Universal School-based Prevention Program Research Articles

Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process.

Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools.

Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT

Background and objectivesTransdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience. MethodsThis follow-up study captured data from 162 of 316 initial students (aged 8–13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator. ResultsAt 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found. LimitationsAlthough self-report measures are common in universal, school-based research, this represents a study limitation. ConclusionsBoth interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research.

Promoting Protective Factors for Suicidal Behavior in Adolescents at Risk

Abstract: Theoretical Background: Suicide is among the leading causes of death for young people and a major public health concern. While intervention programs targeting youth at risk seem promising, more research is warranted to determine what works for whom. The HEYLiFE universal school-based suicide prevention program aims to promote three putative protective factors, namely, knowledge about mental health, agency, and help-seeking intention in students aged 14 years and older. While its overall efficacy was confirmed previously, specific effects in adolescents with different risk profiles remain to be determined. Objective: We explored whether program efficacy differed for students aged 14 – 18 years (mean age M= 16.2 years, SD = 1.2 years) at low, medium, and high risk for suicidality. Method: A pre–post within-group comparison trial was designed to evaluate the HEYLiFE suicide prevention program in a convenience sample of 304 adolescents from five public schools. The data of 218 adolescents (45.2 % female) with completed data sets were analyzed. Using a two-step cluster analysis, we identified three distinct at-risk clusters for suicidality based on self-reported suicidality, depression, impulsivity/carelessness, and avoidance. We then applied a mixed-model analysis of covariance to evaluate program efficacy in these clusters. Results: While knowledge improved to a similar degree across all clusters, agency and help-seeking intentions improved in the low- and medium-risk cluster but not in the high-risk cluster. Efficacy across time ranged from small to medium effects. Conclusion: Our results confirm that the HEYLiFE suicide prevention program is efficacious for the majority of students. The promotion of protective factors among students with different risk profiles is a viable strategy for universal suicide prevention, although efforts are warranted to specifically target individuals exhibiting the greatest risk for suicide.

The Effectivity of a School-Based Early Intervention Targeting Psychological Complaints and Non-Suicidal Self-Injury in Adolescents.

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11-14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study.

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Maternal depression and parenting stress in English-speaking Latina mothers with a history of adverse childhood experiences

BackgroundIn the United States, Latinx populations report higher prevalence of adverse childhood experiences (ACEs) compared to non-Latinx White populations. ACEs have been associated with maternal depression and parenting stress, while social support often functions as a protective factor. However, these relationships have not been adequately researched in Latinx samples. ObjectiveThis research aims to clarify the prevalence of maternal ACEs, and the relationships between ACEs, maternal depression, parenting stress, and social support among a sample of English-speaking Latina mothers. Participants and SettingParticipants were 167 English-speaking Latina mothers (average age of 29 years old) with at least one pre-kindergarten aged child recruited from 12 Title-I public elementary schools. MethodRecruitment happened as part of a quasi-experimental effectiveness trial of a universal school-based prevention program. Data from baseline assessments were analyzed using linear regression and bootstrapping was used to assess mediation. Outcome67.7% of the sample reported 1 or more ACEs. Multiple regression demonstrated that ACEs (b = 0.30, p <.001) and parenting stress (b = 0.66, p <.001) predicted depression; depression (b = 0.36, p <.001) and social support (b = -0.40, p =.025) predicted parenting stress. The effect of ACEs on parenting stress was mediated by depression (β = 0.15, 95% CI [0.063, 0.24]). The relationship between depression and parenting stress was moderated by social support (b = -0.08, p =.006). ConclusionsResults suggest that ACEs increase the likelihood of depression and parenting stress; however, social support may buffer the effects of depression on parenting stress among Latinx families, thus increasing family well-being.

Protocol for a Trial Assessing the Efficacy of a Universal School-Based Prevention Program for Addictive Behaviors.

