School Intervention to Improve Mental Health of Students in Santiago, Chile: A Randomized Clinical Trial | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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Original Investigation
November 2013

School Intervention to Improve Mental Health of Students in Santiago, Chile: A Randomized Clinical Trial

Author Affiliations
  • 1School of Social and Community Medicine, University of Bristol, Bristol, England
  • 2Departamento de Psiquiatría, Hospital Clínico, Universidad de Chile, Santiago, Chile
  • 3Departamento de Psiquiatría, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
  • 4Escuela de Piscología, Universidad de Los Andes, Santiago, Chile
  • 5Department for Health, University of Bath, Bath, England
  • 6Bristol Randomized Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, and Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, England
JAMA Pediatr. 2013;167(11):1004-1010. doi:10.1001/jamapediatrics.2013.2361

Importance  Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries.

Objective  To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families.

Design, Setting, and Participants  A 2-arm, parallel, cluster, randomized clinical trial was conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated.

Interventions  Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum.

Main Outcomes and Measures  Scores on the self-administered Beck Depression Inventory–II at 3 months (primary) and 12 months (secondary) after completing the intervention.

Results  There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1% of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, −0.19; 95% CI, −1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months.

Conclusions and Relevance  A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms.

Trial Registration Identifier: ISRCTN19466209