Research consistently reveals that universal programs don’t work to reduce depression among adolescents. Universal programs – targeting all the students in a grade, for example – avoid the stigma of singling out students for intervention, but there are questions over their effectiveness in preventing depression. While some programs do help in the short term, any benefits have usually dissipated within six months.

However, Australian psychologists have recently proposed that while universal strategies have few advantages for the prevention of depression among adolescents, they do promote self-esteem and coping skills in the long run. Could it be that positive aspects of mental health, such as self-esteem, are independent of negative aspects such as depression?

Emilie Rivet-Duval and colleagues from the University of Sydney, writing in the latest edition of the journal Child and Adolescent Mental Health, report on the findings of a prevention experiment conducted on the island of Mauritius. With few mental health specialists (1 psychologist per 100,000 people) and one of the highest suicide rates in Africa, the researchers believed they would find a high level of unmet psychological need amongst Mauritian youth.

Having recruited 160 young people aged between 12 and 16 years in two secondary schools, the experiment randomly assigned half of them to attend a universal prevention program called the Resourceful Adolescent Program (RAP-A) and the other half to a wait-list control condition. Adolescents in the control group received the intervention one year later than those assigned to the program group.

At the heart of the program is the well-known story of the “Three Little Pigs,” in which only the house made of bricks was resilient enough to withstand the huffing and puffing of the Big Bad Wolf. Adolescents who take part in RAP-A construct their own metaphorical “RAP-A house” using different “personal resource bricks.” The bricks represent different coping skills and strategies nurtured in the adolescents during the course of the program, such as “Personal Strength Bricks,” “Keeping Calm Bricks,” and “Problem Solving Bricks.”

Although the study set out to test the effectiveness of RAP-A on the reduction of Mauritian adolescents’ levels of depression and sense of hopelessness, the research team also collected data on more positive aspects of mental well-being, such as self-esteem and coping skills. Data was collected at three times – before the intervention, at the end of the intervention, and at a follow-up six months later.

Although the program resulted in a significant reduction in depression symptoms immediately after the intervention, these positive results had disappeared by the six-month follow-up.

However, RAP-A did enhance the positive mental health of participants. A large majority of the young people who participated in the program showed significant improvements in self-esteem and coping skills immediately after the intervention – and the results were still positive six months later.

Why did the program achieve so little in terms of preventing depression yet prove so effective at increasing more positive aspects of mental health?

The researchers first point out that the level of need amongst Mauritian teenagers for programs of this kind is may not be as substantial as they first thought. Levels of depression across the sample as a whole were remarkably low, which suggests that the large majority of children would not actually become depressed in the absence of the intervention.

The wider literature on preventing depression reveals that “indicated prevention” programs (those targeted at those who display subclinical symptoms) and “selective prevention” programs (designed for those who are exposed to certain risk factors) are generally more effective at reducing levels of depression than those provided universally to whole population groups.

Even more interesting, it could be that different effects were found because positive mental health exists independently from psychological difficulties. Rivet-Duval and colleagues reference data originating from the Dunedin Multidisciplinary Health and Development Study that show that self-esteem exists independently from depression. Thus it is possible that a program could have effects in one area of mental health and not another, although it is worth noting that high self-esteem is a known protective factor against the development of problems in later life.

Another potential explanation is that the program delivered as part of this experiment, RAP-A, focuses heavily on the positive. Developed by Professor Ian Shochet of the School of Psychology and Counselling at Queensland University of Technology in Australia, the theory underpinning the program has its roots in cognitive-behavioral and interpersonal approaches to building resilience. According to program developers, “The common thread that runs through the program is the teaching of techniques to maintain self-esteem in the face of a variety of stressors.”

Reference:
Rivet-Duval, Emilie, Sandra Heriot, and Caroline Hunt. 2011. “Preventing Adolescent Depression in Mauritius: A Universal School-Based Program.” Child and Adolescent Mental Health 16(2): 86-91.