"Juego de Llaves" [ Set of Keys ] is a universal school-based prevention program for adolescents aged 12-15. It is aimed at reducing drug use and other addictive behaviors. This paper describes the full protocol for the evaluation design, instruments, randomization procedure, follow-ups, and primary outcomes. Non-Randomized Control Cluster Trial in a set of Spanish secondary schools, with follow-ups at 12-, 24- and 36-months. Participants will be allocated to an experimental or control group. Using a digital application designed for the study, a battery of instruments will be used to assess addictive behaviors, sociodemographic variables, school climate and other transdiagnostic psychological variables. A pilot test will be carried out to test the implementation protocol and to calculate the sample size needed for outcome evaluation. After implementing the program, longitudinal statistical approaches will be used to report intervention efficacy and potential moderators and mediators. There is a lack of assessments on the effectiveness of school prevention programs, and this paper is expected to improve monitoring and ongoing evaluation in prevention.

Long-term behavioral effects of a school-based prevention program on illicit drug use among young adults.

Most universal drug abuse prevention efforts target early adolescents with the goal of delaying or preventing the onset of substance use. The present study examined long-term follow-up data from a large-scale randomized trial of a school-based prevention program that used cognitive-behavioral skills-training techniques to enhance social and personal competence skills and drug refusal skills. The preventive intervention was implemented in junior high schools, and pretest data were collected from students in the classroom. Approximately 13 years later, follow-up data were collected by mail from 2042 young adults. Rates of overall lifetime illicit drug use, as well as lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use, were lower among students who received the prevention program (Life Skills Training) during junior high school compared to control group participants. These findings support the hypothesis that comprehensive, universal school-based prevention programs can produce long-term effects on illicit drug use behavior.

Examining Potential Mechanisms of an Online Universal Prevention for Adolescent Alcohol Use: a Causal Mediation Analysis

Several universal school-based prevention programs, notably the Australian Climate Schools program, have proven efficacious at reducing and maintaining a lower level of harmful alcohol consumption relative to a control condition. Yet, there are limited studies investigating the potential mechanisms that account for the reduction in harmful alcohol consumption. The current study utilised modern causal mediation analysis to investigate whether several harm minimisation and social influence mediators could jointly account for the intervention effect observed in a large school-based sample. Four mediators representing knowledge, attitudes, normative perceptions, and self-efficacy to resist peer pressure were entered into a multiple casual mediation model using the potential outcomes framework. The results did not provide evidence for a joint multiple mediation model consisting of the hypothesised harm minimisation and social influence mediators. Additional research is required to further investigate the potential mechanisms underlying universal school-based prevention programs including social connectedness and cultural/environmental factors.

Gun violence in K-12 schools in the United States: Moving towards a preventive (versus reactive) framework

Intentional shootings in K-12 schools in the U.S. persist as a public health problem. The number of shootings in K-12 schools has increased precipitously since 2017. And with approximately 100,000 K-12 public schools nationally serving 51 million children, investing in a comprehensive gun violence prevention strategy is critical. Unfortunately, our current school gun violence prevention approach almost exclusively centers reactive strategies that are in place to respond to acts of gun violence in the moment, rather than preventive strategies that would prevent them from occurring at all. Reliance on these strategies alone, however, is not sufficient. In line with the core tenets of public health prevention and the Whole School, Whole Child, Whole Community model, we present a more expansive school gun violence prevention framework that broadens the spectrum of what constitutes “school gun violence prevention.” Our work highlights how enhancing basic neighborhood and school structures—including investments in public libraries, affordable housing, and universal school-based violence prevention programs—are key to both preventing gun violence and promoting well–being. We also highlight the role of stricter gun laws, reasonable school security efforts, bystander interventions, building awareness within school communities, and meaningful investments in early interventions and mental health services. Children, who have been tragically exposed to any number of adverse experiences in the wake of the COVID–19 pandemic, deserve more reasoned choices and large-scale investments in understanding and cutting off the root causes of school gun violence; not just a reliance on strategies that focus on what to do in the moment of a violent act. As gun violence in K–12 schools persists, we must reframe the discourse about school gun violence around prevention, not reaction.

