Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Anxiety | Study protocol

The effectiveness of school-based skills-training programs promoting mental health in adolescents: a study protocol for a randomized controlled study

Authors: Amanda W. G. van Loon, Hanneke E. Creemers, Simone Vogelaar, Nadira Saab, Anne C. Miers, P. Michiel Westenberg, Jessica J. Asscher

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Adolescence is a period of elevated stress sensitivity, which places adolescents at increased risk of developing mental health problems such as burnout, depression, anxiety, and externalizing problems. Early intervention of psychological needs and low-threshold care addressing such needs may prevent this dysfunctional development. Schools may provide an important environment to identify and address psychological needs. The aim of this protocol is to describe the design of a study aiming to evaluate the effectiveness of low-threshold school-based skills-training programs promoting the mental health of adolescents and to examine moderators of the effectiveness.

Methods

A Randomized Controlled Trial will be conducted to examine the effectiveness of two school-based skills-training programs aiming to promote mental health by improving either skills to deal with performance anxiety or social skills. A multi-informant (i.e., students, parents, and trainers) and multi-method (i.e., questionnaires and physiological measurements) approach will be used to assess program targets (skills to deal with performance anxiety or social skills), direct program outcomes (performance or social anxiety) and mental health outcomes (i.e., stress, internalizing and externalizing problems, self-esteem and well-being), as well as specific moderators (i.e., student, parent and program characteristics, social support, perfectionism, stressful life events, perceived parental pressure, positive parenting behavior, treatment alliance and program integrity).

Discussion

The current study will provide information on the effectiveness of school-based skills-training programs. It is of crucial importance that the school environment can provide students with effective, low-threshold intervention programs to promote adolescents’ daily functioning and well-being and prevent the emergence of mental health problems that negatively affect school performance.

