-Zinn J. Meditation is not what you think. New York: Hachette Book Group; 2018.
    1. Kuyken W, Nuthall E, Byford S, Crane C, Dalgleish T, Ford T, et al. The effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial. Trials. 2017;18(1):194. doi: 10.1186/s13063-017-1917-4.
    1. Kuyken W, Weare K, Ukoumunne OC, Vicary R, Motton N, Burnett R, et al. Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study. Br J Psychiatry. 2013;203(2):126–131. doi: 10.1192/bjp.bp.113.126649.
    1. Khoury B, Sharma M, Rush SE, Fournier C. Mindfulness-based stress reduction for healthy individuals: a meta-analysis. J Psychosom Res. 2015;78(6):519–528. doi: 10.1016/j.jpsychores.2015.03.009.
    1. Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386(9988):63–73. doi: 10.1016/S0140-6736(14)62222-4.
    1. Volanen SM, Lassander M, Hankonen N, Santalahti P, Hintsanen M, Simonsen N, et al. Healthy Learning Mind—a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial. BMC Psychol. 2016;4(1):35. doi: 10.1186/s40359-016-0142-3.
    1. Volanen SM, Lassander M, Hankonen N, Santalahti P, Hintsanen M, Simonsen N, et al. Healthy learning mind—effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: a cluster-randomised controlled trial. J Affect Disord. 2020;260:660–669. doi: 10.1016/j.jad.2019.08.087.
    1. Weare K, Nind M. Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int. 2011;26(Suppl 1):i29–69. doi: 10.1093/heapro/dar075.
    1. Kenny M, Luck P, Koerbel L. Tending the field of mindfulness-based programs: the development of international integrity guidelines for teachers and teacher training. Glob Adv Health Med. 2020;9:2164956120923975. doi: 10.1177/2164956120923975.
    1. Crane Ph DC, Ganguli Ph DP, Ball MS, Taylor Ph DL, Blakemore Ph DS, Byford Ph DS, et al. Training school teachers to deliver a mindfulness program: exploring scalability, acceptability, effectiveness, and cost-effectiveness. Glob Adv Health Med. 2020;9:2164956120964738. doi: 10.1177/2164956120964733.
    1. Wilde S, Sonley A, Crane C, Ford T, Raja A, Robson J, et al. Mindfulness training in UK secondary schools: a multiple case study approach to identification of cornerstones of implementation. Mindfulness (N Y) 2019;10(2):376–389. doi: 10.1007/s12671-018-0982-4.
    1. Udtræk fra institutionsregisteret 2019 [updated 2019. version 1.04. . Accessed 22/04 2020.
    1. Danmarks statistik. Stadigt flere skolebørn begynder på fri- og privatskoler . Accessed 26/05 2020
    1. Perera R, Heneghan C, Yudkin P. Graphical method for depicting randomised trials of complex interventions. BMJ (Clin Res Ed) 2007;334(7585):127–129. doi: 10.1136/bmj.39045.396817.68.
    1. UK MISPM. Mindfulness In Schools Project (MISP) UK. . Accessed 28/11 2019.
    1. The Danish Association for promoting life wisdom in children. Training empathy 2020. . Accessed 11/3 2020.
    1. Kabat-Zinn J, et al. Mindfulness-Based Stress Reduction (MBSR) Authorised Curriculum GuideÓ 2017: University of Massachusetts Medical School. Center for Mindfulness; 2017. . Accessed 8 Feb 2021.
    1. Goodman R, Meltzer H, Bailey V. The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version. Int Rev Psychiatry (Abingdon Engl) 2003;15(1–2):173–177. doi: 10.1080/0954026021000046137.
    1. Goodman A, Goodman R. Strengths and difficulties questionnaire as a dimensional measure of child mental health. J Am Acad Child Adolesc Psychiatry. 2009;48(4):400–403. doi: 10.1097/CHI.0b013e3181985068.
    1. Arnfred J, Svendsen K, Rask C, Jeppesen P, Fensbo L, Houmann T, et al. Danish norms for the Strengths and Difficulties Questionnaire. Danish Med J. 2019;66(6).
    1. Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, Britton WB. The varieties of contemplative experience: a mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE. 2017;12(5):e0176239. doi: 10.1371/journal.pone.0176239.
    1. Baer R, Crane C, Miller E, Kuyken W. Doing no harm in mindfulness-based programs: conceptual issues and empirical findings. Clin Psychol Rev. 2019;71:101–114. doi: 10.1016/j.cpr.2019.01.001.
    1. Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5:63. doi: 10.1186/1477-7525-5-63.
    1. Koushede V, Lasgaard M, Hinrichsen C, Meilstrup C, Nielsen L, Rayce SB, et al. Measuring mental well-being in Denmark: validation of the original and short version of the Warwick-Edinburgh mental well-being scale (WEMWBS and SWEMWBS) and cross-cultural comparison across four European settings. Psychiatry Res. 2019;271:502–509. doi: 10.1016/j.psychres.2018.12.003.
    1. Clarke A, Friede T, Putz R, Ashdown J, Martin S, Blake A, et al. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health. 2011;11:487. doi: 10.1186/1471-2458-11-487.
    1. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194–200. doi: 10.1080/10705500802222972.
    1. Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9:8. doi: 10.1186/1477-7525-9-8.
    1. Niclasen J, Keilow M, Obel C. Psychometric properties of the Danish student well-being questionnaire assessed in >250,000 student responders. Scand J Public Health. 2018;46(8):877–85. doi: 10.1177/1403494818772645.
    1. Kreimeier S, Greiner W. EQ-5D-Y as a Health-related quality of life instrument for children and adolescents: the Instrument's characteristics, development, current use, and challenges of developing its value set. Value Health. 2019;22(1):31–37. doi: 10.1016/j.jval.2018.11.001.
    1. Meijer AMWGVD. The joint contribution of sleep, intelligence and motivation to school performance. Pers Individ Dif. 2004;37.
    1. Greco LA, Baer RA, Smith GT. Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM) Psychol Assess. 2011;23(3):606–614. doi: 10.1037/a0022819.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.

Source: PubMed

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