POLICY OF PREVENTIVE WORK WITH JUVENILE DRUG USERS IN THE USA

This article deals with the problem of preventive work with young drug users. This is one of the most important problems in the world, including the USA. Substance misuse can put individual users and others among them at risk of harm. Early substance misuse and substance use disorders are associated with a variety of negative results, including deteriorating relationships, poor school performance, loss of employment, diminished mental health and increases in sickness and death. It is therefore critical to prevent the full spectrum of substance misuse problems in addition to treating those with substance use disorders. The aim of the study is to reveal the peculiarities of preventive work with young drug users in USA. Theoretical research methods have been used in this study: analysis of scientific sources, systematisation and generalisation of available data; defining of the essence of basic concepts; identification of the current state of the problem. The results of investigation give possibility to state that preventing or reducing early substance use initiation, substance misuse and the harms related to misuse requires the implementation of the effective programs and policies that address substance misuse across the lifespan. The effective prevention programs exist in the USA, and if implemented well, they can markedly reduce substance misuse and related threats to the health of population. There are three main categories of prevention interventions: universal, selected and indicated. Universal interventions are aimed at all members of a given population; selective interventions are aimed at a subgroup determined to be at high risk for substance; indicated interventions are targeted to individuals who are already using substance but have not developed a substance use disorder. It is recommended to provide a mix of universal, selective and indicated preventive intervention. Different programs are used for different categories of population. The program «Family Partnership» is focused on children younger than age 5. «The Good Behavior Game» and «Classroom-Centered Intervention» is an universal elementary school-based prevention program. For adolescents aged 10 to 18 programs «Life Skills Training» and «Towards No Drug Abuse» are used. There are also family-based programs («Strengthening Family», «For Parents and Youth»), program for College Students («Brief Alcohol Screening»), Internet-based program («I hear what you are saying») and many others. drug; juvenile; youth; preventive work; rehabilitation; programs of prevention; USA.

The Evaluation of Boost Camp: A Universal School-Based Prevention Program Targeting Adolescent Emotion Regulation Skills

The Evaluation of Boost Camp: A Universal School-Based Prevention Program Targeting Adolescent Emotion Regulation Skills

Responsible Behavior with Younger Children: Examining the Feasibility of a Classroom-Based Program to Prevent Child Sexual Abuse Perpetration by Adolescents

ABSTRACT Child sexual abuse (CSA) is a preventable public health problem typically addressed with either after-the-fact interventions or prevention programs focused on teaching children to protect themselves and report abuse. Such responses do little to prevent CSA victimization, leading to calls for prevention efforts targeting individuals most at risk of perpetrating CSA. These individuals include young adolescents, who are prone to making mistakes and bad decisions when it comes to their sexual behaviors. To begin to address this call to action, we developed Responsible Behavior with Younger Children (RBYC), a universal school-based prevention program to provide sixth and seventh grade students (and their parents and educators) with the knowledge, skills, and tools to prevent engaging younger children in sexual behaviors. School-based CSA prevention interventions are often met with feasibility and acceptability concerns including that (a) people at risk of offending are impervious to prevention efforts, (b) schools do not have the resources to take on additional programs, and (c) the content is too sensitive for educators, parents, and students. The goal of this article is to describe how the RBYC program was developed to address these concerns. We also summarize data on the feasibility of the RBYC program obtained from focus groups with educators, parents, and students during the development of the program and interviews with educators after a pilot randomized controlled trial (RCT). Feedback received during program development and after the pilot RCT suggests that RBYC is relevant, salient, palatable, and feasible for implementation in middle schools.

