Depression, Substance-Related Disorders
Conditions
Keywords
Adolescent, Substance Abuse, At-risk
Brief summary
This study will implement a school-based program to prevent depression, academic failure, and substance use in at-risk adolescents transitioning from middle school to high school.
Detailed description
The transition from middle school to high school presents important challenges for adolescents. Programs that enhance personal efficacy and social support resources may prevent at-risk students from developing behaviors that can lead to substance use, academic failure, and depression. This study will implement a skills-based program called Coping and Support Training for the Transition (CAST-T) as a preventive intervention for at-risk students. At-risk students in eighth grade will be randomly assigned to receive either CAST-T or school as usual. The CAST-T program will initially be delivered in twelve sessions over 6 weeks in the middle school setting. The program includes booster sessions, case management, structured home-based parent education, and support and skills training throughout the transition period. Participants will be assessed from the beginning of eighth grade to the end of ninth grade. Vulnerability to academic problems and depression will be assessed with school records and self-report scale scores.
Interventions
BEHAVIORALCAST-T/HSTS
Skills training small group.
BEHAVIORALBrief Intervention
Assessment of needs and referral to services as needed.
Sponsors
National Institute of Mental Health (NIMH)
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
12 Years to 15 Years
Healthy volunteers
Yes
Inclusion criteria
* At-risk for substance abuse, academic failure, and depression * Enrolled in eighth grade in Seattle Public Schools * English-speaking
Exclusion criteria
* Score above the clinical cutoff on the Youth Self Report Aggressive subscale
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Short Moods and Feelings Questionnaire (SMFQ) | Baseline to 18 months | The Short Moods and Feelings Questionnaire is a 13 item measure of level of self reported depressive symptoms. Each item in scored on a 3-point Likert scale as follows: True (0), Sometimes (1), and Not True (2) rated within the timeframe of the previous two weeks. A total score is obtained; scores can range from 0 to 26. Total scores of 12 or higher may signify that a child/adolescent is suffering from depression. Higher scores on this scale suggest a worse outcome or greater endorsement of depressive symptoms. Change is measured based on two time points baseline to the 18 months follow-up assessment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| School Attachment | 18 months | School attachment measure consisted of 4 items. Item responses range from 0 (unsatisfied, rarely attended, not involved, etc.) to 6 (highly satisfied, regularly attended, very involved, etc). Scores could range from 0 to 36 with higher scores indicating more positive school attachment. Item were: My overall satisfaction with classes was… Overall, how safe did school feel last semester… Overall, how friendly did school feel… How involved were you in school activities… |
Countries
United States
Participant flow
Recruitment details
8th graders in 6 middle schools completed the screening battery; those with 15+ on the Moods and Feelings Questionnaire and below the clinical cutoff on the Youth Self Report, Aggressive subscale were eligible. 716 met criteria; 497 were randomized. 123 families or youth declined; the rest could not be contacted.
Pre-assignment details
Participants recruited across 4 annual cohorts, included 241 youth randomized to HSTS and 256 to the Brief Intervention (BI). There were no significant differences between the 2 groups at baseline in terms of gender, race, and socioeconomic status (SES) as well as baseline comparisons of target variables (depression, hopelessness, anxiety, anger).
Participants by arm
| Arm | Count |
|---|---|
| CAST-T/HSTS HSTS condition combined the Brief Intervention and the HSTS protocol. HSTS introduced skills to enhance personal control (management of depression, anger and stress), self-esteem, decision making and interpersonal communications. Skills were taught in school based small groups to foster social support with outreach to teachers, peers, and parents. HSTS skills groups were held in the spring of 8th grade followed by four one-on-one booster sessions delivered to the students as 9th graders by HSTP leaders; parents participated in four educational sessions.
HSTS objectives are: 1) to increase the acquisition of coping skills competencies by teaching and practicing strategies taught; 2) to increase social support resources by building a supportive network; 3) to increase the youth's engagement in positive social activities; and 4) to motivate parents to increase their support via parent educational sessions.
