Gaete Jorge, Martinez Vania, Fritsch Rosemarie, Rojas Graciela, Montgomery Alan A, Araya Ricardo
Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Departamento de Salud Pública y Epidemiología, Facultad de Medicina, Universidad de los Andes, Monseñor Álvaro del Portillo 12455, Las Condes, Santiago, Chile.
BMC Psychiatry. 2016 Aug 4;16:276. doi: 10.1186/s12888-016-0985-4.
Depression is a disabling condition affecting people of all ages, but generally starting during adolescence. Schools seem to be an excellent setting where preventive interventions may be delivered. This study aimed to test the effectiveness of an indicated school-based intervention to reduce depressive symptoms among at-risk adolescents from low-income families.
A two-arm, parallel, randomized controlled trial was conducted in 11 secondary schools in vulnerable socioeconomic areas in Santiago, Chile. High-risk students in year 10 (2° Medio) were invited to a baseline assessment (n = 1048). Those who scored ≥10 (boys) and ≥15 (girls) in the BDI-II were invited to the trial (n = 376). A total of 342 students consented and were randomly allocated into an intervention or a control arm in a ratio of 2:1. The intervention consisted of 8 group sessions of 45 min each, based on cognitive-behavioural models and delivered by two trained psychologists in the schools. Primary (BDI-II) and secondary outcomes (measures of anxiety, automatic thoughts and problem-solving skills) were administered before and at 3 months post intervention. The primary outcome was the recovery rate, defined as the proportion of participants who scored in the BDI-II <10 (among boys) and <15 (among girls) at 3 months after completing the intervention.
There were 229 participants in the intervention group and 113 in the control group. At 3-month follow-up 81.4 % in the intervention and 81.7 % in the control group provided outcome data. The recovery rate was 10 % higher in the intervention (50.3 %) than in the control (40.2 %) group; with an adjusted OR = 1.62 (95 % CI: 0.95 to 2.77) (p = 0.08). No difference between groups was found in any of the secondary outcomes. Secondary analyses revealed an interaction between group and baseline BDI-II score.
We found no clear evidence of the effectiveness of a brief, indicated school-based intervention based on cognitive-behavioural models on reducing depressive symptoms among Chilean adolescents from low-income families. More research is needed in order to find better solutions to prevent depression among adolescents.
Current Controlled Trials ISRCTN33871591 . Retrospectively registered 29 June 2011.
抑郁症是一种致残性疾病，影响各年龄段的人群，但通常始于青春期。学校似乎是开展预防性干预的理想场所。本研究旨在测试一种基于学校的针对性干预措施对降低低收入家庭中处于危险的青少年抑郁症状的有效性。
在智利圣地亚哥社会经济脆弱地区的11所中学进行了一项双臂、平行、随机对照试验。邀请10年级（相当于初中二年级）的高危学生进行基线评估（n = 1048）。贝克抑郁自评量表第二版（BDI-II）得分≥10（男生）和≥15（女生）的学生被邀请参加试验（n = 376）。共有342名学生同意并以2:1的比例随机分配到干预组或对照组。干预包括基于认知行为模型的8次小组课程，每次45分钟，由两名经过培训的心理学家在学校授课。在干预前和干预后3个月进行主要结局指标（BDI-II）和次要结局指标（焦虑、自动思维和解决问题能力的测量）评估。主要结局指标是康复率，定义为在完成干预3个月后BDI-II得分<10（男生）和<15（女生）的参与者比例。
干预组有229名参与者，对照组有113名。在3个月随访时，干预组81.4%和对照组81.7%提供了结局数据。干预组的康复率（50.3%）比对照组（40.2%）高10%；校正后的比值比为1.62（95%可信区间：0.95至2.77）（p = 0.08）。在任何次要结局指标上均未发现组间差异。二次分析显示组与基线BDI-II得分之间存在交互作用。
我们没有发现明确证据表明基于认知行为模型的简短、针对性的学校干预措施对降低智利低收入家庭青少年的抑郁症状有效。需要更多研究以找到预防青少年抑郁症的更好解决方案。
当前受控试验ISRCTN33871591。2011年6月29日追溯注册。
