Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
National Suicide Research Foundation, Cork, Ireland.
BMC Public Health. 2023 Feb 1;23(1):219. doi: 10.1186/s12889-023-15107-x.
Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up.
The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling.
At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention.
This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.
精神病性体验（PEs）与日后精神障碍的风险增加有关，因此在预防研究中可能具有重要价值。然而，迄今为止，很少有干预研究检查过 PEs。鉴于这种证据不足，在当前的研究中，对一项基于 3 所学校的干预措施以减少自杀行为的集群随机对照试验（RCT）进行了二次数据分析，以调查这些措施是否可以降低 3 个月和 1 年随访时 PEs 的发生率并预防 PEs。
欧洲拯救和增强年轻人生命研究的爱尔兰站点，试验注册（DRKS00000214），这是一项集群 RCT，旨在研究基于学校的干预措施对自杀思想和行为的影响。17 所学校（n=1096）被随机分配到 3 个干预组或对照组之一。这些干预措施包括教师培训（守门员）干预、互动式教育（普遍教育）干预和筛查与综合转诊（选择性指示）干预。本次二次数据分析的主要结果是在 12 个月时降低 PEs 的点患病率。进行了排除基线时患有 PEs 的参与者的第二次分析，以检查 PEs 的预防情况。还对每个干预组的抑郁和焦虑评分变化（比较有无 PEs 的参与者）进行了分析。使用混合效应模型进行统计分析。
在 12 个月时，与对照组相比，筛查和转诊干预与 PEs 的显著减少相关（OR：0.12，95%CI[0.02-0.62]）。教师培训和教育干预没有显示出这种效果。仅在筛查和转诊组观察到预防效果（OR：0.30，95%CI[0.09-0.97]）。与没有 PEs 的参与者相比，患有 PEs 的参与者表现出更高水平的抑郁和焦虑症状，并且对筛查和转诊干预与普遍教育干预的反应不同。
本研究首次提供了基于学校的干预措施可以减少和预防青少年精神病性体验的证据。这种干预措施是学校为精神病理学进行筛查和随后的转介干预的结合，显著降低了青少年的 PEs。尽管还需要进一步的研究，但我们的发现指出了基于学校的计划预防未来心理健康问题的有效性。
