Impact and Feasibility of Information Technology to Support Adolescent Well-Being and Mental Health at School: A Quasi-Experimental Study

Figures & data

Table 1 IT-Based Mental Health Support Programs in Schools

Name	Theoretical Background	Target Group	Duration	Outcomes	Results
Bite Back	Positive psychology	12–16 years	6 weeks	Symptoms (depression, anxiety, stress), life satisfaction, mental well-being	No difference between groups. Problems with feasibility and application of the program in the schools.^28
MoodGym	CBT	12–17 years	5–6 weeks	Symptoms (depression, anxiety), attributional style, self-esteem, attitudes toward depression, depression literacy, adherence and attendance	Effective for anxiety and depression in one study involving males (1/3 completed all modules;^29, but not in another, in which drop-out was high. ^21 In a study involving females, there was a positive impact on depression, but intervention adherence was low .^22 A positive relationship between program adherence and outcomes. ^30
e-couch Anxiety and Worry program	CBT	14–15 years	6 weeks	Symptoms (generalized anxiety, social anxiety, anxiety sensitivity, depression), mental well-being	No difference between groups. Participant attrition due to assessment absenteeism was high. All 6 weeks were completed by 36% ^30 and 45% ^31 of adolescents.
SPARX-R	CBT	15–20 years	~5 weeks	Symptoms (depression, anxiety, generalized anxiety), suicidality, depression stigma, mental well-being, coping, emotion regulation, acceptability	A positive impact on emotion regulation ^23 and depression ^20. 30% ^23 and 59% ^20 completed the entire program. Frequent practice of the intervention techniques increased perceived helpfulness of the program. ^23

Figure 1 Flow diagram.

Table 2 Universal School-Based IT-Program Described According to TIDieR Checklist⁴⁷

Type of Intervention	Brief Name	Why (Theory or Framework)	What (Materials)	What (Procedures)	Who Provided	How	Where	When and How Much
Contact Online	“DepisNet”	Self-determination theory	Computer (tablet)	Five modules with specific content and exercises (see Suppl. Table 1.). Five central themes in the following order: well-being, home and family, rights and duties, depression, and support for depression	Tutors explained the modules face-to-face Tutors provided feedback within 3 days in a neutral, non-clinical way	Online in learning management system, Moodle, administered by the University of Turku, Moodle linked to DepisNet-webpage (https://www.hon.ch/ HONcode/Conduct.html? HONConduct825729)	Lower secondary school Classroom, also possible to use at home	The program was open for six weeks (1 theme a week), a maximum of 45 minutes per module.

Table 3 Intervention Providers and Their Roles

Intervention Provider	Role Description
Teacher	● Allowed adolescents to join weekly sessions ● Integrated the program into adolescents’ weekly study curriculum ● Contacted the tutors if problems arose related to adolescents’ workload or other sensitive issues raised by the study
Tutor	● Visited the school every week to meet the adolescents face-to-face, explained new modules and offered support if help was needed. ● Tutors (with professional health care education and experience in the area of mental health) ran the program and offered instructions about the program and its exercises via email. ● Guided adolescents by answering contributory questions ● Read adolescents’ exercises ● Interacted in discussions ● Provided positive and supportive feedback on the exercises ● Monitored adolescents weekly, checking that adolescents had returned their exercises ● Identified any concerns and supported adolescents in need of help according to the specific protocol developed in cooperation with teachers and the school nurse ● Sent reminder messages to adolescents if they had not returned a weekly exercise

Table 4 Baseline Demographic and Clinical Data

Characteristic	Intervention (N=56)	Control (N=55)	p values
Age (years), mean (SD)	14.90 (0.58)	14.60 (0.66)	0.009
Gender, n (%)			0.64
Male	18 (32)	20 (36)
Female	28 (68)	35 (64)
Grade, n (%)			0.01
8^th	7 (13)	18 (33)
9^th	49 (87)	37 (67)
Computer and internet skills, n (%)			0.16
Very good	10 (18)	13 (23)
Good	40 (71)	29 (54)
Neither good nor poor/poor/very poor	6 (11)	13 (23)
Computer and internet attitudes, n (%)			0.19
Very positive	11 (20)	15 (27)
Positive	37 (66)	26 (47)
Neither positive nor  negative/negative/very negative	8 (14)	14 (26)
Depression, median (IQR)	1.00 (3.75)	1.00 (3.00)	0.62
Quality of life, mean (SD)	56.55 (7.65)	56.63 (7.32)	0.77
Self-esteem, mean (SD)	29.59 (6.72)	30.95 (5.36)	0.51
Self-efficacy, mean (SD)	31.93 (4.48)	32.22 (4.47)	0.34

Abbreviations: SD, standard deviation; IQR, interquartile range.

Table 5 Comparison of the Change in Primary and Secondary Outcomes in Intervention and Control Group

Outcome	Intervention Group (N=39)		Control Group (N=43)
	Mean (SD)	Change Mean (SD)	Mean (SD)	Change Mean (SD)	T-value (df)	95% CI	P-value^a
Depression^b, Md (IQR)
Baseline	1.00 (3.75)	NA	1.00 (3.00)	NA	NA	NA	0.88
Follow-up	1.00 (3.00)		0.00 (1.00)
Quality of life
Baseline	56.55 (7.65)	1.36 (5.18)	56.63 (7.32)	−0.49 (4.93)	1.65 (80)	−0.38–4.07	0.10
Follow-up	57.97 (7.93)		56.61 (7.64)
Self-esteem
Baseline	29.64 (6.83)	0.79 (4.43)	31.91 (5.25)	0.16 (2.79)	0.78 (80)	−1.02–2.28	0.44
Follow-up	30.44 (6.73)		32.07 (5.94)
Self-efficacy
Baseline	32.62 (4.13)	0.54 (3.08)	32.30 (4.47)	0.09 (2.93)	0.67 (80)	−0.88–1.77	0.50
Follow-up	33.15 (4.87)		32.40 (3.96)

Notes: ^aP-value of T-tests/Mann Whitney U-test comparing the change in the outcomes between baseline and follow-up in the intervention and control group. ^bMann Whitney U-test, median and interquartile range reported. Range 18 at the intervention group and 17 at the control group.

Figure 2 Realized logging in to modules and completed exercises per adolescent in the intervention group.

Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

 PubMed Web of Science ®Google Scholar