School-based mental health promotion in children and adolescents with StresSOS using online or face-to-face interventions: study protocol for a randomized controlled trial within the ProHEAD Consortium

Abstract Background Schools are an ideal setting in which to promote health. However, empirical data on the effectiveness of school-based mental health promotion programs are rare, and research on universal Internet-based prevention in schools is almost non-existent. Following the life skills approach, stress management training is an important component of health promotion. Mental health literacy is also associated with mental health status, and it facilitates formal help-seeking by children and adolescents (C&A). The main objectives of this study are (1) the development and evaluation of an Internet-based version of a universal school-based health promotion program called StresSOS and (2) demonstrating non-inferiority of the online setting compared to the face-to-face setting. StresSOS aims to improve stress management and mental health literacy in C&A. Methods/design A school-based sample of 15,000 C&A (grades 6–13 and older than 12 years) will be recruited in five regions of Germany within the ProHEAD Consortium. Those with a screening result at baseline indicating no mental health problems will be invited to participate in a randomized controlled trial comparing StresSOS online to an active online control condition (Study A). In addition, 420 adolescents recruited as a separate school-based sample will participate in the StresSOS face-to-face intervention. Participants in both intervention groups (online or face-to-face) will receive the same eight treatment modules to allow for the comparison of both methods of delivery (Study B). The primary outcome is the number of C&A with symptoms of mental health problems at a 12 months follow-up. Secondary outcomes are related to stress/coping (i.e., knowledge, symptoms of stress, coping resources), mental health literacy (knowledge and attitudes toward mental disorders and help-seeking), program usage patterns, cost-effectiveness, and acceptability of the intervention. Discussion This study represents the first adequately powered non-inferiority trial in the area of school-based mental health promotion. If online StresSOS proves efficacious and non-inferior to face-to-face delivery, this offers great potential for health promotion in youths, both in and outside the school environment. Trial registration German Clinical Trials Register, DRKS00014693 . Registered on 14 May 2018

School programs targeting stress management in children and adolescents: a meta-analysis

Introduction This meta-analysis evaluates the effect of school programs targeting stress management or coping skills in school children. Methods Articles were selected through a systematic literature search. Only randomized controlled trials or quasi-experimental studies were included. The standardized mean differences (SMDs) between baseline and final measures were computed for experimental and control groups. Experimental groups were groups that either received an intervention of (a) relaxation training, (b) social problem solving, (c) social adjustment and emotional self-control, or (d) a combination of these interventions. If no baseline measurement was available, SMDs were calculated between final measures of the groups. The overall pooled effect size was calculated and the pooled effect sizes of improvement on stress, coping, (social) behavior, and self-efficacy by random effects meta-analysis. The dependence of the results on study characteristics (i.e. methodological quality and type of intervention) was evaluated using meta-regression analysis. Results Nineteen publications met the inclusion criteria of controlled trials for class programs, teaching coping skills or stress management. Overall effect size for the programs was − 1.51 [95% confidence interval (CI) − 2.29, − 0.73], indicating a positive effect. However, heterogeneity was significant (p < .001). Sensitivity analyses showed that study quality and type of intervention were sources of heterogeneity influencing the overall result (p values < .001). The heterogeneity in quality may be associated with methodological diversity and differences in outcome assessments, rather than variety in treatment effect. Effect was calculated per intervention type, and positive effects were found for stress symptoms with a pooled effect size of − 0.865 (95% CI: − 1.229, − 0.502) and for coping with a pooled effect size of − 3.493 (95% CI: − 6.711, − 0.275). Conclusion It is tentatively concluded that school programs targeting stress management or coping skills are effective in reducing stress symptoms and enhancing coping skills. Future research should use clear quality criteria and strive for less diversity in methodology and outcome assessment

Development of a stress management programme - Learn Young, Learn Fair- for fifth and sixth formers in The Netherlands using Intervention Mapping.

The object of this study was to develop a class stress-management programme which would help children to develop a broader coping repertoire. First a problem analysis was conducted to determine the need for the programme. Next, the programme was developed, using the five steps of intervention mapping (im) as a guide: 1) formulating proximal programme objectives, 2) selecting methods and strategies, 3) producing programme components, 4) planning for adoption and implementation and 5) planning for evaluation. A multidisciplinary group of researchers, health care workers, teachers and fifthand sixth-formers from a primary school were closely involved during all stages of the development process. The final programme is based on therapeutic principles derived from behavioural and cognitive therapy, combined with methods of information-processing principles. The programme was conducted by teachers who had been trained in the programme and who integrated it into their curriculum. The programme was evaluated positively by both teachers and pupils.we conclude that the framework of im contributed to the development and implementation of a qualitative, sound programme