Background
Methods
Design
Participants
Individuals
Clusters
Intervention
Objectives
Outcomes
Knowledge about mental health problems
Recognition of depression in a vignette
Stigma towards depressed students
Beliefs about treatment of depression which are like those of health professionals
Confidence in providing help
Intentions to provide help to a depressed student
Help provided to students
First aid provided to colleagues
School practices and policies
Teacher psychological distress
Recognition of depression in a vignette
Stigma towards a depressed peer
Beliefs in the helpfulness of school staff for a depressed student
Help received from school staff members
Information received from teachers
Student mental health
Sample size estimation
Randomization: sequence generation
Randomization: allocation concealment
Randomization: implementation
Blinding
Statistical methods
Ethics
Results
Participant flow
Numbers analysed
Participants' Characteristics
Characteristics | Intervention group | Control group | Total |
---|---|---|---|
Teachers n
| 221 | 106 | 327 |
Gender n (%): | |||
Male | 78 (35.3) | 36 (34.0) | 114 (34.9) |
Female | 143 (64.7) | 70 (66.0) | 213 (65.1) |
Time working in schools n (%): | |||
Less than 3 years | 24 (10.9) | 4 (3.9) | 28 (8.6) |
3-5 years | 30 (13.6) | 13 (12.5) | 43 (13.2) |
6-10 years | 28 (12.7) | 13 (12.5) | 41 (12.6) |
11-15 years | 22 (10) | 7 (6.7) | 29 (8.9) |
16-20 years | 22 (10) | 14 (13.5) | 36 (11.1) |
More than 20 years | 95 (43) | 53 (51) | 148 (45.5) |
Time working in current school n (%): | |||
Less than 1 year | 34 (15.4) | 15 (14.4) | 49 (15.1) |
1-2 years | 34 (15.4) | 16 (15.4) | 50 (15.4) |
3-5 years | 54 (24.4) | 18 (17.3) | 72 (22.2) |
6-10 years | 53 (24.0) | 26 (25.0) | 79 (24.3) |
11-15 years | 21 (9.5) | 15 (14.4) | 36 (11.1) |
16-20 years | 10 (4.5) | 5 (4.8) | 15 (4.6) |
More than 20 years | 15 (6.8) | 9 (8.7) | 24 (7.4) |
Main role in school n (%): | |||
Leadership | 38 (17.4) | 28 (27.2) | 66 (20.5) |
Classroom teacher | 146 (66.7) | 58 (56.3) | 204 (63.4) |
Student welfare/counsellor | 15 (6.9) | 6 (5.8) | 21 (6.5) |
Support officer (SSO) | 14 (6.4) | 7 (6.8) | 21 (6.5) |
Other | 6 (2.7) | 4 (3.9) | 10 (3.1) |
Teaching subjects n (%): | |||
Arts | 40 (18.1) | 16 (15.1) | 56 (17.1) |
English | 61 (27.6) | 29 (27.4) | 90 (27.5) |
Technology | 30 (13.6) | 11 (10.4) | 41 (12.5) |
Language other than English | 10 (4.5) | 7 (6.6) | 17 (5.2) |
Studies of Society and Environment | 57 (25.8) | 32 (30.2) | 89 (27.2) |
Science | 44 (19.9) | 20 (18.9) | 64 (19.6) |
Physical Education | 30 (13.6) | 19 (17.9) | 49 (15.0) |
Mathematics | 49 (22.2) | 24 (22.6) | 73 (22.3) |
Students
n
|
982
|
651
|
1,633
|
Gender n (%): | |||
Male | 451 (46.2) | 295 (45.6) | 746 (46.0) |
Female | 525 (53.8) | 352 (54.4) | 877 (54.0) |
Age n (%): | |||
12 | 75 (7.7) | 36 (5.6) | 111 (6.9) |
13 | 363 (37.4) | 256 (39.9) | 619 (38.4) |
14 | 317 (32.7) | 220 (34.3) | 537 (33.3) |
15 | 215 (22.2) | 130 (20.3) | 345 (21.4) |
Grade n (%): | |||
7 | 31 (3.2) | 8 (1.2) | 39 (2.4) |
8 | 403 (41.3) | 293 (45.2) | 696 (42.8) |
