Michael Sawyer1, George Patton2, Sue Spence3, Debra Kay4, Sara Glover5, Andrea Krelle5, Jeanie Sheffield3, Jane Burns6, Lyndal Bond2, Brian Graetz1
1 Women’s and Children’s Hospital (SA)
2 Murdoch Children’s Research Institute (VIC)
3 University of Queensland (QLD)
4 Department of Education and Children’s Services (SA)
5 Centre for Adolescent Health (VIC)
Project completion year
The Australian National Survey of Mental Health and Wellbeing reported the prevalence of depression among young people to be 3.7 per cent. Of concern was that only a small proportion of those young people with depression had received professional help for their problems (Sawyer et al., 2000). Clearly there is a great need to develop interventions which can reduce the number of new cases of depressive disorder which emerge during adolescence and provide effective help for those who already have the disorder. Schools provide a valuable and unique setting in which to deliver such interventions.
In 2002, beyondblue gathered a team of health and education professionals to develop a universal intervention in an attempt to reduce and prevent depression in secondary school students. This team developed a comprehensive intervention comprising:
(i) a classroom curriculum program of 30 sessions (10 sessions per year as students progressed through Years 8, 9 and 10) teaching core resilience skills
(ii) strategies aiming to improve students ‘sense of connection’ to the school
(iii) a school community forum highlighting mental health issues affecting students and local service providers
(iv) strategies to improve the service pathways for adolescents who need additional help or educational support. (Spence et al., 2005).
The intervention was delivered over three years (2003 to 2005) and is being evaluated over five years (2003 to 2007) through a randomised controlled trial involving 50 schools across Victoria, Queensland and South Australia. Annual data is being collected from some 5,000 students and 3,000 staff from participating schools as well as from project staff working with schools. The evaluation is examining the degree to which the program is successful in producing the intended changes in: a) mental health and emotional wellbeing, and b) the social and individual risk and protective factors targeted by the intervention.
To date, three annual assessments of student data has been evaluated (2003 to 2005) (Sawyer et al., 2006). This initial evaluation examined symptoms of depressive symptoms and risk and protective factors including problem solving, optimistic thinking style, interpersonal competence and bullying. The findings showed that while several of these factors have changed over the first three years, the size of the changes has been similar for adolescents in the intervention and comparison groups. This suggests that the intervention, as yet, has not had a significant impact on these factors during the first three years of the project. This finding is consistent with other universal interventions that have recently reported only limited changes in the mental health problems experienced by participating adolescents.
While it is disappointing that the intervention has not achieved greater change in levels of adolescent depression, it is important to recognise the strengths and benefits of the project. High levels of school engagement were achieved, with all 50 schools that enrolled in the study in 2003 remaining as participants throughout the whole of the intervention.
Implications for policy and practice
The project demonstrated that it is possible to build a strong partnership between the health and education sectors to undertake a large-scale research aimed at reducing adolescent depression. High levels of cooperation were received from individual schools participating in the project and from the government, Catholic, and independent education systems. The project also showed that beyondblue has the capacity to build and maintain over several years a large collaborative research team drawn from multiple universities, the education sector, and the non-government sector.
Typically, reducing the incidence and prevalence of major health problems in the community takes many years to achieve. Achieving this requires ongoing evaluation of the efficacy and effectiveness of new prevention programs over many years as they are developed, evaluated, and implemented in routine practice.
This need for ongoing work presents a significant barrier for the development of prevention programs for child and adolescent mental health problems. Few research groups in Australia have the funding and infrastructure support, and the strong relationships needed with service providers, to undertake such work for the length of time required to fully develop, evaluate, and implement new programs in this way. beyondblue has clearly demonstrated that it has the capacity to support work of this kind.
Sawyer et al. (2000). The Mental Health of Young People in Australia. Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care.
Sawyer et al (2006), beyondblue Schools Research Initiative: Report of Key Findings (2003 to 2005).
Spence et al. (2005). The beyondblue schools research initiative: the conceptual framework and intervention. Australasian Psychiatry, 13, 159-164.