JMIR Publications

ABSTRACT

Background:

Mental disorders are the leading cause of disease burden among youth. Effective prevention during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders such as depression and anxiety.

Objective:

The current study reports the adaption process of an established universal, school-based prevention program for depression and anxiety, “OurFutures Mental Health”. Using a four-stage process triangulating quantitative, qualitative, and evidence syntheses, centring the voices of young people, the revised program is trauma-informed, LGBTQA+ affirmative, relevant to contemporary youth, and designed to tailor intervention dosage to those who need it most (proportionate universalism).

Methods:

Program adaptation occurred from April 2022 to July 2023 and involved four stages. Stage 1 comprised mixed-methods analysis of student evaluation data (N = 762, Mage = 13.5) collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of three focus groups with high school students (N= 39), regular meetings with a purpose-built, eight-member LGBTQA+ Youth Advisory Committee, and two individual semi-structured, in-depth interviews with LGBTQA+ young people via Zoom/WhatsApp text. Stage 3 involved a clinical psychologist providing in-depth review of all program materials with the view to enhancing readability, improving utility, and normalising emotions, while retaining key cognitive behavioural therapy elements. Lastly, Stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health.

Results:

Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers sourced from Stages 1 through 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualised program content, classroom activities, weekly student, and teacher lesson summaries.

Conclusions:

The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program, aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings of universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster RCT with up to 1,400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate of universal school-based prevention of common mental disorders, and ultimately, improve the mental health and well-being of young people in schools.