Influence of general self-efficacy on the effects of a school-based universal primary prevention program of depressive symptoms in adolescents: A randomized and controlled follow-up study
Depressive disorders in adolescents are a widespread and increasing problem. Prevention seems a promising and feasible approach.
We designed a cognitive-behavioral school-based universal primary prevention program and followed 347 eighth-grade students participating in a randomized controlled trial for three months.
In line with our hypothesis, participants in the prevention program remained on a low level of depressive symptoms, having strong social networks. The control group showed increasing depressive symptoms and a reduced social network. Contrary to our expectations, students low in self-efficacy benefited more from the program than high self-efficient students. Social network did not mediate the relationship between participation in the prevention program and changes in depressive symptoms.
Our results show that the prevention program had favorable effects. Further research is needed to explore the impact of self-efficacy on the effects of prevention programs.
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Available from: Alain C. Vandal
- "Other common interventions reported were building social networks and skills for help-seeking (Aseltine & DeMartino, 2004; Eggert et al., 2002; Thompson et al., 2001) and developing life skills (Eggert et al., 2002; Thompson et al., 2001). A few studies reported interventions based on Interpersonal Therapy (Horowitz et al., 2007), physical activity (Bonhauser et al., 2005), and information processing (Pössel et al., 2005). All of the interventions reviewed were conducted with students in groups and ranged in duration from 1 to 2 hours per week over a period of 8 to 12 weeks. "
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Symptoms of anxiety and depression are common in childhood, as are risk factors that undermine wellbeing: low self-esteem and limited participation in daily occupations. Current treatments focus primarily on modifying internal cognitions with insufficient effect on functional outcomes. Occupational therapists have a role in measuring and enabling children’s functional abilities to promote health and wellbeing. To-date there is no evidence for the use of occupational therapy as an intervention to promote mental health or increase self-esteem, participation and wellbeing in a preventative context. The aim of this cluster-randomised controlled study is to investigate the effectiveness of an 8-week occupational therapy group intervention (Kia Piki te Hauora) at reducing symptoms of anxiety and depression and improving self-esteem, participation and wellbeing in children aged 11–13 years.
In this two-arm, pragmatic, cluster-randomised controlled trial, 154 children will be recruited from 14 schools. All mainstream schools in the region will be eligible and a convenience sample of 14 schools, stratified by decile ranking (i.e. low, medium, and high) will be recruited. Eight to twelve students aged 11–13 years from each school will be recruited by senior school personnel. Following consent, schools will be randomised to either the intervention or waitlist control arm of the trial. The study will employ a parallel and one-way waitlist-to-intervention crossover design. Each cluster’s involvement will last up to 19 or 31 weeks depending on allocation to the intervention or waitlist respectively. The primary outcome is symptoms of anxiety and secondary outcomes are symptoms of depression, self-esteem, participation in daily occupations and wellbeing. Outcome measurement will be repeated at baseline, post-intervention and again at 8–9 weeks follow-up. Planned statistical analyses will utilise repeated measures analysis of covariance. The primary analysis will be based on an intention-to-treat analysis set and include only parallel data. The crossover data will only be used in secondary analyses.
This is the first cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. Results will contribute to the limited evidence base for occupational therapists in this field and potentially support investment in these services.
Australia/New Zealand Clinical Trials Register: ACTRN12614000453684.
06/2014; 2:16. DOI:10.1186/2050-7283-2-16
Available from: Kjersti R Lillevoll
- "The tailored information was based on data collected in the baseline survey on risk of depression, level of self-efficacy and self-esteem. These variables were selected based on their interrelatedness and relevance to help-seeking behaviors [57-59]. The first tailored message included the standard general introduction to module one, as well as feedback on the individual risk of depression based on the CES-D; the second message included the standard general introduction to module two as well as information about their current level of self-esteem; the third message provided information concerning the content of module three in MoodGYM adapted to their level of depression; the fourth message provided feedback regarding their level of self-efficacy which was related to the content of module four; the fifth message introduced the topic of module five adapted to their level of self-esteem. "
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ABSTRACT: Internet-based cognitive behavioural therapy (ICBT) is a promising approach to the prevention and reduction of depressive symptoms among adolescents. This study aimed to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored and weekly e-mail reminders on initial uptake and adherence to the intervention.
A baseline survey was conducted in four senior high schools in two Norwegian municipalities (n = 1337). 52.8% (707/1337) of the students consented to further participation in the trial and were randomly allocated to one of three MoodGYM intervention groups (tailored weekly e-mail reminder (n = 175), standardized weekly e-mail reminder (n = 176 ) or no e-mail reminder (n = 175)) or a waitlist control group (n = 180). We tested for effects of the intervention on depression and self-esteem using multivariate analysis of variance, effects of tailored e-mail and self-reported current need of help on initial uptake of the intervention using logistic regression and the effect of weekly e-mails on adherence using ordinal regression.
There was substantial non-participation from the intervention, with only 8.5% (45/527) participants logging on to MoodGYM, and few proceeding beyond the first part of the programme. No significant effect on depression or self-esteem was found among the sample as a whole or among participants with elevated depression scores at baseline. Having a higher average grade in senior high school predicted initial uptake of the intervention, but tailored e-mail and self-reported current need of help did not. Weekly e-mail prompts did not predict adherence. The main reasons for non-use reported were lack of time/forgetting about it and doubt about the usefulness of the program.
Overall, disseminating a self-directed internet-based intervention to a school population proved difficult despite steps taken to reduce barriers in terms of tailoring feedback and dispatching weekly e-mail reminders. Providing mental health interventions within the school environment is likely to ensure better uptake among senior high school students, but there is a need to effectively communicate that such programmes can be helpful.Trial registration: The trial was registered retrospectively as ACTRN12612001106820.
BMC Psychiatry 01/2014; 14(1):14. DOI:10.1186/1471-244X-14-14 · 2.21 Impact Factor
Available from: Martin Eisemann
- "Nonetheless, it might represent a factor promoting help-seeking behavior and affecting the intervention outcome in mental health prevention programs. Contrary to their hypothesis, Pössel et al.  found students low on self-efficacy to benefit more from a depression prevention program. The current study will investigate whether selfefficacy can predict self-directed use of MoodGYM when presented to students in a school-based setting. "
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ABSTRACT: Background. Focus upon depression and prevention of its occurrence among adolescents is increasing. Novel ways of dealing with this serious problem have become available especially by means of internet-based prevention and treatment programs of depression and anxiety. The use of Internet-based intervention programs among adolescents has revealed some difficulties in implementation that need to be further elucidated. The aim of this study is to investigate the association between personality and adolescent depression and the characteristics of users of an Internet-based intervention program. Method. The Junior Temperament and Character Inventory (JTCI), the General Self-Efficacy scale (GSE) and the Centre for Epidemiological Studies-Depression scale (CES-D) have been administered to a sample (n = 1234) of Norwegian senior high-school students. Results. Multiple regression analysis revealed associations between depression and gender, and several JTCI domains and facets. In line with previous findings in adults, high Harm Avoidance and low Self-Directedness emerged as the strongest predictors of adolescent depressive symptoms. Further, in logistic regression analysis with the covariates JTCI, GSE and CES-D, the only significant variables predicting use/non-use were the CES-D and the temperament domain Reward Dependence. Conclusion. The results in this study revealed level of depressive symptoms as the strongest predictor of the use of the Internet based intervention and that personality might provide useful information about the users.
Depression research and treatment 08/2012; 2012(11):593068. DOI:10.1155/2012/593068
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