Department of Psychology, University of Roehampton, London, UK.
Department of Psychology, University of Roehampton, London, UK.
Lancet Child Adolesc Health. 2021 Mar;5(3):178-189. doi: 10.1016/S2352-4642(20)30363-1. Epub 2021 Jan 21.
About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in England, UK.
We did a two-arm, individually randomised trial in 18 secondary state-funded schools across the Greater London area of the UK. Participants were randomly assigned (1:1) using a centrally secure randomisation procedure with random permuted blocks to either SBHC plus schools' pastoral care as usual (PCAU), or PCAU alone. Participants were pupils aged 13-16 years who had moderate-to-severe levels of emotional symptoms (measured by a score of ≥5 on the Strengths and Difficulties Questionnaire Emotional Symptoms scale) and were assessed as competent to consent to participate in the trial. Participants, providers, and assessors (who initially assessed and enrolled participants) were not masked but testers (who measured outcomes) were masked to treatment allocation. The primary outcome was psychological distress at 12 weeks (Young Person's Clinical Outcomes in Routine Evaluation measure [YP-CORE]; range 0-40), analysed on an intention-to-treat basis (with missing data imputed). Costs were assessed at 24 weeks (Client Service Receipt Inventory and service logs). The trial was registered with ISRCTN, number ISRCTN10460622.
329 participants were recruited between Sept 29, 2016, and Feb 8, 2018, with 167 (51%) randomly assigned to SBHC plus PCAU and 162 (49%) to PCAU. 315 (96%) of 329 participants provided data at 12 weeks and scores were imputed for 14 participants (4%). At baseline, the mean YP-CORE scores were 20·86 (SD 6·38) for the SBHC plus PCAU group and 20·98 (6·41) for the PCAU group. Mean YP-CORE scores at 12 weeks were 16·41 (SD 7·59) for the SBHC plus PCAU group and 18·34 (7·84) for the PCAU group (difference 1·87, 95% CI 0·37-3·36; p=0·015), with a small effect size (0·25, 0·03-0·47). Overall costs at 24 weeks were £995·20 (SD 769·86) per pupil for the SBHC plus PCAU group and £612·89 (1224·56) for the PCAU group (unadjusted difference £382·31, 95% CI £148·18-616·44; p=0·0015). The probability of SBHC being more cost-effective reached 80% at a willingness to pay of £390 for a 1-point improvement on the YP-CORE. Five serious adverse events occurred for four participants in the SBHC plus PCAU group, all involving suicidal intent. Two serious adverse events occurred for two participants in the PCAU group, one involving suicidal intent.
The addition of SBHC to PCAU leads to small reductions in psychological distress, but at an additional economic cost. SBHC is a viable treatment option but there is a need for equally rigorous evaluation of alternative interventions.
This work was supported by the Economic and Social Research Council (grant reference ES/M011933/1).
在英国，大约七分之一的青少年患有精神健康障碍。学校咨询是试图解决此类问题的最常见方法之一。我们旨在确定基于学校的人文咨询（SBHC）对英国年轻人心理困扰的治疗效果和成本效益。
我们在英国大伦敦地区的 18 所中学进行了一项双臂、个体随机试验。参与者使用中央安全随机化程序，按照随机排列的块进行 1:1 随机分组，分别接受 SBHC 加学校常规照顾（PCAU）或仅 PCAU。参与者为年龄在 13-16 岁之间、情绪症状中度至重度（通过 Strengths and Difficulties Questionnaire Emotional Symptoms scale 得分≥5 衡量）、被评估为有能力同意参加试验的学生。参与者、提供者和评估者（最初评估和招募参与者）未进行盲法，但测试者（评估结果）进行了盲法。主要结局是 12 周时的心理困扰（年轻人临床结果常规评估量表 [YP-CORE]；范围 0-40），采用意向治疗进行分析（缺失数据用插补法）。在 24 周时评估成本（客户服务收据清单和服务记录）。该试验在 ISRCTN 注册，编号为 ISRCTN10460622。
2016 年 9 月 29 日至 2018 年 2 月 8 日期间共招募了 329 名参与者，其中 167 名（51%）被随机分配到 SBHC 加 PCAU 组，162 名（49%）被分配到 PCAU 组。329 名参与者中有 315 名（96%）在 12 周时提供了数据，14 名参与者的数据（4%）用插补法。在基线时，SBHC 加 PCAU 组的 YP-CORE 平均得分为 20.86（标准差 6.38），PCAU 组为 20.98（6.41）。SBHC 加 PCAU 组 12 周时的平均 YP-CORE 得分为 16.41（标准差 7.59），PCAU 组为 18.34（标准差 7.84）（差异 1.87，95%CI 0.37-3.36；p=0.015），效果较小（0.25，0.03-0.47）。24 周时的总费用为 SBHC 加 PCAU 组每名学生 995.20 英镑（标准差 769.86），PCAU 组为 612.89 英镑（1224.56 英镑）（未调整差异 382.31 英镑，95%CI 148.18-616.44 英镑；p=0.0015）。在愿意支付 390 英镑以提高 YP-CORE 1 分的情况下，SBHC 更具成本效益的概率达到 80%。SBHC 加 PCAU 组有 4 名参与者发生 5 起严重不良事件，均涉及自杀意念。PCAU 组有 2 名参与者发生 2 起严重不良事件，其中 1 起涉及自杀意念。
SBHC 加 PCAU 可导致心理困扰略有减轻，但成本增加。SBHC 是一种可行的治疗选择，但需要对替代干预措施进行同样严格的评估。
这项工作得到了经济和社会研究委员会（grant reference ES/M011933/1）的支持。
