Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial.
Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial.
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DOI：
10.1016/s2352-4642(20)30363-1
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发表时间：
2021-03
影响因子：
36.4
通讯作者：
Ryan, Gemma
中科院分区：
文献类型：
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作者：
Cooper, Mick;Stafford, Megan R.;Saxon, David;Beecham, Jennifer;Bonin, Eva-Maria;Barkham, Michael;Bower, Peter;Cromarty, Karen;Duncan, Charlie;Pearce, Peter;Rameswari, Tiffany;Ryan, Gemma
在英国，大约七分之一的青少年患有精神健康障碍。学校咨询是试图解决这一问题的最常见手段之一。我们的目的是确定以学校为基础的人文咨询（shbhc）治疗英国青少年心理困扰的有效性和成本效益。我们在英国大伦敦地区的18所公立中学中进行了一项两组随机试验。参与者使用中央安全随机化程序随机分配（1:1），随机排列块随机分配到shbhc加学校教牧照例（PCAU）或单独PCAU。参与者是13-16岁的学生，他们有中度至重度的情绪症状（通过优势和困难问卷情绪症状量表得分≥5来测量），并被评估为有能力同意参加试验。参与者，提供者和评估者（最初评估和招募参与者）没有被掩盖，但测试者（测量结果）被掩盖到治疗分配。主要结局是12周时的心理困扰（Young Person’s Clinical Outcomes in Routine Evaluation measure [YP-CORE]；范围0-40），以意向治疗为基础进行分析（输入缺失数据）。在24周时评估成本（客户服务收据清单和服务日志）。该试验已在ISRCTN注册，注册号为ISRCTN10460622。在2016年9月29日至2018年2月8日期间招募了329名参与者，其中167名（51%）随机分配到shbhc + PCAU组，162名（49%）分配到PCAU组。329名参与者中有315名（96%）提供了12周的数据，14名参与者（4%）提供了评分。基线时，shbhc + PCAU组的YP-CORE平均评分为20.86 (SD值为6.38)，PCAU组的YP-CORE平均评分为20.98 （SD值为6.41）。shbhc + PCAU组12周时YP-CORE平均评分为16.41分（SD 7.59）， PCAU组为18.34分（7.84）（差异1.87,95% CI 0.37 - 3.36; p= 0.015），效应量较小（0.25,0.03 - 0.47）。24周时，shbhc + PCAU组每名学生的总成本为995·20英镑（标准差769·86），PCAU组为612·89英镑（标准差1224·56）（未经调整的差异为382·31英镑，95% CI为148·18-616·44英镑；p= 0.0015）。shbhc更具成本效益的可能性达到80%，愿意为YP-CORE的1点改进支付390英镑。在shbhc + PCAU组中，4名参与者发生了5起严重不良事件，均涉及自杀意图。PCAU组的两名参与者发生了两起严重的不良事件，其中一起涉及自杀意图。将shbhc添加到PCAU中会导致心理困扰的小幅减少，但会带来额外的经济成本。shbch是一种可行的治疗选择，但需要对其他干预措施进行同样严格的评估。这项工作得到了经济及社会研究理事会的支持（资助编号ES/M011933/1）。
About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in England, UK. We did a two-arm, individually randomised trial in 18 secondary state-funded schools across the Greater London area of the UK. Participants were randomly assigned (1:1) using a centrally secure randomisation procedure with random permuted blocks to either SBHC plus schools' pastoral care as usual (PCAU), or PCAU alone. Participants were pupils aged 13–16 years who had moderate-to-severe levels of emotional symptoms (measured by a score of ≥5 on the Strengths and Difficulties Questionnaire Emotional Symptoms scale) and were assessed as competent to consent to participate in the trial. Participants, providers, and assessors (who initially assessed and enrolled participants) were not masked but testers (who measured outcomes) were masked to treatment allocation. The primary outcome was psychological distress at 12 weeks (Young Person's Clinical Outcomes in Routine Evaluation measure [YP-CORE]; range 0–40), analysed on an intention-to-treat basis (with missing data imputed). Costs were assessed at 24 weeks (Client Service Receipt Inventory and service logs). The trial was registered with ISRCTN, number ISRCTN10460622. 329 participants were recruited between Sept 29, 2016, and Feb 8, 2018, with 167 (51%) randomly assigned to SBHC plus PCAU and 162 (49%) to PCAU. 315 (96%) of 329 participants provided data at 12 weeks and scores were imputed for 14 participants (4%). At baseline, the mean YP-CORE scores were 20·86 (SD 6·38) for the SBHC plus PCAU group and 20·98 (6·41) for the PCAU group. Mean YP-CORE scores at 12 weeks were 16·41 (SD 7·59) for the SBHC plus PCAU group and 18·34 (7·84) for the PCAU group (difference 1·87, 95% CI 0·37–3·36; p=0·015), with a small effect size (0·25, 0·03–0·47). Overall costs at 24 weeks were £995·20 (SD 769·86) per pupil for the SBHC plus PCAU group and £612·89 (1224·56) for the PCAU group (unadjusted difference £382·31, 95% CI £148·18–616·44; p=0·0015). The probability of SBHC being more cost-effective reached 80% at a willingness to pay of £390 for a 1-point improvement on the YP-CORE. Five serious adverse events occurred for four participants in the SBHC plus PCAU group, all involving suicidal intent. Two serious adverse events occurred for two participants in the PCAU group, one involving suicidal intent. The addition of SBHC to PCAU leads to small reductions in psychological distress, but at an additional economic cost. SBHC is a viable treatment option but there is a need for equally rigorous evaluation of alternative interventions. This work was supported by the Economic and Social Research Council (grant reference ES/M011933/1).