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      The Effectiveness and Sustainability of a Universal School-Based Programme for Preventing Depression in Chinese Adolescents: A Follow-Up Study Using Quasi-Experimental Design

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          Abstract

          Background

          A pilot study about the effectiveness of a universal school-based programme, “The Little Prince is Depressed”, for preventing depression in Chinese adolescents in Hong Kong was conducted and reported previously. This study used a larger sample to examine the effectiveness and sustainability of the programme.

          Methods

          This study used quasi-experimental design. Twelve schools enrolled in “The Little Prince is Depressed” programme either as an intervention or a control condition. The intervention schools carried out the 12-session programme in two phases: the professional-led first phase and the teacher-led second phase. All participants were required to complete a questionnaire at three time points measuring their (1) depressive, anxiety, and stress levels; (2) knowledge of mental health; (3) attitudes towards mental illness; (4) perceived social support; and (5) help-seeking behaviours.

          Results

          A total of 3,391 students participated in the study. The level of depressive symptoms did not reduce significantly at post-intervention; however, a delayed effect was observed at follow-up assessment for the participants of the teacher-led group in reducing anxiety and stress levels. Also, the knowledge of mental health and attitudes towards mental illness of the intervention-group participants significantly improved at post-test, and the outcomes were maintained at 4 to 5 months after the intervention in both the professional-led and the teacher-led conditions (p<.05). A preference among schoolchildren for whom to seek help from was identified.

          Conclusions

          The universal depression prevention programme was effective in enhancing knowledge of mental health and promoting a more positive attitude towards mental illness among adolescents in Hong Kong. In particular, the teacher-led group showed better outcomes than the professional-led group in reducing students’ anxiety and stress at follow-up period. The programme can achieve sustainability in schools if teachers are provided with adequate support.

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          Most cited references18

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          Stress, social support, and the buffering hypothesis.

          S. Cohen, T A Wills (1985)
          Article 0 comments Cited 1066 times – based on 0 reviews     Review now
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            Epidemiology of mental disorders in children and adolescents

            Kathleen Ries Merikangas, Erin Nakamura, Ronald C Kessler (2009)
            This article provides a review of the magnitude of mental disorders in children and adolescents from recent community surveys across the world. Although there is substantial variation in the results depending upon the methodological characteristics of the studies, the findings converge in demonstrating that approximately one fourth of youth experience a mental disorder during the past year, and about one third across their lifetimes. Anxiety disorders are the most frequent conditions in children, followed by behavior disorders, mood disorders, and substance use disorders. Fewer than half of youth with current mental disorders receive mental health specialty treatment. However, those with the most severe disorders tend to receive mental health services. Current issues that are now being identified in the field of child psychiatric epidemiology include: refinement of classification and assessment, inclusion of young children in epidemiologic surveys, integration of child and adult psychiatric epidemiology, and evaluation of both mental and physical disorders in children.
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              "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

              A Jorm, A E Korten, P A Jacomb … (1997)
              To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.
              Article 0 comments Cited 228 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Igor Branchi: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 26 February 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 2
                Electronic Location Identifier: e0149854
                Affiliations
                [1 ]The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
                [2 ]Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
                [3 ]Journalism and Media Studies Centre, The University of Hong Kong, Hong Kong
                Istituto Superiore di Sanità, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: PWCW KWF YWL PSFY. Performed the experiments: ESYL. Analyzed the data: CLK. Wrote the paper: ESYL CLK PWCW KWF YWL PSFY.

                Article
                Publisher ID: PONE-D-15-24526
                DOI: 10.1371/journal.pone.0149854
                PMC ID: 4769012
                PubMed ID: 26921275
                SO-VID: 2474f3e8-429c-4d46-9150-8abc62e3ca34
                Copyright © © 2016 Lai et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 14 June 2015
                Date accepted : 6 February 2016
                Page count
                Figures: 3, Tables: 3, Pages: 20
                Funding
                The Quality Education Fund ( www.qef.org.hk) supported the development, implementation and evaluation of the "Little Prince is Depressed" programme (Project no. 2007/0340). The funding institution is The Hong Kong Jockey Club Centre for Suicide Research and Prevention at The University of Hong Kong. Author PSFY received the funding on behalf of the Centre. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Schools
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Mood Disorders
                Subject: Depression
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Psychological Stress
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Psychological Stress
                Subject: Social Sciences
                Subject: Psychology
                Subject: Psychological Stress
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Teachers
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Adolescents
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Emotions
                Subject: Anxiety
                Subject: Social Sciences
                Subject: Psychology
                Subject: Emotions
                Subject: Anxiety
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Instructors
                Custom metadata
                Data Availability Deposition of the data was not mentioned in the informed consent form, therefore, the data cannot be made publicly available. The data will be made available to all interested researchers upon request, and requests should be sent to the corresponding authors Prof. Paul Yip ( sfpyip@ 123456hku.hk ), Eliza Lai ( elizalsy@ 123456hku.hk ), or their affiliated organization, Centre for Suicide Research and Prevention, The University of Hong Kong ( csrp@ 123456hku.hk ).

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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