9 | 308 (31.6) | 208 (32.1) | 516 (31.8) |
10 | 234 (24.0) | 140 (21.6) | 374 (23.0) |
Language spoken at home n (%): | |||
English | 901 (92.2) | 591 (91.2) | 1,492 (91.8) |
Another language | 10 (1.0) | 12 (1.9) | 22 (1.4) |
English and another language | 66 (6.8) | 45 (6.9) | 111 (6.8) |
Teacher outcomes
Intervention group | Control group | Mean diff./OR for pre vs post by intervention interaction (95% CI) | Mean diff./OR for pre vs follow-up by intervention interaction (95% CI) | |||||
---|---|---|---|---|---|---|---|---|
Pre | Post | Follow-up | Pre | Post | Follow-up | |||
Mental Health Knowledge
| ||||||||
Knowledge quiz: mean (SD) | 11.14 (3.57) | 13.07 (3.30) | 12.68 (3.44) | 11.26 (3.07) | 11.11 (3.58) | 10.76 (3.89) | 2.08 (1.38-2.78)*** | 1.79 (1.06-2.52)*** |
Recognition of depression % | 81.8 | 86.1 | 92.9 | 80.6 | 85.9 | 83.8 | 0.98 (0.27-3.56) | 3.09 (0.77-12.43) |
Beliefs about treatment for depression: mean (SD) | 8.22 (2.39) | 8.85 (2.54) | 8.86 (2.39) | 7.91 (2.44) | 7.84 (2.74) | 7.92 (2.46) | 0.79 (0.23-1.34)** | 0.73 (0.15-1.31)* |
Personal Stigma Items: % Strongly Disagree
| ||||||||
Could snap out of it | 32.1 | 40.1 | 37.3 | 31.1 | 29.6 | 26.4 | 2.12 (0.76-5.90) | 2.59 (0.87-7.69) |
Personal weakness | 53.9 | 54.4 | 55.4 | 63.2 | 49.0 | 54.0 | 3.07 (1.16-8.14)* | 2.47 (0.91-6.76) |
Not real illness: % | 45.0 | 47.1 | 48.7 | 43.4 | 37.8 | 34.5 | 1.70 (0.67-4.32) | 2.50 (0.94-6.66) |
People with that problem are dangerous | 35.6 | 37.7 | 38.0 | 35.2 | 34.7 | 33.3 | 1.05 (0.39-2.82) | 1.60 (0.57-4.45) |
Best to avoid people with that problem | 72.3 | 62.0 | 66.0 | 68.9 | 62.2 | 59.8 | 0.75 (0.30-1.89) | 1.17 (0.45-3.03) |
People with that problem are unpredictable | 8.1 | 12.3 | 12.7 | 14.2 | 10.4 | 11.5 | 3.54 (0.88-14.17) | 3.36 (0.82-13.83) |
If they had problem they would not tell anyone | 25.0 | 31.4 | 26.4 | 28.3 | 18.6 | 16.1 | 3.79 (1.34-10.71)* | 3.42 (1.13-10.32)* |
Perceived Stigma Items: % ≥ Agree
| ||||||||
Other people think could snap out of it | 64.6 | 57.0 | 57.2 | 64.8 | 59.8 | 54.7 | 0.88 (0.34-2.26) | 1.24 (0.47-3.33) |
Other people believe a sign of personal weakness | 52.7 | 52.9 | 56.0 | 58.5 | 56.7 | 45.9 | 1.10 (0.42-2.87) | 3.01 (1.10-8.23)* |
Other people believe not real illness | 62.4 | 55.8 | 59.8 | 60.4 | 55.7 | 57.0 | 0.86 (0.37-2.02) | 1.07 (0.44-2.60) |
Other people believe they are dangerous | 19.1 | 25.0 | 25.2 | 26.4 | 20.6 | 22.1 | 2.75 (0.98-7.66) | 2.05 (0.72-5.85) |
Other people would avoid people with that problem | 23.6 | 29.7 | 28.9 | 27.4 | 23.7 | 24.4 | 2.42 (0.85-6.87) | 1.90 (0.65-5.54) |
Other people believe they are unpredictable | 53.6 | 50.6 | 51.6 | 45.2 | 46.9 | 45.4 | 0.72 (0.31-1.68) | 0.95 (0.40-2.28) |
Other people would not tell anyone | 61.4 | 59.1 | 51.6 | 67.6 | 51.6 | 52.9 | 2.57 (1.04-6.35)* | 1.32 (0.52-3.36) |
Intended Helping Behaviours Towards Students
| ||||||||
Contact the family: % ≥ often
| 38.2 | 41.8 | 44.0 | 36.2 | 37.5 | 35.3 | 1.28 (0.47-3.48) | 1.46 (0.52-4.13) |
Discuss with another teacher: % ≥ often
| 72.3 | 80.1 | 73.4 | 69.5 | 62.9 | 60.7 | 3.73 (1.31-10.62)* | 2.46 (0.86-7.05) |
