A school-based program to prevent depressive symptoms and strengthen well-being among pre-vocational students (Happy Lessons):protocol for a cluster randomized controlled trial and implementation study

BACKGROUND: Depression is one of the leading causes of illness and disability among young people. In the Netherlands, one in twelve Dutch adolescents has experienced depression in the last 12 months. Pre-vocational students are at higher risk for elevated depressive symptoms. Effective interventions, especially for this risk group, are therefore needed to prevent the onset of depression or mitigate the adverse long-term effects of depression. The aim of this study is to examine the effectiveness and implementation of a school-based program Happy Lessons (HL), that aims to prevent depression and promote well-being among pre-vocational students. METHODS: A cluster randomized controlled trial (RCT) with students randomized to HL or to care as usual will be conducted. Pre-vocational students in their first or second year (aged 12 to 14) will participate in the study. Subjects in both conditions will complete assessments at baseline and at 3- and 6-months follow-up. The primary outcome will be depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) at 6-months follow-up. Secondary outcomes are well-being using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and life satisfaction (Cantril Ladder) measured at 6-months follow-up. Alongside the trial, an implementation study will be conducted to evaluate the implementation of HL, using both quantitative and qualitative methods (interviews, survey, and classroom observations). DISCUSSION: The results from both the RCT and implementation study will contribute to the limited evidence base on effective school-based interventions for the prevention of depression and promotion of well-being among pre-vocational adolescents. In addition, insights from the implementation study will aid identifying factors relevant for optimizing the future implementation and scale-up of HL to other schools and contexts. TRIAL REGISTRATION: This study was registered on 20 September 2021 in the Dutch Trial Register (NL9732). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-12321-3

Conceptualizing vulnerability for health effects of the covid-19 pandemic and the associated measures in utrecht and zeist:A concept map

The COVID-19 pandemic and the associated measures have impacted the health of many. Not all population groups are equally vulnerable to such health effects, possibly increasing health inequalities. We performed a group concept mapping procedure to define a common, context-specific understanding of what makes people vulnerable to health effects of the pandemic and the measures. We organized a two-step, blended brainstorming session with locally involved community members, using the brainstorm focus prompt ‘What I think makes people vulnerable for the COVID-19 pandemic and the measures is … ’. We asked participants to generate as many statements as possible. Participants then individually structured (sorted and ranked) these statements. The structuring data was analysed using the groupwisdom™ software and then interpreted by the researchers to generate the concept map. Ninety-eight statements were generated by 19 participants. Sixteen participants completed both structuring tasks. The final concept map consisted of 12 clusters of vulnerability factors, indicating a broad conceptualization of vulnerability during the pandemic. It is being used as a basis for future research and local supportive interventions. Concept mapping is an effective method to arrive at a vulnerability assessment in a community in a short time and, moreover, a method that promotes community engagement

Psychosocial Factors and Chronic Illness as Predictors for Anxiety and Depression in Adolescence

Adolescence is a challenging time when emotional difficulties often arise. Self-esteem, good relationships with peers, and emotional competences can buffer the effects of these difficulties. The difficulties can be even greater when coupled with the presence of a chronic physical illness (CD). Our goal is to analyze psychosocial factors and CD as predictors for anxiety and depression. It was compared the results of structural equation models (SEM) with models based on qualitative comparative analysis (QCA) to analyze the possible influence of these variables on levels of anxiety-depression in adolescents with and without CD. The sample consisted of 681 adolescents, between 12 and 16 years old (M = 13.94, SD = 1.32). 61.50% were girls and 13.40% (n = 222) presented a CD (mainly pneumo-allergic and endocrine). They were evaluated by the Hospital Anxiety and Depression Scale, the Self-esteem Questionnaire, the Emotional Competences Questionnaire and the Strengths and Difficulties Questionnaire. The results obtained by SEM show that low self-esteem, problems with peers and low emotional competencies predict anxiety in 41% of the variance and depression in 72%. The results obtained by QCA show that the different combinations of these variables explain between 24 and 61% of low levels of anxiety and depression and 47-55% of high levels. Our data show how the presence of a CD, low self-esteem, problems with peers and problems in emotional skills play a fundamental role in explaining levels of anxiety and depression. These aspects will help provide increased resources for emotional adjustment in the educational context, facilitating the transitions to be made by adolescents

Cross-national time trends in adolescent mental well-being from 2002 to 2018 and the explanatory role of schoolwork pressure

Purpose: Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends. Methods: Data from 915,054 adolescents from 36 countries (50.8% girls; meanage = 13.54; standard deviationage = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being. Results: A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the increase in psychosomatic health complaints. Conclusions: Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small increase in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends

Social inequalities in adolescent mental health in the Netherlands

International comparative research shows that Dutch adolescents report high levels of mental health and belong to the “happiest kids in the world”. This does not mean that all adolescents in the Netherlands have such good mental health. In this thesis, we investigated inequalities in adolescent mental health based on country of residence, family affluence, immigration background, adolescent educational level, and gender. Using an adapted and validated instrument, our results showed that adolescents in the Netherlands report relatively low levels of mental health problems compared to their European agemates. Hyperactivity-inattention problems are an exception to this: Dutch adolescents report relatively high levels of hyperactivity-inattention problems. These problem levels were relatively stable across 2003-2013. However, small but rather persistent differences in mental health problems between social groups were found. To illustrate, adolescents with a non-western immigration background and a lower educational level reported highly similar levels of emotional problems, but higher levels of conduct problems and peer relationship problems compared to native Dutch adolescents or adolescents in higher educational levels. Our results also showed that not family affluence, but perceived discrimination seems to play an important role in this relatively high risk of non-western immigrant adolescents. Both in the Netherlands as in Europe, we found little evidence for intersectionality: the idea that adolescents’ belonging to particular combinations of social groups are at a higher risk for poor mental health. The findings highlight the need for selective intervention and prevention efforts targeting at-risk groups of adolescents

Social inequalities in adolescent mental health in the Netherlands

International comparative research shows that Dutch adolescents report high levels of mental health and belong to the “happiest kids in the world”. This does not mean that all adolescents in the Netherlands have such good mental health. In this thesis, we investigated inequalities in adolescent mental health based on country of residence, family affluence, immigration background, adolescent educational level, and gender. Using an adapted and validated instrument, our results showed that adolescents in the Netherlands report relatively low levels of mental health problems compared to their European agemates. Hyperactivity-inattention problems are an exception to this: Dutch adolescents report relatively high levels of hyperactivity-inattention problems. These problem levels were relatively stable across 2003-2013. However, small but rather persistent differences in mental health problems between social groups were found. To illustrate, adolescents with a non-western immigration background and a lower educational level reported highly similar levels of emotional problems, but higher levels of conduct problems and peer relationship problems compared to native Dutch adolescents or adolescents in higher educational levels. Our results also showed that not family affluence, but perceived discrimination seems to play an important role in this relatively high risk of non-western immigrant adolescents. Both in the Netherlands as in Europe, we found little evidence for intersectionality: the idea that adolescents’ belonging to particular combinations of social groups are at a higher risk for poor mental health. The findings highlight the need for selective intervention and prevention efforts targeting at-risk groups of adolescents