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Psychiatry Research Trust
Brief Educational Workshops in Secondary Schools Trial for Depression and Anxiety
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More than half of adult mental health conditions have first onset before the age of 15 years, and almost three-quarters by the age of 18 years. Brief Educational Workshops in Secondary Schools Trial (BESST) has been investigating whether the DISCOVER day-long workshop program delivered in sixth-forms is able to help older adolescents in reducing depression and anxiety.
June Brown
Depression and anxiety are becoming more common among adolescents. Given that more than half of adult mental health conditions have first onset before the age of 15 years, and almost three-quarters by the age of 18 years, adolescence is a key period for early intervention. However formal mental health support is increasingly difficult to access due to barriers such as stigma and limited capacity of specialist mental health services.
Among strategies for improving accessibility, schools stand out as a universal point of access for prevention and early intervention. Brief Educational Workshops in Secondary Schools Trial (BESST) is a large clinical trial for 900 students in 4 regions of England. It has been investigating whether the DISCOVER day-long workshop program delivered in sixth-forms is able to help older adolescents in reducing depression and anxiety. The programme is designed to be accessible and non-stigmatising in order to reach young people in schools and colleges. The trial showed promising results at 3 and 6-months follow-up, with participants receiving the workshop programme showing significantly greater reduction in depression and anxiety symptoms than those not receiving the workshop programme. Students who received the workshop also showed a significantly greater improvement in levels of general wellbeing and resilience.
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We therefore wanted to explore outcomes quantitatively and qualitatively at 12 and 18 months follow-up.
We found several results. We found that the effects of the DISCOVER Workshop were sustained for depression and anxiety symptoms over the 18 month period.
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Further analyses also showed that participants who received the DISCOVER Workshop were less likely to have clinical depression symptoms at 12 months. Participants who had clinical depression at the beginning of the trial and received the workshop were on average 14% less likely to still experience clinical symptoms after one year compared to the control group. They were also more likely show significant improvement in anxiety symptoms after the 18-months period. One implication of this is that the DISCOVER workshop in schools could very well act as an early intervention for adolescents but a longer term follow-up would help reinforce this view.
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Our qualitative study of 20 improvers and deteriorators who had and had not received the intervention revealed 5 themes, including considerable stress leaving secondary education and moving into higher education or work and different methods of coping. Importantly, the participants we interviewed who have improved reported engaging with DISCOVER intervention strategies over the long-term, highlighting the usefulness of various techniques taught in the workshop such as reframing negative thoughts, tackling procrastination, relaxation and mindfulness.
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It also showed a link between improvement in depression and anxiety scores and the cultivation of an inner sense of competence and higher self-esteem. On the other hand, deterioration was associated with feeling disempowered and maladaptive coping strategies, including being too lazy to use the methods from the workshop. Further research would be helpful to examine those whose scores deteriorated to see if what further support may be needed.
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On the whole, this 18 month follow up has shown positive results in the maintenance of the effects of the workshop. The qualitative results support these results in identifying what methods improvers used from the workshops. On the whole, this would support the idea that the DISCOVER workshops could be an early intervention for 16-18 year olds when offered in schools. However, a longer term follow-up would be helpful.
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