CAST/HSTS Preventive Intervention: Brief Intervention | 241 |
| Brief Intervention Brief Intervention: After each youth and parent completed baseline questionnaires the youth participated in a 1 on 1 standardized clinical follow-up with a trained clinician (blind to study condition) to review areas of concern, based on questionnaire responses including stressors at school, home, and with peers, level of support available and how to access support. The teen and clinician then planned a feedback call to parents, allowing teens to shape requests for support from parents as well as understand exactly what information would be shared with parents. Feedback call to parents reviewed concerns and made recommendations for services as needed. A similar procedure was followed after each assessment for all participants who indicated a risk of clinical depression or self-harm.
CAST/HSTS Preventive Intervention: Brief Intervention | 256 |
| Total | 497 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Follow-up Assessment | Withdrawal by Subject | 6 | 6 |
| Intervention Component | Withdrawal by Subject | 2 | 3 |
Baseline characteristics
| Characteristic | Total | CAST-T/HSTS | Brief Intervention |
|---|---|---|---|
| Age, Categorical <=18 years | 497 Participants | 241 Participants | 256 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 13.57 years STANDARD_DEVIATION 0.75 | 13.5 years STANDARD_DEVIATION 0.83 | 13.65 years STANDARD_DEVIATION 0.67 |
| Region of Enrollment United States | 497 participants | 241 participants | 256 participants |
| Sex: Female, Male Female | 314 Participants | 149 Participants | 165 Participants |
| Sex: Female, Male Male | 183 Participants | 92 Participants | 91 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 241 | 0 / 256 |
| serious Total, serious adverse events | 0 / 241 | 0 / 256 |
Outcome results
Primary
Change in Short Moods and Feelings Questionnaire (SMFQ)
The Short Moods and Feelings Questionnaire is a 13 item measure of level of self reported depressive symptoms. Each item in scored on a 3-point Likert scale as follows: True (0), Sometimes (1), and Not True (2) rated within the timeframe of the previous two weeks. A total score is obtained; scores can range from 0 to 26. Total scores of 12 or higher may signify that a child/adolescent is suffering from depression. Higher scores on this scale suggest a worse outcome or greater endorsement of depressive symptoms. Change is measured based on two time points baseline to the 18 months follow-up assessment.
Time frame: Baseline to 18 months
Population: The main study hypothesis was that at-risk middle school students randomly assigned to participate in the CAST-T/HSTS versus the Brief Intervention would demonstrate a greater reduction in self-reported depressive symptoms after the 8th grade intervention as well as lower rate of increase in depressive symptoms at the 18 mos. follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| CAST-T/HSTS | Change in Short Moods and Feelings Questionnaire (SMFQ) | 2.19 units on a scale | Standard Deviation 6.18 |
| Brief Intervention | Change in Short Moods and Feelings Questionnaire (SMFQ) | 1.21 units on a scale | Standard Deviation 6.4 |
Comparison: Mean changes in Short Moods and Feelings measure of depression was the unit of analysis.p-value: <0.05t-test, 2 sided
Comparison: A secondary hypothesis of the study was that attachment to school and/or perceptions of school supportiveness would mediate the effect of the HSTS intervention on depressive symptoms.p-value: <0.01t-test, 2 sided
Secondary
School Attachment
School attachment measure consisted of 4 items. Item responses range from 0 (unsatisfied, rarely attended, not involved, etc.) to 6 (highly satisfied, regularly attended, very involved, etc). Scores could range from 0 to 36 with higher scores indicating more positive school attachment. Item were: My overall satisfaction with classes was… Overall, how safe did school feel last semester… Overall, how friendly did school feel… How involved were you in school activities…
Time frame: 18 months
Population: T-test differences for HSTS versus Brief Intervention on the School Attachment scale.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| CAST-T/HSTS | School Attachment | 4.53 units of a scale | Standard Deviation 1.21 |
| Brief Intervention | School Attachment | 3.95 units of a scale | Standard Deviation 1.31 |