Abstract
BackgroundEvidence suggests that current treatments cannot fully alleviate the burden of disease associated with depression but that prevention approaches offer a promising opportunity to further reduce this burden. Adolescence is a critical period in the development of mental illness, and final school examinations are a significant and nearly universal stressor that may act as a trigger for mental health difficulties such as depression. The aim of the present trial is to investigate the impact of SPARX-R, an online, gamified intervention based on cognitive behavioural principles, on the prevention of depression in secondary school students before their final examinations.Methods/DesignGovernment, independent and Catholic secondary schools in New South Wales, Australia, will be recruited to participate in the trial. All students enrolled in their final year of high school (year 12) in participating schools will be invited to participate. To account for possible attrition, the target sample size was set at 1600 participants across 30 schools. Participating schools will be cluster randomised at the school level to receive either SPARX-R or lifeSTYLE, an attention-controlled placebo comparator. The control intervention is an online program aimed at maintaining a healthy lifestyle. The primary outcome will be symptoms of depression, and secondary outcomes will include symptoms of anxiety, suicidal ideation and behaviours, stigma and academic performance. Additional measures of cost-effectiveness, as well as process variables (e.g., adherence, acceptability) and potential predictors of response to treatment, will be collected. Consenting parents will be invited to complete measures regarding their own mental health and expectations for their child. Assessments will be conducted pre- and post-intervention and at 6- and 18-month follow-up. Primary analyses will compare changes in levels of depressive symptomatology for the intervention group relative to the attention control condition using mixed-effects model repeated-measures analyses to account for clustering within schools.DiscussionThis is the first trial of a universal depression prevention intervention delivered to school students in advance of a specific, significant stressor. If found to be effective, this program may offer schools a new approach to preparing students for their final year of schooling.Trial registrationAustralian New Zealand Clinical Trials Registry identifier: ACTRN12614000316606. Registered 25 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0929-1) contains supplementary material, which is available to authorized users.
Highlights
Evidence suggests that current treatments cannot fully alleviate the burden of disease associated with depression but that prevention approaches offer a promising opportunity to further reduce this burden
This is the first trial of a universal depression prevention intervention delivered to school students in advance of a specific, significant stressor
ACSS Acquired Capability for Suicide Scale; AQoL Assessment of Quality of Life; ATAR Australian Tertiary Admission Rank; DSS-P Depression Stigma Scale–Personal Stigma subscale; GAD-7 Generalized Anxiety Disorder 7-item scale; HPLS Hopelessness Scale for Children; IIAM Internet Intervention Adherence Measure; INQ Interpersonal Needs Questionnaire; ISI Insomnia Severity Index; MDI Major Depression Inventory; Morningness-Eveningness Questionnaire (MEQr) Reduced version of the Morningness Eveningness Questionnaire PS/PC Perceived Sensitivity/Perceived Criticism scale; PHQ-9 Patient Health Questionnaire-9; PID-5-BF Personality Inventory for DSM-5; Brief Form; PMS Pearlin Mastery Scale; RRS Ruminative Response Scale; SCAS Spence Children’s Anxiety Scale; SSSS Schuster Social Support Scale; TiC-P Trimbos/iMTA questionnaire for Costs associated with Psychiatric illness; YRBS Youth Risk Behavior Survey
Summary
We will investigate the effectiveness of the SPARX-R intervention in the prevention of depression in young people. The nature of the sample ensures that we are delivering the intervention to young people who may be at risk of developing mental health difficulties caused by increased rates of stress, achievement orientation and perfectionism [47,48,49]. This may limit the generalizability of our findings, as selective schools provide a unique sample of youth.
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