Discuss with counsellors: % ≥ often
| 82.3 | 87.1 | 86.6 | 81.9 | 74.5 | 75.9 | 3.87 (1.21-12.41)* | 2.98 (0.90-9.91) |
Discuss with member of administration: % ≥ often
| 37.7 | 39.2 | 40.8 | 42.9 | 39.8 | 47.1 | 1.36 (0.52-3.60) | 0.99 (0.37-2.68) |
Have conversation with student: % ≥ often
| 68.6 | 72.5 | 70.3 | 61.0 | 58.2 | 49.4 | 2.06 (0.75-5.68) | 3.16 (1.10-9.06)* |
Talk with peers of student: % ≥ often
| 18.2 | 22.2 | 21.0 | 13.6 | 9.2 | 12.6 | 3.24 (0.91-11.54) | 1.70 (0.49-5.94) |
Do nothing: % never
| 65.5 | 66.1 | 66.5 | 69.5 | 65.0 | 61.6 | 1.95 (0.70-5.48) | 2.37 (0.82-6.81) |
Help Given Towards Students: % ≥ Occasionally
| ||||||||
Spoken with students about their mental health problems | 52.1 | 52.1 | 54.8 | 53.3 | 51.0 | 47.7 | 1.34 (0.48-3.75) | 1.73 (0.59-5.08) |
Discussed a students' mental health problems with other teachers | 67.9 | 72.4 | 66.2 | 70.5 | 68.4 | 58.1 | 1.87 (0.67-5.22) | 1.91 (0.68-5.41) |
Mental health issues raised in staff meetings | 57.9 | 50.3 | 47.1 | 62.1 | 52.6 | 47.7 | 1.26 (0.51-3.07) | 1.22 (0.48-3.08) |
Confidence in Helping Students and Staff with Mental Health Problems: % ≥ Quite a Bit
| ||||||||
Confidence to talk with students about mental health problems | 19.0 | 32.6 | 34.2 | 20.8 | 20.4 | 17.4 | 8.09 (1.89-34.63)** | 7.02 (1.65-29.79)** |
Confidence in helping a colleague with mental health problem | 16.4 | 25.0 | 32.3 | 20.8 | 15.3 | 14.9 | 7.22 (1.84-28.4)** | 11.65 (2.87-47.32)*** |
School Policies on Student Mental Health
| ||||||||
Review curriculum options/classroom practices: % ≥ often
| 54.3 | 56.7 | 58.0 | 59.1 | 48.5 | 41.9 | 2.22 (0.93-5.26) | 3.76 (1.51-9.34)** |
Review/changes school policy: % ≥ often
| 18.6 | 24.1 | 21.2 | 20.4 | 12.4 | 12.9 | 3.20 (1.12-9.14)* | 2.44 (0.82-7.26) |
Improve the relationships within the school: % ≥ often
| 65.6 | 69.4 | 68.2 | 71.4 | 61.2 | 58.1 | 3.09 (1.12-8.52)* | 3.26 (1.14-9.27)* |
School has written policy to deal with students with mental health problems: % yes
| 10.1 | 22.7 | 28.5 | 11.5 | 11.2 | 10.5 | 4.57 (1.28-16.26)* | 7.28 (1.92-27.54)** |
Policy been implemented in the last month: % ≥ occasionally
| 9.8 | 14.2 | 17.8 | 13.4 | 7.0 | 11.3 | 7.23 (0.85-61.37) | 13.30 (1.32-133.44)* |
Interacting with Colleagues: % ≥ Occasionally
| ||||||||
Talked with staff member about their mental health problem | 39.1 | 38.0 | 38.3 | 38.4 | 38.1 | 36.1 | 0.88 (0.35-2.22) | 0.93 (0.35-2.45) |
Talk about own mental health problem with a staff member | 35.8 | 39.4 | 38.2 | 37.1 | 34.7 | 34.5 | 1.49 (0.58-3.82) | 1.23 (0.46-3.29) |
Seeking Additional Mental Health Information: % ≥ Occasionally
| ||||||||
Visit any websites giving information about mental health | 21.8 | 23.5 | 26.8 | 21.0 | 19.6 | 17.2 | 1.29 (0.42-3.91) | 1.81 (0.56-5.79) |
Read books or other written material bout mental health problems | 43.9 | 49.1 | 39.9 | 38.1 | 38.8 | 35.6 | 1.30 (0.51-3.34) | 0.85 (0.31-2.31) |
Teacher Mental Health
| ||||||||
K6 6-24 (severe psychological distress) % | 29.8 | 34.3 | 25.8 | 25.5 | 22.1 | 25.3 | 2.41 (0.77-7.49) | 0.66 (0.20-2.13) |
