hkr.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Hälsopromotion i skolan: utvärdering av DISA - ett program för att förebygga depressiva symtom hos ungdomar
Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Högskolan Kristianstad.ORCID iD: 0000-0003-1643-0171
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Health promoting interventions in schools : evaluation of the DISA program (English)
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 [en]
Adolescents, depressive symptoms, school-based program, prevention
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hkr:diva-15243Libris ID: 19196205ISBN: 978-91-7619-238-2 (print)OAI: oai:DiVA.org:hkr-15243DiVA: diva2:898925
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
List of papers
1. Evaluation of a school-based program aimed at preventing depressive symptoms in adolescents
Open this publication in new window or tab >>Evaluation of a school-based program aimed at preventing depressive symptoms in adolescents
Show others...
2015 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 31, no 2, 117-125 p.Article in journal (Refereed) Published
Abstract [sv]

The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.

Keyword
health education, mental health, high school, program development/evaluation
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-11779 (URN)10.1177/1059840514523296 (DOI)000351473300006 ()24526572 (PubMedID)
Available from: 2014-02-16 Created: 2014-02-16 Last updated: 2016-04-01Bibliographically approved
2. Supporting positive mental health development in adolescents with a group cognitive intervention
Open this publication in new window or tab >>Supporting positive mental health development in adolescents with a group cognitive intervention
2014 (English)In: British Journal of School Nursing, ISSN 1752-2803, Vol. 9, no 1, 24-29 p.Article in journal (Refereed) Published
Abstract [en]

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used.

Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents.

Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis.

Findings: The overall theme identified in the study consists of 'striking a balance between strictly following the manual and meeting the students' needs'. Three subthemes emerged: 'doing good and sowing seeds for the future', working with insufficient tools, and 'personal development as a professional and as an individual'.

Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.

National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-11838 (URN)
Available from: 2014-03-11 Created: 2014-03-11 Last updated: 2016-04-01Bibliographically approved
3. A qualitative study exploring adolescents’ experiences with a school-based mental health program
Open this publication in new window or tab >>A qualitative study exploring adolescents’ experiences with a school-based mental health program
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.

Keyword
Adolescents, depression, school-based program, prevention, cognitive behavior program
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-14964 (URN)10.1186/s12889-015-2368-z (DOI)000363117700001 ()
Funder
Sven Jerring FoundationThe Crafoord Foundation
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2016-02-03Bibliographically approved

Open Access in DiVA

fulltext(1779 kB)344 downloads
File information
File name FULLTEXT01.pdfFile size 1779 kBChecksum SHA-512
e4865a72307a5eb8b5e68816622080c2c1989177584d0a98766c188d83ed51eb2f225493857bd4548eceaad7673153aa91897144d3b710a7f35e752d3941ad54
Type fulltextMimetype application/pdf

Other links

Fulltext

Search in DiVA

By author/editor
Garmy, Pernilla
By organisation
Avdelningen för Sjuksköterskeutbildningarna
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 344 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 774 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf