Evaluating the long-term effectiveness of school-based intervention for anxiety and depression in older adolescents

描述工作的背景，包括主管自己团队中开展的工作和以前的工作。[审查者将利用这些信息来了解拟议研究的背景]。然而，绝大多数年轻人患有精神健康不良，其中只有一小部分人获得服务，这表明需求缺口很大。不幸的是，青少年寻求帮助受到共同障碍的阻碍，例如提供的服务有限、不愿寻求帮助以及害怕被污名化。此外，学校提供的心理健康方案只显示出不大的效果，主要针对较小的儿童。DISCOVER是专门为16-18岁的儿童开发的基于认知行为疗法(CBT)的简短小组研讨会方案。它的目标是可获得、提供有效的治疗和良好的覆盖范围，因为它是一种集体干预。它还更多地迎合了年轻人对更实际、更互动、更少耗时的干预措施的需求。一项初步的事后试点研究表明，DISCOVER讲习班的校本授课是可以接受的，并在干预后12周在减少焦虑和抑郁症状方面有所改善。一项随机对照试验评估了在伦敦南部学校举办发现研讨会的可行性30。参与学校的12.6%的学生参加了探索工作坊。在这些人中，81%是女性。这项研究表明，在“难以接触到的”群体中，学生的心理健康水平很高，超过一半(57.4%)的学生(57.4%)来自BME，超过三分之二(69.7%)的学生以前没有正式的心理健康求助经验。这项试验还显示，在3个月的随访中，抑郁(d=0.27CI-0.49至-0.04，p=0.021)和焦虑(d=0.25CI-0.46至-0.04，p=0.018)都有希望得到缓解。该计划将在英国4个不同地区(伦敦、巴斯、曼彻斯特、北安普顿)进行整群随机对照试验BESST试验，涉及60所学校和900名学生。该学生将在干预后12个月和18个月进行长期跟踪。BESST试验队列的年龄在17岁到19岁之间，将在12个月的随访中进入新兴成年期。刚成年是一个具有挑战性的过渡期，其特点是许多变化，包括新的关系和生活安排，经济和社会独立性的提高，以及对就业和/或高等教育的追求。尽管越来越多的有力证据表明，普遍的以学校为基础的预防性干预可以改善青春期的心理健康症状，但很少有证据表明它们在成年后的关键时期会持续有效，其长期影响也是不确定的。我们想知道，与学校通常提供的帮助相比，发现计划是否会减少抑郁和焦虑症状，以及这些变化是否会在干预后的12个月和18个月的长期随访中保持下去。我们希望，如果这项研究成功，Discovery将由新的校本专业人员运营。

Describe background to the work including that carried out in the supervisor's own team and previous work. [This information will be used by the reviewers to understand the context of the proposed study].An overwhelming proportion of young people struggle with poor mental health, however, only a small proportion of them access services, indicating a large need gap. Unfortunately, help seeking in adolescents is hindered by common barriers such as limited provision of services, reluctance to seek help, and fear of being stigmatised. Furthermore, school-delivered mental health programs have only shown modest results and are mainly targeted at younger children.DISCOVER, a brief cognitive-behavioural therapy (CBT)-based group workshop programme has been specially developed for 16-18-year-olds. It aims to be accessible, offer effective treatment and good reach as it is a group intervention. It is also more catered to young people's need for more practical, interactive and less time-intensive interventions. An initial pre-post pilot study showed that the school-based delivery of the DISCOVER workshop is acceptable, and registered improvement in reducing anxiety and depression symptoms at 12 weeks post-intervention21. A randomised controlled trial assessed the feasibility of delivering the DISCOVER Workshop in schools in South London30. 12.6% of students in the participating schools attended the DISCOVER Workshop. Out of these, 81% were female. The study registered high levels of uptake among "hard-to-reach" groups, with over half of students (57.4%) from BME and more than two thirds (69.7%) with no previous experience of formal mental health help-seeking. The trial also showed promising reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at 3 months follow-up.This programme will be tested during a cluster randomized controlled trial, THE BESST trial, in 4 different areas of the UK (London, Bath, Manchester, Northampton) and will involve 60 schools and 900 students.The student will conduct a long-term follow up of thew BESST trial, at 12 months and 18 months post-intervention. At ages 17 to 19 years, the BESST trial cohort is will be entering emerging adulthood at 12 months follow-up. Emerging adulthood represents a challenging transition period characterized by numerous changes including new relationships and living arrangements, increased financial and social independence, and pursuit of employment and/or higher education. Despite strong and growing evidence that universal school-based preventative interventions can improve mental health symptoms during adolescence, there is scant evidence for their sustained effect into the critical period of emerging adulthood and their long-term impact is uncertain.We want to see if the DISCOVER programme will reduce depression and anxiety symptoms compared the help normally offered in schools, and whether these changes will be sustained at long term follow-up, at 12- and 18-months post-intervention. We hope that if this study is successful, DISCOVER will be run by new school-based professionals.