Reducing depression in 9–10 year old children in low SES schools: A longitudinal universal randomized controlled trial

Abstract

The Aussie Optimism: Positive Thinking Skills Program (AOP-PTS) is an innovative curriculum-based mental health promotion program based on cognitive and behavioural strategies. The program is aimed at preventing depressive and anxiety symptoms and disorders in middle primary school children aged 9-10 years. Students from 22 low SES primary schools (N = 910) were randomly assigned to an intervention or a control group and assessed at baseline, post-test, 6 months and 18 months. The intervention group received the program implemented by teachers and the control group received their regular Health Education curriculum. Students completed questionnaires on depression, anxiety, and attribution style. At risk students were further assessed with the computerised Diagnostic Interview for Children and Adolescents. Parents reported on their children's externalising and internalising problems at home. Children in the intervention condition reported a significant pre-post reduction in depressive symptoms, and there was a significant pre-post reduction in parent-reported emotional difficulties which was maintained at 6 month follow-up; no changes were evident in the control group. Both groups showed significant improvements in child-reported anxiety and attribution style, and significant improvements in parent-reported pro-social behaviours. For both groups, there were no significant post-baseline changes in incidence and recovery rates for depression, anxiety, or internalising symptoms. These findings suggest that AOP-PTS has the potential to treat depressive symptomatology in the immediate term but the effects were not sustained. There is also evidence of improved emotional resilience up to 6 months following the program. Further follow-up to investigate longer term effects is needed.

Prevention of depression and anxiety symptoms in adolescents: 42 and 54 months follow-up of the Aussie Optimism Program-Positive Thinking Skills

“…In a small randomized controlled trial (pilot study), delivered by psychologists, Rooney et al (2006) found the AOP-PTS was associated with significant reductions in depressive symptoms and more positive attributions at post-test, as well as fewer depressive disorders at 9 month follow-up. Further, a larger randomized control study (Rooney et al, 2013), involving 22 low SES primary schools in the Perth metropolitan region, supported the earlier findings. In this larger trial, the program was delivered by teachers to year 4 and 5 children.…”

“…Due to attrition, the sample sizes for data collected at 42 and 54 months was 190 and 180 respectively. Child gender was not reported by 27 (14%) and 34 (19%) cases at 42 and 54 month follow-up, respectively; however, as earlier reports of this intervention (up to 18 month follow-up) found no significant gender by group by time interaction (Rooney et al, 2013), gender was not expected to impact on the 42 and 54 month follow-up results. Whilst the previous study also obtained clinical diagnoses for children at or beyond clinical cut-off on symptom measures, such information was not collected for the current study due to lower numbers.…”

“…Although the cognitive aspect of the program may be too complex, children who received the intervention did demonstrate a benefit at post-intervention, 6 and 30 months follow-up (Rooney et al, 2013; Morrison et al, 2013), suggesting they were able to benefit from the program in the short and medium term. However, the single 10 week delivery of the program may have been insufficient to develop and consolidate learning to enable children to continue utilizing the skills for the longer term.…”

“…The 10-week AOP-PTS program was delivered to 8–9 year old children in years 4–5 of primary school, with follow-up assessment of internalizing symptoms and attributional styles conducted at 42 and 54 months post intervention. Data were also collected at 6 and 18 and 30 months post-intervention (Rooney et al, 2013; Morrison et al, 2013). Of these previous studies, the AOP-PTS program was found to be associated with reduced in depression symptoms at post-test, emotional difficulties at 6 months post-intervention but not at 18 months follow-up, and less hyperactive at 30 months follow-up (Morrison et al, 2013; Rooney et al, 2013).…”

Comments on Hankin BL. Adolescent depression: Description, causes, and interventions. Epilepsy & Behavior 2006;8:102-114

“…However, the findings of large-scale prevention studies in schools using group CBT [57], bibliotherapy [57,58], group CBT focused on positive thinking [59], and social skills training [60] have not been promising. Supporting the importance of parenting and the family environment, a recent program to improve resiliency skills and positive school support successfully reduced depressive and anxiety symptoms only in youth who experienced poor family support [61].…”