Peer selection as a mechanism for preventing adolescent substance use: Current approaches and future directions

• One third of lessons in the prevention programs examined focused on peer selection. • Behavioral similarity was the most frequently targeted peer selection process. • Reflection was often encouraged when peer selection was targeted. • Peer selection holds great promise as a mechanism for preventing substance use. Despite previous research highlighting the importance of peer selection and socialization as distinct processes contributing to adolescent substance use, prior research indicates that universal school-based substance use prevention programs focus more heavily on socialization when compared to selection. This content analysis examining the peer selection processes targeted by prevention programs is guided by the following research questions: (1) To what extent do current evidence-based programs target peer selection? (2) When peer selection is targeted, what underlying mechanisms are the focus? (3) What level of depth is reached when peer selection is targeted by prevention programs? Using the Blueprints for Healthy Youth Development database, two programs meeting our inclusion criteria were included in this study. Thirty-three percent of program lessons included a focus on the peer selection process. Behavioral similarity was targeted more frequently than selection based on popularity. When peer selection was targeted, reflection was often encouraged. Peer selection is a promising mechanism for the development of future prevention programs. Future intervention research that helps to test the malleability of peer selection processes would help to better understand how to best incorporate peer selection processes into prevention program content.

A pilot investigation of universal school-based prevention programs for anxiety and depression symptomology in children: A randomized controlled trial.

The current study aimed to provide a preliminary evaluation of two universal school-based prevention programs, Emotion Regulation (ER) and Behavioral Activation (BA), by increasing resilience to manage excessive worry, a transdiagnostic feature across anxiety and depression. Primary school children (N = 295; 52.5% female; 8-13 years) from five Australian schools were cluster randomized to an ER, BA or usual class control condition. Outcome measures included resilience, worry, anxiety, and depression symptomology; ER and BA were measured as potential mediators. Participants completed measures at pre- and postprogram, and at 6-month follow-up. Children in the BA condition showed increased resilience at 6 months. Expressive suppression mediated the effects of both programs on worry. The current study aimed to provide a preliminary evaluation of two universal school-based prevention programs, ER and BA, by increasing resilience to manage excessive worry, a transdiagnostic feature across anxiety and depression.

Preventing Adolescent Substance Use: A Content Analysis of Peer Processes Targeted Within Universal School-Based Programs.

Universal school-based substance use prevention programs are widely disseminated and often include a focus on peer relationships. Network theory and social network analysis (SNA) have emerged as useful theoretical and methodological frameworks for examining the role of peer relationships in prevention and intervention research. We used content analysis to systematically code the peer processes targeted by three universal school based prevention programs. We found that programs focused on peer socialization more than peer selection, and programs focused about evenly on descriptive and injunctive norms. Programs varied in their focus on positive and negative peer processes and behaviors, but most references to peer processes focused on positive processes and negative behaviors. The focus on peer processes at the dyadic, subgroup, and network levels varied across the three programs, with the heaviest focus on network level processes. When peer processes were targeted, it was rare that lessons focused on peer processes for an extended (> 50%) amount of the lesson content. However, when peer processes were a focus, discussion and reflection were commonly encouraged. These patterns are considered in the context of non-intervention research on adolescent peer relations, which highlights the importance of peer selection and dyad-level processes, and the existence of positive peer processes that promote adolescent development. In doing so, we provide a framework that can be used to (1) examine the extent to which a particular program focuses on the different peer processes, and (2) inform systematic experimental studies of the extent to which particular peer processes are malleable in response to intervention efforts.