Trial registration

Dutch Trial Register number NL7438. Registered 12 December 2018.
Literature
1.
2.
Andersen SL, Teicher MH. Stress, sensitive periods and maturational events in adolescent depression. Trends Neurosci. 2008;31:183–91.PubMedCrossRef
3.
Fuhrmann D, Knoll LJ, Blakemore SJ. Adolescence as a sensitive period of brain development. Trends Cogn Sci. 2015;19:558–66.PubMedCrossRef
4.
5.
de Bruin EI, Sieh DS, Zijlstra BJH, Meijer AM. Chronic childhood stress: psychometric properties of the chronic stress questionnaire for children and adolescents (CSQ-CA) in three independent samples. Child Indic Res. 2018;11:1389–406.CrossRef
6.
Jayanthi P, Thirunavukarasu M, Rajkumar R. Academic stress and depression among adolescents: a cross-sectional study. Indian Pediatr. 2015;52:217–9.PubMedCrossRef
7.
Snyder HR, Young JF, Hankin BL. Chronic stress exposure and generation are related to the P-factor and externalizing specific psychopathology in youth. J Clin Child Adolesc Psychol. 2017;00:1–10.
8.
Walburg V. Burnout among high school students: a literature review. Child Youth Serv Rev. 2014;42:28–33.CrossRef
9.
Burger K, Samuel R. The role of perceived stress and self-efficacy in Young People’s life satisfaction: a longitudinal study. J Youth Adolesc. 2017;46:78–90.PubMedCrossRef
10.
Chappel AM, Suldo SM, Ogg JA. Associations between adolescents’ family stressors and life satisfaction. J Child Fam Stud. 2014;23:76–84.CrossRef
11.
Kiang L, Buchanan CM. Daily stress and emotional well-being among Asian American adolescents: same-day, lagged, and chronic associations. Dev Psychol. 2014;50:611–21.PubMedCrossRef
12.
Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10:434–45.PubMedCrossRef
13.
Arsenio WF, Loria S. Coping with negative emotions: connections with adolescents’ academic performance and stress. J Genet Psychol. 2014;175:76–90.PubMedCrossRef
14.
Kaplan DS, Liu RX, Kaplan HB. School related stress in early adolescence and academic performance three years later: the conditional influence of self expectations. Soc Psychol Educ. 2005;8:3–17.CrossRef
15.
Liu Y, Lu Z. The Chinese high school student’s stress in the school and academic achievement. Educ Psychol. 2011;31:27–35.CrossRef
16.
Dupéré V, Leventhal T, Dion E, Crosnoe R, Archambault I, Janosz M. Stressors and turning points in high school and dropout. Rev Educ Res. 2015;85:591–629.CrossRef
17.
Suldo S, Thalji A, Ferron J. Longitudinal academic outcomes predicted by early adolescents’ subjective well-being, psychopathology, and mental health status yielded from a dual factor model. J Posit Psychol. 2011;6:17–30.CrossRef
18.
Lazarus RS. Psychological stress and the coping process; 1966.
19.
Nicolai KA, Laney T, Mezulis AH. Different stressors, different strategies, different outcomes: how domain-specific stress responses differentially predict depressive symptoms among adolescents. J Youth Adolesc. 2013;42:1183–93.PubMedCrossRef
20.
de Anda D, Baroni S, Boskin L, Buchwald L, Morgan J, Ow J, Gold JS, Weiss R. Stress, stressors and coping among high school students. Child Youth Serv Rev. 2000;22:441–63.CrossRef
21.
Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: a review and meta-analysis. J Affect Disord. 2013;148:1–11.PubMedCrossRef
22.
Saunders T, Driskell JE, Johnston JH, Salas E. The effect of stress inoculation training on anxiety and performance. J Occup Health Psychol. 1996;1:170–86.PubMedCrossRef
23.
Juth V, Dickerson S. Social stress. In: Gellman MD, Turner JR, editors. Encycl. Behav. Med. New York, NY: Springer New York; 2013. p. 1842–3.CrossRef
24.
Ditzen B, Heinrichs M. Psychobiology of social support: the social dimension of stress buffering. Restor Neurol Neurosci. 2014;32:149–62.PubMed
25.
Lazarus RS, Folkman S. Coping and adaptation; 1984.
26.
Compas BE, Jaser SS, Dunbar JP, Watson KH, Bettis AH, Gruhn MA, Williams EK. Coping and emotion regulation from childhood to early adulthood: points of convergence and divergence. Aust J Psychol. 2014;66:71–81.PubMedCrossRef
27.
Yahav R, Cohen M. Evaluation of a cognitive-behavioral intervention for adolescents. Int J Stress Manag. 2008;15:173–88.CrossRef
28.
Weems CF, Scott BG, Graham RA, et al. Fitting anxious emotion-focused intervention into the ecology of schools: results from a test anxiety program evaluation. Prev Sci. 2014;16:200–10.CrossRef
29.
Yeo LS, Goh VG, Liem GAD. School-based intervention for test anxiety. Child Youth Care Forum. 2016;45:1–17.CrossRef
