School Intervention to Improve Mental Health of Students in Santiago, Chile A Randomized Clinical Trial
School Intervention to Improve Mental Health of Students in Santiago, Chile A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2013.2361
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发表时间：
2013-11-01
期刊：
影响因子：
26.1
通讯作者：
Montgomery, Alan A.
中科院分区：
文献类型：
--
作者：
Araya, Ricardo;Fritsch, Rosemarie;Montgomery, Alan A.
抑郁症可以有破坏性的影响，除非预防或治疗早期和有效。学校提供了一个很好的机会来干预有情绪问题的青少年。有很少的普遍以学校为基础的抑郁症干预措施进行在低收入和中等income countries. ObjectiveTo评估的有效性，以学校为基础的，普遍的心理干预，以减少抑郁症状的青少年从低收入family.DESIGN，SETTING，和PARTICIPANTS一个2臂，平行，集群，随机临床试验进行了中学在贫困的社会经济领域的圣地亚哥，智利。几乎所有在选定学校注册的学生都同意参加这项研究。来自22所学校和66个班级的2512名中学生共participated.INTERVENTIONS干预臂的学生参加了11个一小时的每周和2个助推器课堂会话的认知行为模型的基础上的干预。干预措施由受过训练的非专家提供。学校在控制臂收到了标准的学校course.Main结果和措施得分在3个月（小学）和12个月（中学）完成intervention.Results后，有1291名参与者在控制臂和1221在干预arm. Primary结果数据可用于82.1%的参与者。在干预完成后3个月，没有证据表明两组之间的平均抑郁评分存在任何具有临床意义的差异（平均值的校正差异，-0.19; 95% CI，-1.22至0.84）或任何其他结局。没有显着差异，发现在12 months.Conclusions和相关性设计良好，实施以学校为基础的干预措施，并没有减少抑郁症状的社会经济贫困的青少年在圣地亚哥，智利。越来越多的证据表明，普遍的学校干预措施可能不足以有效减少或预防抑郁症状。
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 trialwas 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 Awell-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.