A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children

Anxiety and depression are among the most common mental health issues experienced in childhood. Implementing school-based prevention programs during childhood, rather than adolescence, is thought to provide better mental health outcomes. The present meta-analysis aimed to investigate the efficacy of universal school-based prevention programs that target both anxiety and depression in children (aged 13years or below), and examine three moderators (i.e., program type, primary target of program, and number of sessions) on prevention effects. PsycINFO, PubMED, and Google Scholar were systematically searched for relevant articles published up to and including January 2018. Fourteen randomised controlled trials, consisting of 5970 children, met eligibility criteria. Prevention programs led to significantly fewer depressive symptoms at post-program (g = 0.172) and at long-term follow-up periods (g = 0.180), but not at short-term follow-up. Programs were not found to prevent anxiety symptoms across any time point. Considerable heterogeneity was observed for all effects. Program type and length were found to moderate the relationship between prevention program and outcomes. Prevention programs were effective in preventing depressive symptoms at post-program and long-term follow-up, while no significant preventative effect on anxiety symptoms was observed. The FRIENDS Program and programs which contained a greater number of sessions showed beneficial effects on anxiety and depressive symptoms. Universal programs aimed at preventing both anxiety and depression in children are limited. Future research should investigate the long-term evaluation of school-based prevention programs for anxiety and depression in children.

\u2018Boost Camp\u2019, a universal school-based transdiagnostic prevention program targeting adolescent emotion regulation; evaluating the effectiveness by a clustered RCT: a protocol paper

BackgroundThe transition from childhood into adolescence can be considered as a critical developmental period. Moreover, adolescence is associated with a decreased use of adaptive emotion regulation strategies and an increased use of maladaptive emotion regulation strategies increasing the risk of emotional problems. Targeting emotion regulation is therefore seen as an innovative prevention approach. The present study aims to evaluate the effectiveness of Boost camp, an innovative school-based prevention program targeting ER, on adolescents’ emotion regulation skills and emotional wellbeing. Also secondary outcomes and possible moderators will be included.MethodsThe aim is to reach 300 adolescents (16 class groups, 6 schools) in their first year of high school. A clustered Randomized Controlled Trial (RCT) with two conditions, intervention (n = 150) and control (n = 150), will be set up. Adolescents in the intervention condition will receive 14 lessons over the course of 2 days, followed by Booster sessions, and will be compared with adolescents in a non-intervention control group. The outcomes will be measured by self-report questionnaires at baseline, immediately after Boost camp, and at three and 6 months follow-up.DiscussionData-collection is planned to be completed in May 2018. Data-analyses will be finished the end of 2018. The presented paper describes the Boost camp program and the clustered RCT design to evaluate its effectiveness. It is expected that Boost camp will have beneficial effects. If found effective, Boost camp will have the potential to increase adolescent’s ER and well-being, and reduce the risk to become adults in need. The trials is registered on the 13th of June 2017 in ISRCTN registry [ISRCTN68235634].

The Efficacy of a Universal School-Based Prevention Program for Eating Disorders among German Adolescents: Results from a Randomized-Controlled Trial.

Disordered eating is highly prevalent during adolescence and has a detrimental effect on further development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure, perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group). Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing. Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful program elements and whether gender-specific programs are needed.

A Comprehensive Evaluation of a Universal School-Based Depression Prevention Program for Adolescents.

The present study proposes and demonstrates a comprehensive framework for evaluation of a universal school-based depression prevention program. Efficacy was evaluated by considering the impact of continuous versus categorical approaches to operationalizing outcome, the effect of the intervention on key change agent variables, and moderation of intervention effects by student symptom severity at baseline. Participants 252 adolescent boys and girls (60% male), aged 13 to 17years (M = 13.62years, SD = 0.60years) from four schools in the state of Victoria, Australia, who were allocated by school into a waitlist = control (n = 88) or a CBT-based intervention (n = 164) group. The intervention involved six 45-min weekly sessions run during wellbeing classes. While the intervention and control groups did not differ in average improvement in symptoms by post-intervention, further analyses showed that responsiveness was highly variable within the intervention, and those with elevated depressive symptoms benefitted most. The proposed change agents of self-esteem, resilience, body image satisfaction, and perceived social support did not uniquely predict change in depressive symptoms but collectively accounted for substantial variance in this change process. Collectively, this framework provided insights into aspects of the intervention that worked and highlighted areas for improvement, thus providing clear direction for future research.