Abstract
BackgroundThe 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.MethodsWe 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).ResultsAccording 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.ConclusionsNo 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 registration27/08/2018. Registration number NCT03647826.
Highlights
The previous decades have shown increased symptoms of depression and anxiety among adolescents
The depression and anxiety mean scores (SCL-8) in Table 1 show that before the start of MindPower (T1), the SCL-mean scores in Intervention group 1 (IG1) were very different from Intervention group 2 (IG2), but both IG1 and IG2 were under the cut-off at 1.95 at time point 1 (T1), (1G1 = 1.76 and IG2 = 1.89), indicating no or minimal symptoms of anxiety and depression
In IG1 there was an increase from the beginning (1.76 at T1) to the end of the eighth week of the program (1.88 at T2), no change at the booster sessions (T3 and T4), a slight increase at T5, and almost no change at T6
Summary
The previous decades have shown increased symptoms of depression and anxiety among adolescents. During the past decade, increasing levels of mental distress and common mental disorder have been reported across countries, especially among young girls [2]. To meet these challenges, initiatives to promote mental health and reduce mental illness in educational settings are at the forefront in many countries [3]. Systematic reviews and meta-analyses show positive short-term effects of school-based initiatives aimed at enhancing across a wide range of outcomes [8], including children’s life-skills [9], resilience [10], mindfulness Numerous guidelines and policies on how to integrate health and education in schools have been published [19,20,21]
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