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. 2021 Jun 12:12:100178.
doi: 10.1016/j.lanwpc.2021.100178. eCollection 2021 Jul.

A cluster randomised controlled trial of a web-based youth mental health service in Australian schools

Bridianne O'Dea  1   2 , Mirjana Subotic-Kerry  1 , Catherine King  1 , Andrew J Mackinnon  1 , Melinda R Achilles  1 , Melissa Anderson  1 , Belinda Parker  1 , Aliza Werner-Seidler  1   2 , Michelle Torok  1   2 , Nicole Cockayne  1   2 , Simon T E Baker  1 , Helen Christensen  1   2
Affiliations

A cluster randomised controlled trial of a web-based youth mental health service in Australian schools

Bridianne O'Dea et al. Lancet Reg Health West Pac. .

Abstract

Background: Secondary schools have attempted to address gaps in help-seeking for mental health problems with little success. This trial evaluated the effectiveness of a universal web-based service (Smooth Sailing) for improving help-seeking intentions for mental health problems and other related outcomes among students.

Methods: A cluster randomised controlled trial was conducted to evaluate the 12-week outcomes of the Smooth Sailing service among 1841 students from 22 secondary schools in New South Wales, Australia. Assignment was conducted at the school level. The control condition received school-as-usual. The primary outcome was help-seeking intentions for general mental health problems at 12-weeks post-baseline. Secondary outcomes included help-seeking behaviour, anxiety and depressive symptoms, psychological distress, psychological barriers to help-seeking, and mental health literacy. Data were analysed using mixed linear models. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224).

Findings: At 12-weeks post-baseline, there was a marginal statistical difference in the relative means of help-seeking intentions (effect size=0•10, 95%CI: -0•02-0•21) that favoured the intervention condition. Help-seeking from adults declined in both conditions. There was a greater reduction in the number of students who "needed support for their mental health but were not seeking help" in the intervention condition (OR: 2•08, 95%CI: 1•72-2.27, P<•0001). No other universal effects were found. Participants found the service easy to use and understand; However, low motivation, time, forgetfulness, and lack of perceived need were barriers to use.

Interpretation: Smooth Sailing led to small improvements in help-seeking intentions. Refinements are needed to improve its effectiveness on other mental health outcomes and to increase student uptake and engagement.

Funding: HSBC and Graf Foundation.

Keywords: Anxiety; Depression; School; Stepped care; Web-based.

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Conflict of interest statement

Dr O'Dea and Professor Helen Christensen reports philanthropic non-competitive research grants from HSBC and the Graf Foundation during the conduct of the trial. Dr O'Dea reports speaker fees and travel reimbursements from the New South Wales and Queensland Departments of Education, paid to the Black Dog Institute for educational training seminars, that were outside the submitted work. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Smooth Sailing: Application of Rickwood and colleagues’ theory of help-seeking for mental health problems in youth.
Figure 2
Figure 2
The Smooth Sailing service model: Step criteria and care provided.
Figure 3
Figure 3
CONSORT flowchart for participation, withdrawals, and attrition.
See this image and copyright information in PMC

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