Anxiety Depression, Suicidal Ideation
Conditions
Brief summary
Adolescence is a developmental period of significant risk for anxiety, depressive symptoms, and suicidality, and the investigators propose to target key peer-based risk and protective factors using Cooperative Learning (CL). CL is a small-group instructional approach that can enhance peer relations and reduce peer-related risks, as well as promote academic engagement and achievement and reduce racial disparities. CL will be delivered with the aid of technology that automates the design and delivery of CL lessons, promoting rapid implementation, scalability, high fidelity, accessibility, and sustainability.
Detailed description
Internalizing symptoms (i.e., anxiety, depressive symptoms, suicidality) are alarmingly common among adolescents. In 2019, nearly 37% of high school students reported feeling anxious, sad, or hopeless, representing an increase from 2017 (i.e., 31%), and nearly 19% seriously considered suicide, an increase from 2017 (17%). The coronavirus pandemic has exacerbated this problem, with research finding that social isolation resulting from the pandemic was linked to higher levels of stress, fear, loneliness, anxiety, depression, and suicide ideation among adolescents. Importantly, ethnic/racial disparities have been documented in internalizing symptoms, with more negative outcomes for Latinas and Black males. Current universal school-based approaches to prevention have reported uneven or limited effects, or no effects at all. Questions have also been raised regarding cost and accessibility. Despite the uneven track record of universal school-based (Tier 1) approaches, which has led some to recommend an emphasis on targeted (Tier 2) approaches, Tier 1 programs possess several advantages. First, given the demographic heterogeneity in risk factors, as well as disparate access to high-quality, culturally-sensitive health care, schools remain attractive as Tier 1 programs can ensure equitable access to primary prevention services. Second, universal programs avoid the difficulty of identifying adolescents at risk, and third, Tier 1 programs minimize the risk of stigmatizing adolescents who seek out or are referred to services. In this project, submitted to the Transformative Research Award initiative, the investigators will use cooperative learning (CL) as a universal (Tier 1) school-based prevention program to target malleable peer-based risk factors and subsequently evaluate how change in these mechanisms can reduce adolescent internalizing symptoms. CL targets various forms of maladaptive peer relations that create stress and comprise a significant risk factor for internalizing symptoms in adolescence; CL also promotes peer protective factors that can reduce the likelihood of internalizing symptoms (e.g., peer acceptance). CL has also been found to promote more cross-race interaction and interracial attraction, greater cross-ethnic academic support, and more frequent cross-ethnic friendships. To support teachers in implementing CL, the investigators will use a Web-based software platform that provides an accessible, high-fidelity mechanism to deliver CL lessons. The investigators will not only test for intervention effects, but will also evaluate the relative strength of specific, theoretically-derived change mechanisms, and uncover key issues/barriers related to implementation that will allow the investigators to dynamically adjust our implementation approach to achieve maximum impact during subsequent scale-up. This project is designed to establish feasibility with teachers and schools and counter potential threats to implementation fidelity while also creating a roadmap to enhanced scalability and sustained implementation. Significant results from this project could inspire broad uptake of this approach in educational contexts, potentially addressing a significant public health need during a time of crisis due to the coronavirus pandemic.
Interventions
BEHAVIORALPeerLearning.net
PeerLearning.net provides an easy-to-use, scalable, and widely accessible means to support teachers in effectively designing and delivering high-fidelity Cooperative Learning (CL) lessons and, in turn, it has the potential to amplify the positive effects of CL found in previous research. Using PeerLearning.net, teachers design their lesson by selecting from among a set of typical CL lesson templates (e.g., jigsaw, peer tutoring, group projects) which they can customize and populate with their own curriculum and materials. These design templates represent the optimal, high-fidelity design that is required in order for CL to be successful. During lesson delivery, PeerLearning.net manages membership in learning groups, distributes instructional materials, directs student activities according to a pre-specified timetable, supports teacher observations of student behavior, and delivers post-lesson group activities and reviews.
Sponsors
Arizona State University
University of Wisconsin, Madison
Oregon Research Institute
University of Oregon
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Investigators will allocate 20 high schools to intervention vs. control groups. Investigators will recruit in two cohorts (Fall 2023 and Fall 2024). Students will be in 9th grade in the first year, and will be followed into 10th, 11th, and then 12th grade, so in total the investigators will be working in each school for four years.
Eligibility
Sex/Gender
ALL
Age
14 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* All students and teachers in target grades in participating schools.
Exclusion criteria
* None.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Generalized Anxiety Disorder 7 | Fall of Year 1 | Anxiety (scores zero to 3, higher scores imply worse outcome) |
| Patient Health Questionnaire | Fall of Year 1 | Depressive symptoms (scores zero to 3, higher scores imply worse outcome) |
| Youth Risk and Behavior Survey | Fall of Year 1 | Suicide ideation (scores zero to 6, higher scores imply worse outcome) |
| Service Assessment for Children and Adolescents | Fall of Year 1 | Service utilization (scores zero to 20, higher scores imply worse outcome) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Substance use | Fall of Year 1 | Use of tobacco, alcohol, and marijuana (scores 1 to 5, lower scores imply better outcome) |
| Adolescent Stress Questionnaire | Fall of Year 1 | Social stress (scores 1 to 5, higher scores imply worse outcome) |
| Classroom Life Scale | Fall of Year 1 | Peer academic support (scores 1 to 5, higher scores imply better outcome) |
| Everyday Discrimination Scale | Fall of Year 1 | Discrimination (scores zero to 4, higher scores imply worse outcome) |
| Reasons for Non-Attendance | Fall of Year 1 | Social issues causing non-attendance (scores 0 to 4, lower scores imply better outcome) |
| UCLA Loneliness Scale | Fall of Year 1 | Loneliness (scores 1 to 3, lower scores imply better outcome) |
| Secondary School Readiness Inventory | Fall of Year 1 | School engagement (scores 1 to 5, higher scores imply better outcome) |
| School Attendance | Fall of Year 1 | Degree of truancy (scores 0 to 4, lower scores imply better outcome) |
| University of Illinois Bully Scale | Fall of Year 1 | Bullying and victimization (scores 1 to 5, higher scores imply worse outcome) |
| Child Peer Social Skills Scale | Fall of Year 1 | Peer acceptance (scores 1 to 5, higher scores imply better outcome) |
| Perceived Stress Scale | Fall of Year 1 | Stress (scores 0 to 4, higher scores imply worse outcome) |
Countries
United States
Outcome results
None listed