The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
Lancet Digit Health. 2020 Feb;2(2):e74-e84. doi: 10.1016/S2589-7500(19)30213-4. Epub 2020 Jan 3.
Substance use, depression, and anxiety in adolescence are major public health problems requiring new scalable prevention strategies. We aimed to assess the effectiveness of a combined online universal (ie, delivered to all pupils) school-based preventive intervention targeting substance use, depression, and anxiety in adolescence.
We did a multicentre, cluster-randomised controlled trial in secondary schools in Australia, with pupils in year 8 or 9 (aged 13-14 years). Participating schools were randomly assigned (1:1:1:1) to one of four intervention conditions: (1) Climate Schools-Substance Use, focusing on substance use only; (2) Climate Schools-Mental Health, focusing on depression and anxiety only; (3) Climate Schools-Combined, focusing on the prevention of substance use, depression, and anxiety; or (4) active control. The interventions were delivered in school classrooms in an online delivery format and used a mixture of peer cartoon storyboards and classroom activities that were focused on alcohol, cannabis, anxiety, and depression. The interventions were delivered for 2 years and primary outcomes were knowledge related to alcohol, cannabis, and mental health; alcohol use, including heavy episodic drinking; and depression and anxiety symptoms at 12, 24, and 30 months after baseline. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000723785) and an extended follow-up is underway.
Between Sept 1, 2013, and Feb 28, 2014, we recruited 88 schools (12 391 pupils), of whom 71 schools and 6386 (51·5%) pupils were analysed (17 schools dropped out and 1308 pupils declined to participate). We allocated 18 schools (1739 [27·25%] pupils; 1690 [97·2%] completed at least one follow-up) to the substance use condition, 18 schools (1594 [25·0%] pupils; 1560 [97·9%] completed at least one follow-up) to the mental health condition, 16 schools (1497 [23·4%] pupils; 1443 [96·4%] completed at least one follow-up) to the combined condition, and 19 schools (1556 [23·4%] pupils; 1513 [97·2%] completed at least one follow-up) to the control condition. Compared with controls, the combined intervention group had increased knowledge related to alcohol and cannabis at 12, 24, and 30 months (standardised mean difference [SMD] for alcohol 0·26 [95% CI 0·14 to 0·39] and for cannabis 0·17 [0·06 to 0·28] at 30 months), increased knowledge related to mental health at 24 months (0·17 [0·08 to 0·27]), reduced growth in their odds of drinking and heavy episodic drinking at 12, 24, and 30 months (odds ratio for drinking 0·25 [95% CI 0·12 to 0·51], and for heavy episodic drinking 0·15 [0·04 to 0·58] at 30 months), and reduced increases in anxiety symptoms at 12 and 30 months (SMD -0·12 [95% CI -0·22 to -0·01] at 30 months). We found no difference in symptoms or probable diagnosis of depression. The combined intervention group also showed improvement in alcohol use outcomes compared with the substance use and mental health interventions and improvements in anxiety outcomes when compared with the mental health intervention only.
Combined online prevention of substance use, depression, and anxiety led to increased knowledge of alcohol, cannabis, and mental health, reduced increase in the odds of any drinking and heavy episodic drinking, and reduced symptoms of anxiety over a 30-month period. These findings provide the first evidence of the effectiveness of an online universal school-based preventive intervention targeting substance use, depression, and anxiety in adolescence.
Australian National Health and Medical Research Council.
青少年时期的物质使用、抑郁和焦虑是重大的公共卫生问题，需要新的可扩展的预防策略。我们旨在评估一种针对青少年物质使用、抑郁和焦虑的综合在线普遍（即向所有学生提供）学校预防干预措施的有效性。
我们在澳大利亚的中学进行了一项多中心、集群随机对照试验，参与者为 8 年级或 9 年级（年龄 13-14 岁）的学生。参与学校被随机分配（1:1:1:1）到以下四个干预条件之一：（1）气候学校-物质使用，仅关注物质使用；（2）气候学校-心理健康，仅关注抑郁和焦虑；（3）气候学校-综合，预防物质使用、抑郁和焦虑；或（4）积极对照。干预措施以在线形式在学校教室中进行，并使用了一系列针对酒精、大麻、焦虑和抑郁的同伴卡通故事板和课堂活动。干预措施持续进行了 2 年，主要结局是与酒精、大麻和心理健康相关的知识；酒精使用，包括重度饮酒；以及抑郁和焦虑症状，在基线后 12、24 和 30 个月进行评估。该试验在澳大利亚和新西兰临床试验注册中心（ACTRN12613000723785）注册，正在进行扩展随访。
在 2013 年 9 月 1 日至 2014 年 2 月 28 日期间，我们招募了 88 所学校（12391 名学生），其中 71 所学校和 6386 名（51.5%）学生进行了分析（17 所学校退出，1308 名学生拒绝参与）。我们将 18 所学校（1739 名学生[27.25%]；1690 名[97.2%]至少完成了一次随访）分配到物质使用组，18 所学校（1594 名学生[25.0%]；1560 名[97.9%]至少完成了一次随访）分配到心理健康组，16 所学校（1497 名学生[23.4%]；1443 名[96.4%]至少完成了一次随访）分配到综合组，19 所学校（1556 名学生[23.4%]；1513 名[97.2%]至少完成了一次随访）分配到对照组。与对照组相比，综合干预组在 12、24 和 30 个月时酒精和大麻相关知识增加（酒精标准平均差异[SMD]为 0.26 [95%CI 0.14 至 0.39]，大麻为 0.17 [0.06 至 0.28]，在 30 个月时），心理健康相关知识在 24 个月时增加（0.17 [0.08 至 0.27]），12、24 和 30 个月时饮酒和重度饮酒的发生率降低（饮酒比值比为 0.25 [95%CI 0.12 至 0.51]，重度饮酒比值比为 0.15 [0.04 至 0.58]，在 30 个月时），12 和 30 个月时焦虑症状增加减少（30 个月时 SMD 为-0.12 [95%CI -0.22 至 -0.01]）。我们没有发现抑郁症状或可能诊断的差异。与物质使用和心理健康干预相比，综合干预组在酒精使用结果方面也有所改善，与心理健康干预相比，焦虑结果也有所改善。
针对青少年物质使用、抑郁和焦虑的综合在线预防措施可提高对酒精、大麻和心理健康的认识，降低任何饮酒和重度饮酒的可能性，减少焦虑症状在 30 个月内的增长。这些发现为在线普遍的基于学校的预防干预措施针对青少年物质使用、抑郁和焦虑的有效性提供了首个证据。
澳大利亚国家卫生和医学研究理事会。
