Abstract
School-based mental health intervention programs have demonstrated efficacy for the prevention and reduction of depressive symptoms, though the effect tends to be variable and is often unsustained longitudinally. However, it is possible that these intervention programs may have an indirect impact on adolescent functioning via positive mediators, and that this influence may predict more durable protective benefits. This study evaluated the efficacy of the Resilient Families program for improving social-emotional skills and depressive symptoms for adolescents over a two-year period. Twenty-four secondary schools in Melbourne, Australia were randomly allocated to either Resilient Families or a control condition. 1826 students (M= 12.3, SD = .05 years at W1; 56% female) completed the curricula and subsequent surveys. Inconsistent with hypotheses, analysis with Structural Equation Modelling revealed that the program had no significant effect on social-emotional skills and these skills had no significant effects on adolescent depressive symptoms. However, family attendance at parent education events within the intervention schools was associated with longitudinal reductions in depressive symptoms. The findings highlight the importance of increasing emphasis on family and community protective factors in adolescent social-emotional development and depression prevention programs.
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Data Sharing and Declaration
The dataset generated and analyzed during this study are not publicly available, but are available from the authors upon reasonable request.
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Funding
NHMRC Project Grant No. 251721 provided funding for the original project. NS completed this project as a component of her Clinical Psychology Masters degree at Deakin University. MGM, DRS and JWT are supported as contracted staff members at Deakin University. DRS is also a contracted staff member at Barwon Health.
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NS is the primary author and performed the analyses on the data. MGM assisted with the design of the original study and data set, and assisted with the analyses performed by NS. DRS performed textual edits and prepared the manuscript for submission. JWT conceived of the original study design and provided editorial assistance. All authors read and approved the final manuscript.
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A potential conflict of interest is noted in that the author JWT holds intellectual property responsibility for the Resilient Families intervention. The remaining authors declare that they have no conflict of interest.
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The Human Research Ethics Committee at the University of Melbourne and Deakin University granted ethics approval (Deakin Ethic’s number 2015-213).
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Informed consent was obtained from all individual participants included in the study.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors further assert their adherence to the ethical standards outlined by the journal.
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Appendices
Appendix A
Scales, number of items, example items, response options and reliability (Cronbach’s alpha) for variables in the analysis
Variable scale | Alpha (wave 1) | Number of items | Example item(s) | Response options |
|---|---|---|---|---|
Depressive symptoms: | 20 items | |||
CES-D (Fechner-Bates et al. 1994) | .86 | How many times in the past seven days have you: Had trouble keeping your mind on what you were doing? | Not at all (0), Some or a little of the time (1), Occasionally (2), Most or all of the time (3) | |
Social-emotional skills: | 23 items | |||
Social competence Teen Version of Social Questionnaire (Shortt et al. 2007) | .75 | 5 items | How are you at … Letting friends know you like them by telling them or showing them? Introducing yourself to someone for the first time? Helping someone feel better when they are upset? Showing that you care when someone talks about their problems? Letting someone really get to know you? | Very bad at this (1), Poor at this (2), Good at this (3), Very good at this (4) Very bad at this (1), Poor at this (2), Good at this (3), Very good at this (4) |
Social Self-Efficacy Questionnaire for Children (Muris 2001)a | – | 1 item | Staying friends with people? | |
Emotional competence Social Self-Efficacy Questionnaire for Children | .81 | 3 items | How are you at … Cheering yourself up when something bad has happened? Not worrying about things that might happen? Taking your mind off upsetting or unpleasant thoughts? | Very bad at this (1), Poor at this (2), Good at this (3), Very good at this (4) |
