Population Health Sciences, University of Bristol, Bristol, United Kingdom.
DECIPHer, School of Social Sciences, Cardiff University, Cardiff, United Kingdom.
PLoS Med. 2021 Nov 11;18(11):e1003847. doi: 10.1371/journal.pmed.1003847. eCollection 2021 Nov.
Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention.
The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was £9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures.
In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being.
www.isrctn.com ISRCTN95909211.
教师面临更高的心理健康和福祉风险，这可能会影响他们为学生提供的支持以及学生的成绩。我们进行了一项集群随机对照试验，以测试改善高中教师心理健康支持和培训的干预措施是否会改善教师和学生的心理健康和福祉，与常规做法相比。我们还对干预措施进行了成本评估。
该干预措施包括（i）针对支持学生的教师进行心理健康急救培训；（ii）心理健康意识课程；和（iii）机密的员工同行支持服务。在基线测量收集后，共有 25 所主流、非收费的中学按照地理位置和免费校餐资格进行分层，随机分配到干预组（n = 12）或对照组（n = 13）。我们使用混合效应重复测量模型对意向治疗人群进行了数据分析，调整了分层变量、性别和经验年限。主要结果是教师福祉（华威-爱丁堡心理健康量表）。次要结果是教师抑郁、缺勤和出勤、学生福祉、心理健康困难、出勤率和成绩。随访时间为 12 个月（T1）和 24 个月（T2）。我们收集了过程数据，以测试干预措施的逻辑模型，以帮助解释研究结果。共有 1722 名教师参与了主要分析。T2 时两组教师的福祉没有差异（干预组平均福祉得分 47.5，对照组平均福祉得分 48.4，调整平均差异-0.90，95%CI-2.07 至 0.27，p = 0.130）。唯一对次要结果有影响的是干预组教师报告的缺勤率较高，T2 时（干预组缺勤天数中位数 0，对照组缺勤天数中位数 0，几何均数比 1.04，95%CI 1.00 至 1.09，p = 0.042）。过程测量表明，对心理健康支持、关系质量和工作相关压力的感知几乎没有变化。干预的平均成本为每所学校 9103 英镑。该研究的主要局限性是研究参与者缺乏盲法和结果测量的自我报告性质。
在这项研究中，我们没有观察到干预措施对教师或学生的心理健康有任何改善，这可能是由于学校环境中对不良心理健康的关键驱动因素缺乏影响。未来的研究应侧重于学校环境的结构性和文化性变革，这可能更有效地改善教师和学生的心理健康和福祉。
www.isrctn.com ISRCTN95909211。
