Braund Taylor A, Baker Simon T E, Subotic-Kerry Mirjana, Tillman Gabriel, Evans Nathan J, Mackinnon Andrew, Christensen Helen, O'Dea Bridianne
Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.
Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
Child Adolesc Psychiatry Ment Health. 2024 Apr 2;18(1):46. doi: 10.1186/s13034-024-00734-y.
Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools.
A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models.
Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition.
The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821 .
焦虑症和抑郁症通常在青春期出现，如果不及早发现和治疗，可能会发展成慢性疾病并导致功能障碍。基于学校的普遍心理健康筛查可以识别出需要心理健康支持的年轻人，并促进他们获得治疗。然而，很少有研究评估这种方法的潜在危害。本文探讨了澳大利亚中学进行焦虑和抑郁普遍筛查所带来的一些与心理健康相关的潜在危害。
澳大利亚新南威尔士州22所中学的1802名青少年学生被整群随机分组（在学校层面），分别接受强化筛查程序（干预组）或轻度筛查程序（对照组）。强化筛查组的参与者接受有监督的基于网络的自我报告筛查问卷，以评估焦虑、抑郁和自杀倾向，并根据症状严重程度提供后续护理。轻度筛查组的参与者仅接受无监督的基于网络的焦虑和抑郁筛查，随后是关于寻求帮助的一般性建议。该组不提供其他护理。研究结果包括焦虑、抑郁、心理困扰风险增加，寻求帮助的风险降低，心理健康污名化风险增加，这些结果通过在基线、基线后6周和基线后12周评估的指标来确定。使用混合效应模型分析组间差异。
与轻度筛查组相比，强化筛查组的参与者在一系列潜在危害方面未受到不利影响。相反，与轻度筛查组相比，强化筛查组的参与者被发现抑制寻求帮助行为的风险降低。
相对于轻度筛查程序，强化筛查程序似乎并未对青少年的心理健康产生不利影响。未来的研究应探讨其他基于学校的方法，这些方法可能比普遍筛查更有效、更高效地减轻学生的心理健康负担。试验注册 澳大利亚和新西兰临床试验注册中心（ACTRN12618001539224）https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821 。