K6 3-24 (medium-high psychological distress) % | 63.5 | 59.2 | 58.9 | 58.8 | 55.8 | 59.0 | 0.96 (0.34-2.70) | 0.61 (0.20-1.85) |
Student outcomes
Intervention group | Control group | Mean diff./OR for pre vs follow-up by intervention interaction (95% CI) | |||
---|---|---|---|---|---|
Pre | Follow-up | Pre | Follow-up | ||
Mental Health Knowledge
| |||||
Recognition of depression %
| 56.4 | 68.1 | 58.5 | 70.5 | 1.03 (0.67-1.59) |
Beliefs and Intentions About Where to Seek Help for Depression
| |||||
Help-seeking intentions - any adult source from 11 bullet point items1: mean (SD)
| 3.79 (2.76) | 3.77 (2.91) | 3.67 (2.61) | 3.61 (2.81) | 0.01 (-0.30-0.32) |
Help-seeking intentions - all 11 adult source bullet point items above: % yes
| 2.2 | 2.8 | 2.2 | 3.0 | 0.90 (0.31-2.58) |
Help-seeking intentions (all 5 items)2: % yes
| 9.3 | 10.1 | 7.2 | 8.2 | 0.91 (0.49-1.70) |
Help-seeking beliefs (all 5 items)3: % helpful
| 23.9 | 24.0 | 20.4 | 20.5 | 0.96 (0.61-1.52) |
Personal Stigma: % Strongly Disagree
| |||||
Could snap out of it | 12.5 | 16.5 | 13.9 | 19.9 | 0.84 (0.51-1.40) |
Personal weakness | 12.3 | 14.6 | 15.5 | 19.5 | 0.89 (0.51-1.56) |
Not real illness | 15.4 | 17.6 | 17.8 | 20.7 | 0.96 (0.60-1.55) |
People with that problem are dangerous | 12.9 | 12.8 | 16.4 | 13.9 | 1.25 (0.76-2.06) |
Best to avoid people with that problem | 34.7 | 33.6 | 36.4 | 38.1 | 0.85 (0.58-1.25) |
People with that problem are unpredictable | 3.9 | 3.5 | 3.1 | 4.3 | 0.59 (0.25-1.41) |
If they had problem they would not tell anyone | 21.9 | 19.8 | 27.4 | 22.7 | 1.26 (0.81-1.96) |
Perceived Stigma: % ≥ Agree
| |||||
Other people think could snap out of it | 47.9 | 46.0 | 43.5 | 41.3 | 1.00 (0.71-1.42) |
Other people believe a sign of personal weakness | 52.2 | 53.0 | 52.5 | 46.9 | 1.42 (0.99-2.04) |
Other people believe not real illness | 43.1 | 41.4 | 46.2 | 38.6 | 1.33 (0.95-1.86) |
Other people believe they are dangerous | 37.4 | 38.2 | 39.0 | 34.4 | 1.34 (0.94-1.90) |
Other people would avoid people with that problem | 37.4 | 38.4 | 39.0 | 37.7 | 1.13 (0.79-1.61) |
Other people believe they are unpredictable | 44.1 | 47.6 | 53.7 | 48.2 | 1.64 (1.15-2.33)** |
Other people would not tell anyone | 48.0 | 47.6 | 48.4 | 46.0 | 1.07 (0.76-1.51) |
Help Received from Teacher
| |||||
Talked with staff member about mental health problem: % ≥ occasionally
| 5.2 | 6.7 | 2.4 | 4.2 | 0.67 (0.28-1.62) |
Received information about mental health problems: % yes
| 19.0 | 25.2 | 19.7 | 13.0 | 2.60 (1.68-4.05)*** |
Student Mental Health
| |||||
SDQ 20-40 (abnormal) % | 9.1 | 9.6 | 7.0 | 10.3 | 0.51 (0.25-1.05) |
SDQ 16-40 (borderline-abnormal) % | 21.9 | 21.1 | 16.8 | 19.9 | 0.58 (0.33-1.01) |
SDQ Subscales
| |||||
Emotional symptoms 7-10 (abnormal) % | 9.4 | 9.2 | 8.1 | 8.5 | 0.84 (0.42-1.70) |
Conduct problems 5-10 (abnormal) % | 9.6 | 9.0 | 7.8 | 9.2 | 0.68 (0.35-1.32) |
Hyperactivity 7-10 (abnormal) % | 16.2 | 16.2 | 14.7 | 15.8 | 0.90 (0.52-1.57) |
Peer problems 6-10 (abnormal) % | 4.5 | 4.1 | 3.7 | 4.6 | 0.55 (0.21-1.45) |
Prosocial behaviour 0-4 (abnormal) % | 10.8 | 10.5 | 10.3 | 9.0 | 1.09 (0.59-2.02) |