Universal school‐based intervention targeting depressive symptoms in adolescents: A cluster randomized trial

Abstract

We investigated the effects of three different interventions on depressive symptoms in adolescents. As a secondary aim, we explored the mediating role of social isolation, anxiety, sleep quality, and cognitive function of the intervention effect on depressive symptoms. We conducted a cluster randomized controlled trial, in which schools were randomly assigned to 1. Doubling physical education (PE) classes (3:20 h of PE/week); 2. Workshop with the PE teachers; 3. Workshop with the PE teachers + Doubling PE classes; and 4. Control group (1:40 h of PE/week). In total, 1279 adolescents were included, 56.4% females. Doubling PE classes and the workshop with the PE teachers + Doubling PE classes groups did not affect depressive symptoms (−0.947, 95% CI −3.176 to 1.281; and, 0.726, 95% CI −1.558 to 3.009, respectively). The workshop with the PE teachers decreased adolescents' depressive symptoms (−2.495, 95% CI −4.668 to −0.323), social isolation (−4.759, 95% CI −9.025 to −0.493), and poor sleep quality (−0.560, 95% CI −1.108 to −0.012) compared with the control group. Social isolation mediated 32% of the workshop effect on depressive symptoms. The workshop with the PE teachers and the workshop with the PE teachers + Doubling PE classes groups lowered in 93% and in 54% the risk of the adolescents in developing high depressive symptomatology compared with the control group, respectively. A workshop updating PE teachers on pedagogical and health-related topics decreased depressive symptoms in adolescents. Moreover, improvements in the adolescents' social isolation mediated the effect of PE teachers' workshop intervention on the depressive symptoms in adolescents.

Lifestyle Behaviors and Depressive Symptoms in Chinese Adolescents Using Regression and fsQCA Models

“…Physical activity during PE classes can relieve fatigue and improve pleasure through neurophysiological stimulation and the brain's information processing function (i.e., cerebral cortex), so as to improve children's preparation ability for all day exercise ( 35 , 36 ). The decrease in the frequency of physical education will affect adolescents' opportunities to develop friendship and social skills, increasing the risk of depressive symptoms ( 9 ).…”

“…There are many factors affecting depressive symptoms, such as living conditions, life events and lifestyle factors ( 7 ). Among them, lifestyle factors, such as sleep duration, physical activity, physical education (PE) class participation, screen time and sedentary time could lead to a greater effect on depressive symptoms than previously believed ( 7 – 9 ). A recent meta-analysis showed that although the existing evidence base was still low, universal multi-risk lifestyle interventions may have a modest but statistically significant effect on reducing depressive symptoms ( 10 ).…”

A National Audit of Typical Secondary School Provision of Physical Education, Physical Activity and Sports in the Republic of Ireland

“…Adolescents spend a high proportion of their waking day in schools which consequently have been identified as a cost-effective investment and key contributor to engagement in physical activity for health [10]. Due to some empirical evidence supporting the impact of typical school provision of physical education, physical activity and sports on adolescent physical activity behaviors [11][12][13][14][15][16][17], wellbeing [18][19][20][21][22][23][24][25] and health [26][27][28][29][30][31][32][33][34], various strategies have been put forward to further utilize schools as primary vehicles to promote physical activity and health. The International Society for Physical Activity and Health's (ISPAH) "Eight Investments that Work for Physical Activity" acknowledges a systems-based, whole-of-school approach to best practice and was devised in response to the both the aforementioned empirical evidence and the Global Action Plans targets to reduce physical inactivity [35].…”

The Impact of Different Levels of Typical School Provision of Physical Education, Physical Activity and Sports on Adolescent Physical Activity Behaviors, Health and Wellbeing

“…Nationally, the prevalence of physical inactivity in the Republic of Ireland is high, with 90% of adolescents failing to reach the World Health Organization's physical activity recommendations [11]. Consequently, school environments have been promoted as key facilitators for enhancing physical activity levels in parallel with improving and maintaining the health and wellbeing of adolescents [12,13], the benefits of which are becoming evident in the literature [14][15][16][17][18][19].…”

“…The breadth and depth of provision is often determined by the resource base and ethos of schools. The literature indicates support for individual components of typical school provision of physical education, physical activity and sports to increase adolescent physical activity levels and attitudes to physical activity engagement that may predict enhanced health and wellbeing, e.g., obesity, health-related physical fitness, depression and anxiety [16,17,21,22]. However, a paucity of evidence exists that examines the impact of both multicomponent, whole school and systems-based approaches to typical school provision and the impact of different levels of such approaches on indicators of health in adolescent populations.…”