School-Based Curriculum to Improve Depression Literacy Among US Secondary School Students: A Randomized Effectiveness Trial

Abstract

Objectives: To determine the effectiveness of a universal school-based depression education program.

Methods: In 2012-2015, we matched 6679 students from 66 secondary schools into pairs by state (Maryland, Delaware, Pennsylvania, Michigan, and Oklahoma) and randomized to the Adolescent Depression Awareness Program (ADAP; n = 3681) or to a waitlist control condition (n = 2998). Trained teachers delivered ADAP as part of the health education curriculum to students aged 14 to 15 years. The primary outcome was depression literacy. Secondary outcomes included mental health stigma and, in a subset of the sample, the receipt of mental health services. Follow-up was at 4 months.

Results: ADAP resulted in significantly higher levels of depression literacy among participating students than did waitlist controls, after adjusting for pretest assessment depression literacy (P < .001). Overall, ADAP did not significantly affect stigma (P = .1). After ADAP, students approached 46% of teachers with concerns about themselves or others. Of students who reported the need for depression treatment, 44% received treatment within 4 months of ADAP implementation.

Conclusions: ADAP is an effective public health intervention for improving depression literacy among students.

Trial registration: Clinicaltrials.gov NCT02099305.

Figures

FIGURE 1—

Consolidated Standards of Reporting Trials (Consort) Flow Diagram Displaying the Progress of Participants Through the Trial: Randomized, School-based Effectiveness Trial of the Adolescent Depression Awareness Program (ADAP), 5 US States, 2012–2015 Note. The states studied were Maryland, Delaware, Michigan, Oklahoma, and Pennsylvania.

FIGURE 2—

Proportions Depression Literate Among Students Who Received the Adolescent Depression Awareness Program (ADAP) Intervention and Control Students at Pretest, Posttest, and Follow-up Assessment: Randomized, School-Based Effectiveness Trial of ADAP, 5 US States, 2012–2015 Note. Posttest was 6 weeks after ADAP; follow-up assessment was 4 months after ADAP implementation. The states studied were Maryland, Delaware, Michigan, Oklahoma, and Pennsylvania.

FIGURE 3—

Proportions With High Mental Health Stigma Among Students Who Received the Adolescent Depression Awareness Program (ADAP) Intervention and Control Students at Pretest, Posttest, and Follow-up Assessment: Randomized, School-Based Effectiveness Trial of ADAP, 5 US States, 2012–2015 Note. Posttest was 6 weeks after ADAP; follow-up assessment was 4 months after ADAP implementation. The states studied were Maryland, Delaware, Michigan, Oklahoma, and Pennsylvania.