30.
Putwain DW, Pescod M. Is reducing uncertain control the key to successful test anxiety intervention for secondary school students? Findings from a randomized control trial. Sch Psychol Q. 2018;33:283–92.PubMedCrossRef
31.
Bradley RT, McCraty R, Atkinson M, Tomasino D, Daugherty A, Arguelles L. Emotion self-regulation, psychophysiological coherence, and test anxiety: results from an experiment using electrophysiological measures. Appl Psychophysiol Biofeedback. 2010;35:261–83.PubMedCrossRef
32.
Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, Schellinger KB. The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based universal interventions. Child Dev. 2011;82:405–32.PubMedCrossRef
33.
Schonert-Reichl KA, Lawlor MS. The effects of a mindfulness-based education program on pre- and early adolescents’ well-being and social and emotional competence. Mindfulness (N Y). 2010;1:137–51.CrossRef
34.
Durlak JA, Weissberg RP, Pachan M. A meta-analysis of after-school programs that seek to promote personal and social skills in children and adolescents. Am J Community Psychol. 2010;45:294–309.PubMedCrossRef
35.
Harrell AW, Mercer SH, DeRosier ME. Improving the social-behavioral adjustment of adolescents: the effectiveness of a social skills group intervention. J Child Fam Stud. 2009;18:378–87.CrossRef
36.
37.
Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol. 2014;14:42.PubMedCrossRefPubMedCentral
38.
Sen CP, Saucier DA, Hafner E. Meta-analysis of the relationships between social support and well-being in children and adolescents. J Soc Clin Psychol. 2010;29:624–45.CrossRef
39.
Rothon C, Head J, Klineberg E, Stansfeld S. Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London. J Adolesc. 2011;34:579–88.PubMedCrossRefPubMedCentral
40.
Beckner V, Howard I, Vella L, Mohr DC. Telephone-administered psychotherapy for depression in MS patients: moderating role of social support. J Behav Med. 2010;33:47–59.PubMedCrossRef
41.
Thrasher S, Power M, Morant N, Marks I, Dalgleish T. Social support moderates outcome in a randomized controlled trial of exposure therapy and (or) cognitive restructuring for chronic posttraumatic stress disorder. Can J Psychiatr. 2010;55:187–90.CrossRef
42.
Fox JK, Halpern LF, Ryan JL, Lowe KA. Stressful life events and the tripartite model: relations to anxiety and depression in adolescent females. J Adolesc. 2010;33:43–54.PubMedCrossRef
43.
Meng XH, Tao FB, Wan YH, Hu Y, Wang RX. Coping as a mechanism linking stressful life events and mental health problems in adolescents. Biomed Environ Sci. 2011;24:649–55.PubMed
44.
Low NCP, Dugas E, O’Loughlin E, Rodriguez D, Contreras G, Chaiton M, O’Loughlin J. Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents. BMC Psychiatry. 2012;12:116.PubMedCrossRefPubMedCentral
45.
Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry. 2012;169:141–51.PubMedCrossRef
46.
Henderson CE, Dakof GA, Greenbaum PE, Liddle HA. Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: report from two randomized controlled trials. J Consult Clin Psychol. 2010;78:885–97.PubMedCrossRefPubMedCentral
47.
Menting ATA, Orobio de Castro B, Matthys W. Effectiveness of the incredible years parent training to modify disruptive and prosocial child behavior: a meta-analytic review. Clin Psychol Rev. 2013;33:901–13.PubMedCrossRef
48.
Flett GL, Hewitt PL, Besser A, Su C, Vaillancourt T, Boucher D, Munro Y, Davidson LA, Gale O. The child–adolescent perfectionism scale: development, psychometric properties, and associations with stress, distress, and psychiatric Symptos. J Psychoeduc Assess. 2016;34:634–52.CrossRef
49.
Deb S, Strodl E, Sun J. Academic stress, parental pressure, anxiety and mental health among Indian high school students. Int J Psychol Behav Sci. 2015;5:26–34.
50.
O’Connor RC, Rasmussen S, Hawton K. Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress. Behav Res Ther. 2010;48:52–9.PubMedCrossRef
51.
Limburg K, Watson HJ, Hagger MS, Egan SJ. The relationship between perfectionism and psychopathology: a meta-analysis. J Clin Psychol. 2017;73:1301–26.PubMedCrossRef
52.
Quach AS, Epstein NB, Riley PJ, Falconier MK, Fang X. Effects of parental warmth and academic pressure on anxiety and depression symptoms in Chinese adolescents. J Child Fam Stud. 2013;24:106–16.CrossRef
53.
Zuroff DC, Blatt SJ, Sotsky SM, Krupnick JL, Martin DJ, Sanislow CA, Simmens S. Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression. J Consult Clin Psychol. 2000;68:114–24.PubMedCrossRef