Emotional Control Scale (Shortt et al. 2007) | 3 items | Calming yourself down if you are feeling nervous? Keeping your feelings under control? Controlling your temper when people are angry with you? | Very bad at this (1), Poor at this (2), Good at this (3), Very good at this (4) | |
Positive problem-solving Beyondblue Social Problem-Solving Inventory (D’Zurilla et al. 2001)b | .66 | 8 items | When I have a problem, I try to think of different ways to solve it. I try to see my problems as challenges. When making decisions, I try to predict the good points and bad points of each option. I believe I can solve difficult problems on my own if I try hard enough. I wait to see if a problem goes away before trying to solve it myself. I doubt that I can solve difficult problems no matter how hard I try. Difficult problems make me very upset I put off solving problems until it is too late to do anything about them. | Not true at all (1), Slightly true of me (2), Moderately true of me (3), Very true of me (4), Extremely true of me (5) |
Coping skills Self-Report Coping Scale (Kochenderfer-Ladd and Skinner 2002) | .84 | 3 items | I talk to someone about how it makes me feel. | Not true at all (1), Slightly true of me (2), Moderately true of me (3), Very true of me (4), Extremely true of me (5) |
Family protective factor: | 24 items | |||
Recognition for prosocial behavior Resilient Families (Shortt et al. 2007) | .88 | 2 items | My parents notice when I am doing a good job and let me know about it. How often do your parents tell you they are proud of you for something you have done? | Never or Almost Never (1), Sometimes (2), Often (3), All the time (4) |
Attachment to mother Resilient Families (Shortt et al. 2007)c | .78 | 3 items | Do you feel very close to your mother? Do you share your thoughts and feelings with your mother? Do you enjoy spending time with your mother? | No! (1), No (2), Yes (3), YES! (4) |
Attachment to father Resilient Families (Shortt et al. 2007)c | .83 | 3 items | Do you share your thoughts and feelings with your father? Do you share your thoughts and feelings with your father? Do you enjoy spending time with your father? | No! (1), No (2), Yes (3), YES! (4) |
Opportunities for prosocial Involvement Resilient Families (Shortt et al. 2007)c | .79 | 3 items | If I had a personal problem, I could ask my mum or dad for help. My parents give me lots of chances to do fun things with them My parents ask me what I think before most family decisions affecting me are made | No! (1), No (2), Yes (3), YES! (4) |
Family resilience Resilient Families (Shortt et al. 2007)c | .93 | 13 items | Everyone in our family has a say in making decisions. If someone in my family had a problem, we would all help. We are hopeful about the future - good things will happen for people in our family. My family works as a team to solve problems. The people in my family enjoy each other’s company. We are happy as a family. We have a strong sense of being together as a family. We share jokes and funny stories together. We enjoy talking about the things our family has done in the past. We listen to each other. If we disagree about something, we talk it through. In my family, each of us has responsibilities and jobs to do. The people in my family value my opinion and respect my thoughts and wishes. | No! (1), No (2), Yes (3), YES! (4) |
Community protective factor: | 13 items | |||
Significant adult Psychological Sense of School Membership (Goodenow 1993)c | .65 | 1 item | There is at least one teacher or other adult in this school I can talk to if I have a problem. | No! (1), No (2), Yes (3), YES! (4) |
Resilient Families (Shortt et al. 2007)c | .65 | 2 items | Apart from my parents, there is another adult in my life (e.g., grandparent, friend’s parent, aunt) that I can talk to about something important. There’s at least one teacher or other adult in this school I can talk to if I have a problem | No! (1), No (2), Yes (3), YES! (4) |
Family connectedness to others Resilient Families (Shortt et al. 2007) | .65 | 5 items | There are other people like friends and relatives who my parent(s) can rely on when they feel upset. When good things happen in our family we share them with friend, relatives or neighbours. The people in my family are involved in groups like sporting clubs, school committees, church groups, & volunteer groups. My parent(s) attend school events like sports days, swimming carnivals and school plays. My parent(s) know other parents at the school. | No! (1), No (2), Yes (3), YES! (4) |
Family connectedness to school Resilient Families (Shortt et al. 2007) | .69 | 5 items | My parent(s) attend parent teacher evenings. My parent(s) helps me with my homework. My parent(s) think that school is important. My parent(s) say good things about most of my teachers. My parent(s) say good things about my school. | No! (1), No (2), Yes (3), YES! (4) |
Appendix B—Iterative history of model specification
Proposed visualized conceptual model.
