Evaluating the long-term effectiveness of school-based intervention for anxiety and depression in older adolescents

Describe background to the work including that carried out in the supervisor's own team and previous work. [This information will be used by the reviewers to understand the context of the proposed study].
An overwhelming proportion of young people struggle with poor mental health, however, only a small proportion of them access services, indicating a large need gap. Unfortunately, help seeking in adolescents is hindered by common barriers such as limited provision of services, reluctance to seek help, and fear of being stigmatised. Furthermore, school-delivered mental health programs have only shown modest results and are mainly targeted at younger children.
DISCOVER, a brief cognitive-behavioural therapy (CBT)-based group workshop programme has been specially developed for 16-18-year-olds. It aims to be accessible, offer effective treatment and good reach as it is a group intervention. It is also more catered to young people's need for more practical, interactive and less time-intensive interventions. An initial pre-post pilot study showed that the school-based delivery of the DISCOVER workshop is acceptable, and registered improvement in reducing anxiety and depression symptoms at 12 weeks post-intervention21. A randomised controlled trial assessed the feasibility of delivering the DISCOVER Workshop in schools in South London30. 12.6% of students in the participating schools attended the DISCOVER Workshop. Out of these, 81% were female. The study registered high levels of uptake among "hard-to-reach" groups, with over half of students (57.4%) from BME and more than two thirds (69.7%) with no previous experience of formal mental health help-seeking. The trial also showed promising reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at 3 months follow-up.

This programme will be tested during a cluster randomized controlled trial, THE BESST trial, in 4 different areas of the UK (London, Bath, Manchester, Northampton) and will involve 60 schools and 900 students.The student will conduct a long-term follow up of thew BESST trial, at 12 months and 18 months post-intervention. At ages 17 to 19 years, the BESST trial cohort is will be entering emerging adulthood at 12 months follow-up. Emerging adulthood represents a challenging transition period characterized by numerous changes including new relationships and living arrangements, increased financial and social independence, and pursuit of employment and/or higher education. Despite strong and growing evidence that universal school-based preventative interventions can improve mental health symptoms during adolescence, there is scant evidence for their sustained effect into the critical period of emerging adulthood and their long-term impact is uncertain.

We want to see if the DISCOVER programme will reduce depression and anxiety symptoms compared the help normally offered in schools, and whether these changes will be sustained at long term follow-up, at 12- and 18-months post-intervention. We hope that if this study is successful, DISCOVER will be run by new school-based professionals.