54.
Nobel R, Manassis K, Wilansky-Traynor P. The role of perfectionism in relation to an intervention to reduce anxious and depressive symptoms in children. J Ration Emotive Cogn Behav Ther. 2012;30:77–90.CrossRef
55.
Mitchell JH, Newall C, Broeren S, Hudson JL. The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children. Behav Res Ther. 2013;51:547–54.PubMedCrossRef
56.
Festen H, Hartman CA, Hogendoorn S, de Haan E, Prins PJM, Reichart CG, Moorlag H, Nauta MH. Temperament and parenting predicting anxiety change in cognitive behavioral therapy: the role of mothers, fathers, and children. J Anxiety Disord. 2013;27:289–97.PubMedCrossRef
57.
Taylor ZE, Conger RD, Robins RW, Widaman KF. Parenting practices and perceived social support: longitudinal relations with the social competence of Mexican-origin children. J Lat Psychol. 2016;3:193–208.CrossRef
58.
Pinquart M. Do the parent-child relationship and parenting behaviors differ between families with a child with and without chronic illness? A meta-analysis. J Pediatr Psychol. 2013;38:708–21.PubMedCrossRef
59.
Liber JM, McLeod BD, Van Widenfelt BM, Goedhart AW, van der Leeden AJM, Utens EMWJ, Treffers PDA. Examining the relation between the therapeutic alliance, treatment adherence, and outcome of cognitive behavioral therapy for children with anxiety disorders. Behav Ther. 2010;41:172–86.PubMedCrossRef
60.
61.
Perepletchikova F, Treat TA, Kazdin AE. Treatment integrity in psychotherapy research: analysis of the studies and examination of the associated factors. J Consult Clin Psychol. 2007;75:829–41.PubMedCrossRef
62.
Asscher JJ, Dijkstra S, Stams GJJM, Deković M, Creemers HE. Family group conferencing in youth care: characteristics of the decision making model, implementation and effectiveness of the family group (FG) plans. BMC Public Health. 2014;14:154.PubMedCrossRefPubMedCentral
63.
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3:a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Psychon Soc Inc. 2007;39:175–91.
64.
Kearney CA, Graczyk P. A response to intervention model to promote school attendance and decrease school absenteeism. Child Youth Care Forum. 2014;43:1–25.CrossRef
65.
Garnefski N, Kraaij V. Cognitive emotion regulation questionnaire - development of a short 18-item version (CERQ-short). Pers Individ Dif. 2006;41:1045–53.CrossRef
66.
Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and depression. Pers Individ Dif. 2001;30:1311–27.CrossRef
67.
Arrindel WA, de Groot PM, Walburg JA. Handleiding Schaal voor Interpersoonlijk Gedrag. SIG, deel 1. Lisse: Swets & Zeitlinger; 1984.
68.
Bijstra JO, Oostra L. Sociale vaardigheid van adolescenten in kaart gebracht. Kind en Adolesc. 2000;21:166–71.CrossRef
69.
Conroy DE, Willow JP, Metzler JN. Multidimensional fear of failure measurement: the performance failure appraisal inventory. J Appl Sport Psychol. 2002;14:76–90.CrossRef
70.
Conroy DE, Coatsworth JD. The effects of coach training on fear of failure in youth swimmers: a latent growth curve analysis from a randomized, controlled trial. J Appl Dev Psychol. 2004;25:193–214.CrossRef
71.
Van der Ploeg HM. The validation of the Dutch form of test anxiety inventory. Adv Test Anxiety Res Lisse, Netherlands. 1983;2:191–202.
72.
Spielberger CD. Test anxiety inventory: sampler set: manual, test scoring: “test attitude inventory”: preliminary professional manual. Mind Gard; 1980.
73.
Spielberger CD, Gonzalez HP, Taylor CJ, Algaze B, Anton WD. Examination stress and test anxiety. Stress Anxiety. 1978;5:167–91.
74.
Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE. Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther. 2000;38:835–55.PubMedCrossRef
75.
Ferdinand RF, Lang NDJV, Ormel J, Verhulst FC. No distinctions between different types of anxiety symptoms in pre-adolescents from the general population. J Anxiety Disord. 2006;20:207–21.PubMedCrossRef
76.
Shimmer3 GSR+. Shimmer Res. Ltd, Dublin Irel.
77.
Piferi RL, Kline KA, Younger J, Lawler KA. An alternative approach for achieving cardiovascular baseline: viewing an aquatic video. Int J Psychophysiol. 2000;37:207–17.PubMedCrossRef
78.
Stern RA, Arruda JE, Hooper CR, Wolfner GD, Morey CE. Visual analogue mood scales to measure internal mood state in neurologically impaired patients: description and initial validity evidence. Aphasiology. 1997;11:59–71.CrossRef
