In a recent study published in lancet digital health, A group of researchers evaluated the long-term effectiveness of four school-based online interventions to prevent youth mental health and substance use disorders with a 72-month follow-up.
study: Effectiveness of a universal school-based online program to prevent anxiety, depression and substance abuse in Australian adolescents: 72-month results of a cluster randomized controlled trial.. Image credit: Matej Kastelic/Shutterstock.com
background
Global costs from mental health and substance use disorders exceed $2.4 trillion and are expected to double by 2030. Trends show that mental health problems are on the rise among young people, exacerbated by coronavirus disease 2019 (COVID-19).
Alcohol consumption among young adolescents around the world lags behind, but drinking increases significantly between the ages of 15 and 18.
Further research is needed to determine the long-term sustainability of prevention efforts and to adapt interventions to the evolving needs of youth and society.
About research
This study was conducted between September 2013 and December 2016 and included 6,386 participants from a four-arm, multicenter, cluster-randomized trial of 71 schools in New South Wales, Queensland, and Western Australia. The youth were tracked.
Schools were randomly assigned to one of four interventions: Climate School Combined (CSC), Climate School Substance Use (CSSU) alone, Climate School Mental Health (CSMH) alone, or standard health education. . After consent was obtained, participants were recontacted for follow-up at 60 and 72 months.
The intervention included 18 classroom sessions that focused on mental health and substance use and employed principles of social learning and cognitive behavioral therapy. The CSSU and CSMH interventions targeted fewer classes and specifically focused on substance use and mental health, respectively.
Due to high attrition rates, the 84-month follow-up was discontinued to focus resources on the initial evaluation. Follow-up included a web-based survey, and retention efforts included financial incentives and multiple communication strategies.
The primary outcomes assessed were alcohol and cannabis use, and symptoms of anxiety and depression using validated self-report measures.
Analyzes utilized multilevel mixed-effects regression models that accounted for the clustered nature of the data and analyzed by intent-to-treat to provide insight into the long-term effectiveness of these interventions.
research result
Between September 2013 and December 2016, the study enrolled 6,386 students from 71 schools across New South Wales, Queensland and Western Australia. Participants were assigned to four groups. 1,556 were standard education, 1,739 were she CSSU, 1,594 were she CSMH, and 1,497 were he CSC.
The study followed these participants for up to 72 months after baseline and focused on participants who did not decline further contact at 30 months of follow-up. The intention-to-treat analysis included all original participants, whose mean age at baseline was 13.5 years, and more than half were female.
Follow-up assessments at 60 and 72 months revealed differences in participation rates between groups, with the CSC group showing significant retention rates. No adverse events were observed in this study.
Regarding alcohol consumption, weekly drinking and episodic heavy drinking increased over time in the control group, whereas these increases were significantly slower in the CSC group.
However, at 72-month follow-up, there were no significant differences in the odds of weekly or episodic heavy drinking between the CSC group and other groups.
Similarly, monthly cannabis use increased in the control group, but changes over time were not significantly different between intervention groups.
Mental health outcomes, including depression and anxiety, showed small increases over time in the control group, but there was little evidence of significant changes between groups throughout the follow-up period.
Sensitivity analyzes adjusting for baseline covariates associated with outcome and attrition showed similar trends, but increased uncertainty in the effect estimates.
conclusion
In summary, this study evaluated the effectiveness of a school-based prevention program targeting mental health and substance use disorders in middle school students over 72 months. We found that the CSC intervention significantly reduced increases in weekly drinking and episodic binge drinking.
However, these findings may be moderated by baseline differences between the CSC and control groups, which may influence the results.
Sensitivity analyzes further reduced the certainty in these results and showed minimal long-term differences between groups for alcohol use disorder, cannabis use, and mental health symptoms.
This study suggests that while such programs can initially reduce certain behaviors, continued intervention may be required to achieve long-term effects.
