Prevention in adolescent mental health: The development and evaluation of school-based interventions in disadvantaged communities

Jonathan Sae-Koew

School-based prevention frameworks for mental health in disadvantaged communities are essential for determining evidence-based action to address poorer adolescent mental health. Frameworks addressing vulnerability and sustained mental health problems in adolescence can be examined at several levels, ranging from structural and place-based factors to the role of community factors and proximal factors such as family and the school setting. The overall aim of this thesis was to develop recommendations for prevention-based practice by combining local and national predictors of depressive symptoms and then apply these recommendations to an evaluation of a school-based intervention. Study 1 examined a national dataset (N = 19,987) from the Communities That Care (CTC) study of 18 years of nationally representative data on adolescents to examine risk and protective factors predicting adolescent depressive symptoms. Results revealed several critical risk (self-blame, family conflict and friend’s use of drugs) and protective factors (good coping, school rewards for prosocial involvement and belief in the moral order) for depressive symptoms in adolescents at a national level. However, when examined in the context of several disadvantaged communities, profiles of risk and protection for depressive symptoms were found to differ. A measurement tool was developed for identifying young people with high levels of depressive symptoms based on these predictors. A prevention-focused framework was then applied to evaluating a school-based intervention, the Resilience, Emotional Awareness, Careers, and Health (REACH) program across three studies spanning 2015 to 2018. REACH aimed at targeting school- and individual-level risk and protective factors associated with mental health. Included empirical studies collected data from four yearly cohorts of students (N = 1098) who participated in the REACH program. Evaluation outcomes suggest that the REACH program was not effective for targeting school- and individual-level risk factors or protective factors, or reducing adolescent depressive symptoms compared to a comparison group of schools within the same community. Results also suggested that a large proportion of participating students indicated either increased depressive or clinical levels of symptoms. Several recommendations are drawn from these thesis findings. First, prevention-based approaches for disadvantaged communities and schools need to balance targeting risk and protective factors identified at a population level with the local and place-based circumstances in which interventions are delivered. Second, the measurement of needs specific to risk and protective factors are utilised rather than adopting ‘off-the-shelf’ prevention packages. Third, comprehensive approaches to support adolescent mental health in schools incorporate a two-pronged strategy of school-wide prevention, as well as individual or family treatment. This approach requires screening, integration with existing services and school policy changes alongside whole-of-school interventions in the classroom.

Prevention in adolescent mental health: The development and evaluation of school-based interventions in disadvantaged communities

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