Steps to Fit Model 1:
Chi-square (34): | 4450.1 |
CFI: | .395 |
TFL: | −.141 |
AIC: | 4554.5 |
BIC: | 4781.42 |
RMSEA: | .263 |
Second iteration:
At second iteration, the W2 variables were inter-correlated, and Depression at W2 was correlated with Depression at W3.
A cluster of extremely large modification indices was identified (all over 100), and a number of additional pathways were added to the model:
Regression pathways from Depression W1 to Depression at W2 and W3, and Social-Emotional at W2.
Regression pathways from Gender to Depression at W2 and W3, and Family Protection at W2.
Regression pathways from Family Protection at W1 to Depression at W2, and Family Protection at W2.
Regression pathways from Community Protection at W1 to Social Emotional at W2 and Community Protection at W2.
Regression pathways from Social Emotional at W1 to Social Emotional at W2, Family Protection at W2, and Community Protection at W2.
Chi-square (22): | 1681.4 |
CFI: | .773 |
TFL: | .319 |
AIC: | 1793.44 |
BIC: | 2101.99 |
RMSEA: | .203 |
Third iteration:
Inter-W2 regression pathways are now added guided by both theory and the modification indices (again, all over 100):
Regression pathways are added from Family Protection at W2 to Community Protection and Depression at W2.
Regression pathways are added from Community Protection at W2 to Social Emotional at W2.
Regression pathways are added from Depression at W2 to Community Protection at W2.
Chi-square (18): | 513.2 |
CFI: | .773 |
TFL: | .319 |
AIC: | 1793.44 |
BIC: | 2101.99 |
RMSEA: | .203 |
Fourth iteration:
Inter-W2 correlations are specified between each W2 variable, and between Depression at W2 and Depression at W3. A regression pathway is added between the Resilient Families variables.
Chi-square (10): | 36.8 |
CFI: | .996 |
TFL: | .976 |
AIC: | 172.75 |
BIC: | 547.42 |
RMSEA: | .038 |
However, at this stage the model failed to accurately determine a minimum Chi-square within 50 iterations, and a large discrepancy between AIC and BIC estimates was observed – indicating that the model as specified was unstable. Thus, some pathways were trimmed from the model in order to promote parsimony.
We removed non-significant regression pathways and correlations.
Community Protection W1 > Family Protection W2;
Community Protection W2 > Social Emotion W2, and Depression W3;
Depression W1 > Resilient Families (Parents);
Family Protection W1 > Resilient Families (Both variations);
Family Protection W2 > Depression W3;
Gender > Resilient Families (Both variations);
Resilient Families > Community Protection W2; Social Emotional W2, Family Protection W2, and Depression W2;
Resilient Families (Parents) > Family Protection W2, Social Emotional W2;
Social Emotional W1 > Resilient Families (Both variations);
Social Emotional W2 > Depression W3.
Community Protection W2 < > Social Emotional W2, Depression W2
Social-Emotional W2 < > Family Protection W2.
Fit Indices for the final model:
Chi-square (27): | 30.9, p < .273 |
CFI: | .999 |
TFL: | .999 |
AIC: | 132.94 |
BIC: | 413.95 |
RMSEA: | .009 |
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Singh, N., Minaie, M.G., Skvarc, D.R. et al. Impact of a Secondary School Depression Prevention Curriculum on Adolescent Social-Emotional Skills: Evaluation of the Resilient Families Program. J Youth Adolescence 48, 1100–1115 (2019). https://doi.org/10.1007/s10964-019-00992-6
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DOI: https://doi.org/10.1007/s10964-019-00992-6