School intervention to improve mental health of students in Santiago, Chile

A randomized clinical trial

Ricardo Araya, Rosemarie Fritsch, Melissa Spears, Graciela Rojas, Vania Martinez, Sergio Barroilhet, Paul Vohringer, David Gunnell, Paul Stallard, Viviana Guajardo, Jorge Gaete, Sian Noble, Alan A. Montgomery

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Importance: Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries.

Objective: To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families.

Design, Setting, and Participants: A 2-arm, parallel, cluster, randomized clinical trial was conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated.

Interventions: Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum.

Main Outcomes and Measures: Scores on the self-administered Beck Depression Inventory–II at 3 months (primary) and 12 months (secondary) after completing the intervention.

Results: There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1% of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, −0.19; 95% CI, −1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months.

Conclusions and Relevance: A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms.

Trial Registration: isrctn.org Identifier: ISRCTN19466209
Original languageEnglish
Pages (from-to)1004-1010
Number of pages7
JournalJAMA Pediatrics
Volume167
Issue number11
Early online date2 Sep 2013
DOIs
Publication statusPublished - Nov 2013

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Chile
Mental Health
Randomized Controlled Trials
Students
Depression
varespladib methyl
Curriculum
Outcome Assessment (Health Care)
Psychology
Equipment and Supplies

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Araya, R., Fritsch, R., Spears, M., Rojas, G., Martinez, V., Barroilhet, S., ... Montgomery, A. A. (2013). School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial. JAMA Pediatrics, 167(11), 1004-1010. https://doi.org/10.1001/jamapediatrics.2013.2361

School intervention to improve mental health of students in Santiago, Chile : A randomized clinical trial. / Araya, Ricardo; Fritsch, Rosemarie; Spears, Melissa; Rojas, Graciela; Martinez, Vania; Barroilhet, Sergio; Vohringer, Paul; Gunnell, David; Stallard, Paul; Guajardo, Viviana; Gaete, Jorge; Noble, Sian; Montgomery, Alan A.

In: JAMA Pediatrics, Vol. 167, No. 11, 11.2013, p. 1004-1010.

Research output: Contribution to journalArticle

Araya, R, Fritsch, R, Spears, M, Rojas, G, Martinez, V, Barroilhet, S, Vohringer, P, Gunnell, D, Stallard, P, Guajardo, V, Gaete, J, Noble, S & Montgomery, AA 2013, 'School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial', JAMA Pediatrics, vol. 167, no. 11, pp. 1004-1010. https://doi.org/10.1001/jamapediatrics.2013.2361
Araya, Ricardo ; Fritsch, Rosemarie ; Spears, Melissa ; Rojas, Graciela ; Martinez, Vania ; Barroilhet, Sergio ; Vohringer, Paul ; Gunnell, David ; Stallard, Paul ; Guajardo, Viviana ; Gaete, Jorge ; Noble, Sian ; Montgomery, Alan A. / School intervention to improve mental health of students in Santiago, Chile : A randomized clinical trial. In: JAMA Pediatrics. 2013 ; Vol. 167, No. 11. pp. 1004-1010.
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title = "School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial",
abstract = "Importance: Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries.Objective: To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families.Design, Setting, and Participants: A 2-arm, parallel, cluster, randomized clinical trial was conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated.Interventions: Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum.Main Outcomes and Measures: Scores on the self-administered Beck Depression Inventory–II at 3 months (primary) and 12 months (secondary) after completing the intervention.Results: There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1{\%} of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, −0.19; 95{\%} CI, −1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months.Conclusions and Relevance: A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms.Trial Registration: isrctn.org Identifier: ISRCTN19466209",
author = "Ricardo Araya and Rosemarie Fritsch and Melissa Spears and Graciela Rojas and Vania Martinez and Sergio Barroilhet and Paul Vohringer and David Gunnell and Paul Stallard and Viviana Guajardo and Jorge Gaete and Sian Noble and Montgomery, {Alan A.}",
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AU - Barroilhet, Sergio

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AB - Importance: Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries.Objective: To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families.Design, Setting, and Participants: A 2-arm, parallel, cluster, randomized clinical trial was conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated.Interventions: Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum.Main Outcomes and Measures: Scores on the self-administered Beck Depression Inventory–II at 3 months (primary) and 12 months (secondary) after completing the intervention.Results: There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1% of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, −0.19; 95% CI, −1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months.Conclusions and Relevance: A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms.Trial Registration: isrctn.org Identifier: ISRCTN19466209

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