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A qualitative study exploring adolescents’ experiences with a school-based mental health program
Kristianstad University, Research Environment Children's and Young People's Health in Social Context (CYPHiSCO). Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II.
Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II. Kristianstad University, Research Platform for Collaboration for Health.
Kristianstad University, Research Environment Children's and Young People's Health in Social Context (CYPHiSCO). Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II.ORCID iD: 0000-0002-1424-8336
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 1074Article in journal (Refereed) Published
Abstract [en]

Background: Supporting positive mental health development in adolescents is a major public health concern worldwide. Although several school-based programs aimed at preventing depression have been launched, it is crucial to evaluate these programs and to obtain feedback from participating adolescents. This study aimed to explore adolescents’ experiences with a School-based cognitive-behavioral depression prevention program. Methods: Eighty-nine adolescents aged 13–15 years were divided into 12 focus groups. The focus group interviews were analyzed using qualitative content analysis. Results: Three categories and eight subcategories were found to be related to the experience of the school-based program. The first category, intrapersonal strategies, consisted of the subcategories of directed thinking, improved self-confidence, stress management, and positive activities. The second category, interpersonal awareness, consisted of the subcategories of trusting the group and considering others. The third category, structural constraints, consisted of the subcategories of negative framing and emphasis on performance. Conclusions: The school-based mental health program was perceived as beneficial and meaningful on both individual and group levels, but students expressed a desire for a more health-promoting approach.

Place, publisher, year, edition, pages
2015. Vol. 15, 1074
Keyword [en]
Adolescents, depression, school-based program, prevention, cognitive behavior program
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hkr:diva-14964DOI: 10.1186/s12889-015-2368-zISI: 000363117700001OAI: oai:DiVA.org:hkr-14964DiVA: diva2:864045
Funder
Sven Jerring FoundationThe Crafoord Foundation
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2016-02-03Bibliographically approved
In thesis
1. Hälsopromotion i skolan: utvärdering av DISA - ett program för att förebygga depressiva symtom hos ungdomar
Open this publication in new window or tab >>Hälsopromotion i skolan: utvärdering av DISA - ett program för att förebygga depressiva symtom hos ungdomar
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Health promoting interventions in schools : evaluation of the DISA program
Abstract [en]

Background: DISA (Depressive Symptoms In Swedish Adolescents) is a cognitive behavioral intervention aimed at preventing stress and depressive symptoms in adolescents. It is frequently used in Swedish schools for students aged 13-15 years. DISA is commonly offered to females, but at some schools, the intervention is also offered to males. In this study, the application of the intervention for both females and males is evaluated.

Aim: The overarching aim of this thesis was to explore the experience, significance, and effectiveness of the school-based intervention DISA. The specific aims were to investigate the effectiveness of depressive symptoms and self-reporting health, and costs and cost-effectiveness as well as to elucidate the experiences of adolescents and tutors.

Methods: The effectiveness of DISA was investigated using method triangulation. The thesis is based on two quantitative and two qualitative studies. The quantitative studies were quasi-experimental trials with an intervention group (I, IV), and a control group (IV), with follow-up measurements obtained at 3 and 12 months after baseline. The qualitative studies were based on focus group interviews with adolescents (II) and tutors (III). The school-based cognitive behavioral prevention program DISA was presented by school health staff and teachers once per week for ten weeks. Students in grade 8 (median age: 14) participated in the intervention in study I (n=62, 52% females) and study IV (n=462, 79% females), and 486 students (46% females) were allocated to the control group (IV). Focus group interviews were conducted with 89 adolescents (II) and 22 tutors (III). The interviews were analyzed with qualitative content analysis.

Findings: The intervention group decreased their self-reported depressive symptoms and improved their self-rated health more than the control group (p<0.05) at the 12-month follow-up. The majority of the adolescents rated the cognitive behavioral program as a positive experience, and the attendance rate was high. The incremental cost-effectiveness ratio was approximately USD 6,300 per quality-adjusted life year (QALY). The focus group interviews with the adolescents revealed that the students found that they developed intrapersonal strategies through DISA, such as directed thinking, improved self-confidence, stress management, and positive activities. They also gained an increased interpersonal awareness regarding trusting the group and considering others. However, structural constraints of the DISA program, such as negative framing and an emphasis on performance, were also noted. The focus group interviews with the tutors identified an overall theme of striking a balance between strictly following the manual and meeting student needs.

Conclusions: The DISA program appears to be a feasible, cost-effective school-based cognitive behavioral program with high levels of student adherence and satisfaction, as well as positive mental health benefits. However, a desire for a more health-promoting approach was expressed. 

Place, publisher, year, edition, pages
Malmö: Institutionen för kliniska vetenskaper, Malmö, Lund universitet, 2016. 93 p.
Series
Doctoral dissertation series (Lund University, Faculty of Medicine), ISSN 1652-8220 ; 2016:12
Keyword
Adolescents, depressive symptoms, school-based program, prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-15243 (URN)978-91-7619-238-2 (ISBN)
Public defence
2016-02-12, SSSH-salen, HSC, Baravägen 3, Lund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-02-03 Created: 2016-01-29 Last updated: 2017-05-08Bibliographically approved

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