Early intervention for depression and anxiety in 16-18 year olds: a multi-centre trial of self-referral psychological stress workshop programmes in schools

Plain English summary of protocol

Background and study aims
Poor mental health in young people is increasing, with clear evidence of mounting psychiatric problems. However, less than a quarter of young people with mental health problems can access services, meaning there is an urgent need for easily accessible and effective mental health resources. Common barriers include the limited provision of services, reluctance of adolescents to seek professional help as well as a fear of stigmatisation.

Young people’s mental health is a major government priority, with current policy advocating the development of effective education based mental health care to prevent the escalation of mental health problems, improve access and reduce service waiting times. However, existing school-delivered programmes for depression and anxiety only have modest effects. These programmes are also mainly focused on younger children.

With these factors in mind, we have developed an accessible and non-stigmatising workshop program for older students. This award-winning programme, named DISCOVER, is a brief group workshop programme for 16 - 18-year-olds that was developed in collaboration with a Teenage Advisory Group (TAG) of 16 - 18-year-olds. DISCOVER aims to improve engagement, offer effective treatment, and maintain participants’ motivation and improvement to reduce relapse. The DISCOVER workshop is delivered in a group setting, to around 12 - 15 young people, over one school day. The workshop includes videos, discussions, and the chance to learn and practice techniques designed to improve and maintain mental wellbeing. The workshop material is organised into eight short (20 minute) sections and particular attention is paid to personal, relationship and academic worries typical for 16 - 18-year-olds. Specific methods taught include (i) Behavioural methods e.g. time management, sleep hygiene and maintaining motivation (ii) Cognitive methods e.g. learning to challenge negative thoughts and (iii) mindfulness e.g. meditation exercises. Following the workshop, to maintain progress and adherence, participants receive a DISCOVER workbook and access to a workshop-specific DISCOVER app to remind them of the methods. Participants also receive three 'follow-up' phone calls from the workshop leader to discuss how they are progressing with their personal goals.

We would like to understand whether this workshop is more effective at improving students’ mental health than the normal care they receive at school. Specifically, this clinical trial aims to answer the research question of whether the DISCOVER workshop is a clinically effective and cost-effective intervention in schools that reduces symptoms of depression in 16-18-year-olds at 3 and 6 months after the intervention.

The results of this trial will tell us whether DISCOVER is a suitable programme to take forward as a school-based mental health provision. It is very possible that DISCOVER could be a highly effective and popular component in frontline education-based mental health care as advocated by government health and education policy. We see DISCOVER fitting in very well with the current education-based mental health care aims of the government. Therefore, this trial is essential to inform the Department of Health about the effectiveness of this potentially very important intervention for 16 - 18-year-olds.

Who can participate?
The DISCOVER workshop is designed for sixth form/college students between 16 and 18 who are experiencing, or have experienced, stress or low mood problems recently. We hope this program will be helpful for as many people as possible from this group, however we are still assessing how effective it can be. It is not so suitable for young people who have very severe problems or who do not understand spoken and written English.

What does the study involve?
The study involves the comparison of two different intervention groups; the active intervention (the DISCOVER workshop) and a control intervention (normal school care). Each of the 60 schools will be randomly assigned to one of these two groups. Half of the schools (30) will receive the DISCOVER workshop and the other half (30) of schools will receive their normal care. We will assess participants' mood, stress levels and wellbeing before the intervention and at several points afterwards, in both the workshop and control groups. Following trial completion of all participants, we will then analyse this data to evaluate whether the workshop was more beneficial than the normal care students receive.

What are the possible benefits and risks of participating?
If you receive the workshop, it could help you handle stressful situations in a more helpful way, making it easier to tackle everyday problems. The DISCOVER workshop leaders will offer advice and help during the workshop and at the follow up session. However, the decision may be that your school/college will not be receiving the workshops. In which case, you will receive the normal help available from the school/college (e.g. access to websites, school counsellor). This will be helpful for us to know how students get on without receiving any extra help.

Participation does not have any likely risks associated with it. Sometimes, when we ask young people questions about their feelings, it can be mildly upsetting, but there will always be someone available for them to talk to and to provide any help needed.

Where is the study run from?
King's College London (UK). The study will be taking place in 4 sites; London, Bath, Manchester, and Northampton (London is the lead centre for the study). It will involve a total of 60 schools and 900 sixth form students.

When is the study starting and how long is it expected to run for?
January 2020 to April 2024

Who is funding the study?
National Institute for Health Research (NIHR) (UK)

Who is the main contact?
Dr Stephen Lisk, stephen.lisk@kcl.ac.uk
Dr June Brown, june.brown@kcl.ac.uk

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England

Study participating centres

Results and Publications

Study outputs

Editorial Notes

02/09/2024: Publication reference added.
20/05/2024: Publication reference added.
07/05/2024: Publication reference added.
13/12/2023: The recruitment start date was changed from 01/09/2020 to 01/09/2021. Total final enrolment added.
01/09/2023: The following changes have been made:
1. The participant inclusion criteria were changed.
2. The participant exclusion criteria were changed.
3. The intention to publish date was changed from 01/09/2023 to 01/04/2024.
11/11/2022: Publication reference added.
27/09/2022: The exclusion criteria were changed.
27/09/2022: The intention to publish date was changed from 01/09/2022 to 01/09/2023.
22/07/2021: The following changes have been made:
1. The ethics approval has been added.
2. The study hypothesis has been updated.
3. The secondary outcome measures have been updated.
4. The participant inclusion criteria have been updated.
5. The participant exclusion criteria have been updated.
6. The trial website has been added.
28/05/2020: Trial’s existence confirmed by NIHR HTA