School-Based Prevention of Mental Illnesses in Adolescents: Studies on a Screening Instrument and on the Conceptualization and Effectiveness of the StresSOS Program
Year: 2025
Type: dissertation
Study design: Observational Study
Abstract: Mental health problems in childhood and adolescence are a worldwide issue and increasingly lead to reduced quality of life and premature death. Therefore, psychometrically valid approaches to diagnosis and approaches for the effective prevention of mental illness in children and adolescents are urgently needed. The aim of this thesis was to contribute to research into diagnostics and prevention. Three distinct studies were conducted for this purpose. In study I, the Multidimensional Anxiety Inventory for Children and Adolescents (MAICA) was tested within two clinical samples. It provides a diagnostic approach to assess anxiety- and depression-related problems (internalizing symptoms). Valid self-reporting instruments that are specifically formulated for children and adolescents are important tools for identifying problems at an early stage, particularly when it comes to identifying the more silent internalizing problems that are not directly visible in external behavior. First, a clinical sample of children with anxiety- or depression-related problems (n = 94) was compared with a parallelized non-clinical sample of students (n = 282). Then, a clinical sample of children with other, non-anxiety- or depression-related problems (n = 45) was compared with another parallelized non-clinical sample of students (n = 135). It was examined whether the clinical samples differed from the respective control groups in terms of anxiety (i.e., emotionality and worry) and depression (i.e., dysthymia and low joy). With Cronbach's a > .80 for anxiety and >.85 for depression, the internal consistencies for the overall scales were all in the range suitable for individual case diagnostics. The results of the mean comparisons confirmed that children with anxiety- or depression-related symptoms had less favorable scores on all scales of the MAICA than the non-clinical student sample (d = 0.34 to 0.54 for anxiety, 0.55 to 0.68 for depression). The comparison between children with other mental health problems and the control group showed no significant mean differences. Preliminary cutoff scores derived from the results were given. In this way, the MAICA can be used as a screening instrument for diagnostics, but also for measuring disease progression in the context of prevention interventions or for evaluating such interventions. In study II, a school-based program for the prevention of mental health problems and the promotion of mental health (StresSOS face-to-face) was developed and implemented. Some of the previous research supports the efficacy of universal school-based prevention programs, while some of the research finds no efficacy. This inconsistency is particularly true when the aim is to achieve an improvement in general populations, e.g. by reducing stress symptoms or strengthening mental health. To shed further light on this field, potential influencing factors (mental health status, gender, age group) on the pre-post effects of the StresSOS face-to-face program were investigated in study II. The program consisted of eight 90-minute sessions, which were conducted by two trainers in a classroom setting at the school. The content is based on the concept of life skills, stress, and coping as well as mental health literacy. The study involved n = 510 adolescents between the ages of 12 and 18 from grades 7 to 10, 46.7% of whom were female. Most of them had no mental health problems (65.9%), some were at risk of mental health problems (21.6%) and a few had signs of a mental illness (12.5%). The primary outcomes were pre-post comparisons of knowledge about stress and coping, psychological and somatic stress symptoms, and post values for program acceptance, taking into account the influencing factors mental health status, gender, and age group. Using multilevel mixed effects models with the fixed effects time (within factor), mental health status, gender, and grade level (between factors) and the random effects for students within classes, the research questions were analyzed. Mental health status moderated the pre-post changes in psychological stress symptoms (p < 0.05), with adolescents experiencing mental health problems showing an improvement in stress symptoms that was not seen in adolescents at risk and mentally healthy adolescents. Gender and age group had no influence. All adolescents showed an increase in knowledge about stress and coping (p < 0.001). The program was better evaluated by younger adolescents with mental health problems or at risk (p < 0.01). Study II thus reveals that even in a relatively short period of 11 weeks between pre- and post-measurement, knowledge gains can be achieved in all adolescents, but symptoms only improve in adolescents who have already been previously impaired. This finding can be used for the choice of prevention level (universal or selective prevention). The questions remain as to whether StresSOS can prevent the onset of new mental illnesses and what the results will be if longer periods of time are considered. To answer these questions, the StresSOS online program, which has a similar content as the face-to-face intervention, but is delivered as an internet-based program, was developed as a part of study III. The main objective of Study III was to evaluate the efficacy of StresSOS online. To achieve this, a randomized controlled trial was conducted. The participants were between 12 and 25 years old and had no signs of mental health problems. They were randomly assigned to the StresSOS online intervention group or the attention placebo control group. StresSOS online and the control condition consisted of eight web-based sessions which could be accessed voluntarily by the adolescents on a mobile device of their choice. The sessions included an information and an exercise section. Additionally, weekly e-mail teasers including monitoring were sent out. The content of StresSOS online was structured in parallel to StresSOS face-to-face, the control condition received information on healthy eating. The primary outcome of the study was the mental health status after one year, which was evaluated using intention-to-treat analyses. Data from n = 1118 adolescents was analyzed, n = 535 in StresSOS online and n = 583 in the control group. It was found that participation in StresSOS online significantly reduced the number of new mental illnesses after one year (controls: n = 162 [28%] “with problems”, StresSOS: n = 113 [21%] “with problems”, OR 0.70, 95% CI 0.52-0.92, p = 0.010). This result shows that after a longer period of time, even mentally healthy adolescents benefit from StresSOS at the symptom level. Thus, StresSOS online can indeed prevent the onset of new mental illnesses on a longer timescale of one year. Therefore, universal internet interventions have the potential to contribute to a reduction in the burden of disease caused by mental illness in adolescents.
Author: Lehner, Laya
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7125571071