79.
Dunn TW, Burlingame GM, Walbridge M, Smith J, Crum MJ. Outcome assessment for children and adolescents: psychometric validation of the youth outcome questionnaire 30.1 (Y-OQ®-30.1). Clin Psychol Psychother. 2005;12:388–401.CrossRef
80.
WHO. Wellbeing measures in primary health care/the Depcare project. Copenhagen: WHO Reg. Off. Eur; 1998.
81.
De Wit M, Pouwer F, Gemke RJBJ, Delemarre-Van De Waal HA, Snoek FJ. Validation of the WHO-5 well-being index in adolescents with type 1 diabetes. Diabetes Care. 2007;30:2003–6.PubMedCrossRef
82.
Allgaier AK, Pietsch K, Frühe B, Prast E, Sigl-Glöckner J, Schulte-Körne G. Depression in pediatric care: is the WHO-five well-being index a valid screening instrument for children and adolescents? Gen Hosp Psychiatry. 2012;34:234–41.PubMedCrossRef
83.
Rosenberg M. Society and the adolescent self-image. Princeton: Princet Univ Press; 1965.CrossRef
84.
Franck E, De Raedt R, Barbez C, Rosseel Y. Psychometric properties of the Dutch Rosenberg self-esteem scale. Psychol Belg. 2008;48:25–35.CrossRef
85.
Van Leeuwen K, Vermulst A, Kroes G, De Meyer G, Veerman J (2011) De verkorte schaal voor ouderlijk gedrag. VSOG voor ouders van jeugdigen van 4 t/m 18 jaar. Nijmegen, Netherlands Kathol. Univ. Leuven/Praktikon bv.
86.
van Eijk LM, Kempen GIJM, van Sonderen FLP. A short scale for measuring social support in the elderly: the SSL12-I. Tijdschr Gerontol Geriatr. 1994;25:192–6.PubMed
87.
Kempen GIJM, van Eijk LM. The psychometric properties of the SSL12-I, a short scale for measuring social support in the elderly. Soc Indic Res. 1995;35:303–12.CrossRef
88.
O’Connor RC, Dixon D, Rasmussen S. The structure and temporal stability of the child and adolescent perfectionism scale. Psychol Assess. 2009;21:437–43.PubMedCrossRef
89.
Wills TA, Cleary S, Filer M, Shinar O, Mariani J, Spera K. Temperament related to early-onset substance use: test of a developmental model. Prev Sci. 2001;2:145–63.PubMedCrossRef
90.
Wills TA, McNamara G, Vaccaro D, Hirky AE. Escalated substance use: a longitudinal grouping analysis from early to middle adolescence. J Abnorm Psychol. 1996;105:166–80.PubMedCrossRef
91.
92.
Stoeber J, Rambow A. Perfectionism in adolescent school students: relations with motivation, achievement, and well-being. Pers Individ Dif. 2007;42:1379–89CrossRef
93.
O’rourke DJ, Smith RE, Smoll FL, Cumming SP. Trait anxiety in young athletes as a function of parental pressure and motivational climate: is parental pressure always harmful? J Appl Sport Psychol. 2011;23:398–412.CrossRef
94.
Shirk SR, Saiz CC. Clinical, empirical, and developmental perspectives on the therapeutic relationship in child psychotherapy. Dev Psychopathol. 1992;4:713–28.CrossRef
95.
DeVet KA, Kim YJ, Charlot-Swilley D, Ireys HT. The therapeutic relationship in child therapy: perspectives of children and mothers. J Clin Child Adolesc Psychol. 2003;32:277–83.PubMedCrossRef
96.
Ormhaug SM, Shirk SR, Wentzel-Larsen T. Therapist and client perspectives on the alliance in the treatment of traumatized adolescents. Eur J Psychotraumatol. 2015;6:27705.PubMedCrossRef
97.
Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65:467–87.PubMedCrossRef
Metadata
Title
The effectiveness of school-based skills-training programs promoting mental health in adolescents: a study protocol for a randomized controlled study
Authors
Amanda W. G. van Loon
Hanneke E. Creemers
Simone Vogelaar
Nadira Saab
Anne C. Miers
P. Michiel Westenberg
Jessica J. Asscher
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6999-3

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

‘It’s not because we don’t believe in it...’: Headteachers’ perceptions of implementing physically active lessons in school

Research article

Coverage and usage of insecticide treated nets (ITNs) within households: associated factors and effect on the prevalance of malaria parasitemia in the Mount Cameroon area

Research article

Dose-response relation of self-reported and accelerometer-measured physical activity to perceived health in middle age—the Northern Finland Birth Cohort 1966 Study

Study protocol

Study protocol of the X:IT II - a school-based smoking preventive intervention

Research article

Effects of pollution, low temperature and influenza syndrome on the excess mortality risk in winter 2016–2017

Research article

Effect of ambient air pollution on premature SGA in Changzhou city, 2013–2016: a retrospective study