Adolescents, Anxiety, Depression, Health Knowledge, Health Literacy, Mental Health, Parents, Resilience, School Intervention
Conditions
Brief summary
The INSPIRE (Integrated Network for Student Psychosocial Intervention, Resilience, and Education) intervention is an 8-week, school-based mental health program designed to enhance adolescents' mental health literacy and resilience while addressing symptoms of depression and anxiety. Implementation is conducted by school counselors who undergo an intensive two-day training program. The intervention is supported by comprehensive curriculum materials including detailed lesson plans, activities, discussion prompts, and instructional slides featuring key concepts, visuals, and explanatory content. Supplementary materials are developed for both participating adolescents and their parents. The study aims to: 1. Evaluate the usability and feasibility of the INSPIRE intervention within the school environment. 2. Assess the intervention's effectiveness in improving: * Primary outcome: Mental health knowledge among adolescents * Secondary outcomes: Attitudes toward mental health, help-seeking behaviors, mental health literacy, resilience, and symptoms of depression and anxiety among adolescents * Secondary outcomes: mental health knowledge, attitudes, help-seeking behaviors, and mental health literacy among parents 3. Explore the experiences of intervention participants (both adolescents and parents) against the control group to develop comprehensive insights into the psychosocial intervention's impact. The research hypothesis proposes that the INSPIRE intervention group will demonstrate significantly higher scores in mental health knowledge, more positive attitudes toward mental health, increased help-seeking behaviors, enhanced mental health literacy, and greater resilience, while simultaneously showing reduced symptoms of depression and anxiety compared to the control group receiving standard care. These outcomes will be measured immediately following the intervention (post-test 1) and at one-month follow-up (post-test 2).
Detailed description
Pilot Study The pilot study was conducted as a two-centre, two-arm cluster randomised controlled trial with a pre-test-post-test design and a 1:1 allocation ratio. Randomisation was performed at the school (cluster) level to minimise contamination. The pilot phase was implemented from 28 April to July 2025. Randomised Controlled Trial (RCT) The full-scale randomised controlled trial expanded to a multi-centre design involving five centres, maintaining a two-arm cluster randomised structure with school-level allocation. The trial was conducted in two phases. Phase 1 randomised two schools (School 1 and School 2), with one allocated to the control group and the other to the intervention group. Phase 2 randomised three additional schools (Schools 3, 4, and 5) with a 1:2 allocation ratio (one to control, two to intervention) to address recruitment shortfalls. The RCT commenced in September 2025. Participant recruitment and baseline data collection occurred between 12 September and 21 November 2025. Follow-up for primary and secondary outcomes was completed on 27 March 2026. Process Evaluation Process evaluation was conducted from 18 December 2025 to 7 April 2026.
Interventions
BEHAVIORALINSPIRE (Integrated Network for Student Psychosocial Intervention, Resilience, and Education)
The INSPIRE intervention is an 8-week school-based program aimed at enhancing adolescent mental health, attitudes towards mental health and help-seeking behaviors, mental health literacy, resilience and addressing depression and anxiety. Trained school counsellors deliver this structured curriculum using comprehensive materials including lesson plans, activities, and visual aids. the program provides supplementary resources for both participating students and their parents .
Sponsors
National University of Singapore
Indonesia Endowment Fund for Education (LPDP), Republic of Indonesia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Two-group parallel-armed randomized controlled trial (RCT) with a pretest and repeated posttest experimental design. Sample size was determined via power analyses informed by three adolescent mental health intervention studies (Casañas et al., 2022; Kaligis et al., 2023; Liddle et al., 2021). Reported effects ranged from small-to-medium (d = 0.26; Liddle) to medium-to-large (d = 0.64; Kaligis), with Casañas reporting 0.382-0.705. To ensure conservative estimates, calculations used the smallest effect (d = 0.26). A two-tailed test (α = 0.05, power = 0.80) indicated 230 participants per arm. Adjusting for 32% attrition, the final target sample size was set at 340 per arm (N = 680).
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Participants were initially restricted to students aged 13-15 years. However, the inclusion criteria in the RCT were subsequently broadened to encompass all junior high school students (grades 7-9) to ensure adequate recruitment and representativeness. Eligible students were required to be able to read, understand, and converse in Bahasa Indonesia. The inclusion criteria for parents are as follows: * The biological father, mother, or an adult who fulfils a parental or guardian role for the participating adolescent * Able to understand and communicate in Bahasa Indonesia.
Exclusion criteria
* Adolescents who are working, clinically diagnosed with severe mental disorders, such as schizophrenia or psychosis, at high risk for mental health disorders (e.g., teenage pregnancy), or are cognitively impaired will be excluded. * Parents with severe mental disorders or cognitive impairment that may hinder participation will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adolescents' mental health knowledge | Immediately following the intervention (post-test 1) | 13-item mental health knowledge scale. Total scores range from 0 to 13, with higher scores indicating better mental health knowledge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adolescents' attitudes towards mental health | immediately following the intervention (post-test 1) | 12-item attitude toward mental health scale. Scores range from 12 to 60, with higher scores indicating more positive attitudes. |
| Adolescents' attitudes toward help-seeking behaviors | Immediately following the intervention (post-test 1) | 5-item attitude toward mental help-seeking behaviors questionnaire. Scores range from 5 to 15, with higher scores indicating more positive attitudes toward help-seeking behaviors. |
| Adolescents' mental health literacy | Immediately following the intervention (post-test 1) | the 50-item Knowledge and Attitudes to Mental Health Scales, with total scores ranging from 0 to 200. Higher scores indicated higher mental health literacy. |
| Adolescents' resilience | Immediately following the intervention (post-test 1) | the nine-item resilience evaluation scale, with the total scores ranging from 0 to 36. Higher scores indicated higher psychological resilience. |
| Adolescents' depression | Immediately following the intervention (post-test 1) | the nine-item Patient Health Questionnaire, with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptoms. |
| Adolescents' anxiety | Immediately following the intervention (post-test 1) | the 7-item Generalized Anxiety Disorder scale, with total scores ranging from 0 to 21. Higher scores indicate more severe anxiety symptoms. |
| Parents' mental health knowledge | Immediately following the intervention (post-test 1) | 13-item mental health knowledge scale. Total scores range from 0 to 13, with higher scores indicating better mental health knowledge. |
| Parents' attitudes towards mental health | immediately following the intervention (post-test 1) | 12-item attitude toward mental health scale. Scores range from 12 to 60, with higher scores indicating more positive attitudes. |
| Parents' attitudes toward help-seeking behaviors | Immediately following the intervention (post-test 1) | 5-item attitude toward mental help-seeking behaviors questionnaire. Scores range from 5 to 15, with higher scores indicating more positive attitudes toward help-seeking behaviors. |
| Parents' mental health literacy | Immediately following the intervention (post-test 1) | The 16-item Mental Health Literacy Questionnaire, with total scores ranging from 16 to 80. Higher scores indicated higher mental health literacy. |
Countries
Indonesia
Outcome results
None listed