School-based CBT program reduces depression, suicidality




Emotionally distressed Canadian students who completed a school-based cognitive-behavioral therapy program experienced significant improvements in depression and suicidality, according to a multicenter prospective study published in PLoS One.

At the end of the pilot program entitled Empowering a Multimodal Pathway Toward Healthy Youth (EMPATHY), the number of students who were actively suicidal fell by 73%, and depression scores dropped by about 15% across all schools and age groups, Dr. Peter Silverstone, a professor of psychiatry at the University of Alberta, Edmonton, said in an interview.

Depressive disorders affect at least 10% of U.S. young people, and about 8% who live in the United States attempt suicide each year, according to the Centers for Disease Control and Prevention. To explore solutions, Dr. Silverstone and his associates used tablets loaded with a specially designed software “app” to screen 3,244 Canadian students aged 11-18 years (6th-12th grades). The students attended the five middle schools and high schools in a single Alberta school district, and the screen incorporated questions from several short, free mental health scales (PLoS One 2015 [doi:10.1371/journal.pone.0125527]).

Trained staff then interviewed students who were assessed as actively suicidal and met with them and their parents in order to create a safety plan, make referrals to appropriate health services, and invite students to participate in the guided Internet cognitive behavioral therapy (CBT) program. Students who scored in the top 10% of a combined measure of depression, anxiety, and low self-esteem also were invited to participate in the CBT program, and an eight-session version of the program was deployed for all seventh and eighth graders.

Among 503 high-risk students who were offered the CBT program, 151 (30%) enrolled, and 90% completed the program.

Parents and students had only a week to sign and return the consent forms, which led to the low participation rate in the pilot phase of the study, Dr. Silverstone noted. “We changed the processes after the pilot and got much higher acceptance rates, nearer to 70% percent.”

At 12-week follow-up, program participants had significantly improved from baseline, compared with nonparticipants in terms of the combined mental health, depression, anxiety, self-esteem, and quality of life scales, but not in terms of self-reported use of drugs, alcohol, or tobacco, the investigators reported.

Of the 104 actively suicidal students at baseline who completed both assessments, 76 (73%) were in the no-risk group at 12 weeks, a significant difference.

The results are promising, but their durability remains unclear, as other studies have reported strong short-term results that did not hold several years later, the investigators noted.

“All staff hired in the schools to implement the program had to have some experience working with youth, and many had an undergraduate degree,” the investigators added. “However, it is important to note that they were specifically not highly trained individuals (such as psychologists or teachers), as it was felt that it would not be feasible for widespread expansion if such highly trained (and expensive) staff were required.”

“We have follow-up data for 15 months, until the end of June 2015, that we hope to be able to start analyzing before the end of the year,” Dr. Silverstone said. But in the meantime, the new provincial government has cut the program’s funding, which he called a “major disappointment. We have had to abandon all further plans for the program,” he said, adding that it will terminate at the end of 2015.

Alberta Health Services funded the study. The researchers declared having no relevant competing interests.

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