COMPLETE - a school-based intervention project to increase completion of upper secondary school in Norway: study protocol for a cluster randomized controlled trial

Professional strategies in upper secondary school dropout management among youth in the Sami areas of Norway: a focus group study

The upper secondary school dropout rate is a challenge in many western countries, and measures have been taken to prevent dropout. The dropout rate in Norway is stable but is the highest among the northernmost counties. The aim of this study is to explore the strategies employed by upper secondary school teachers and their collaborators to prevent dropout from upper secondary school among Sami youth in northern Norway. This study is based on three focus group interviews with teachers, advisers, nurses, and counsellors in the Sami areas of northern Norway. The thematic analysis identified two main strategies, namely tracking the student and giving the student time. A transparent environments, cultural competence, and interdisciplinary collaboration were identified as prerequisites for successfully implementing the two strategies to prevent dropout from upper secondary school.

Caring Climate and Support, Mental Health, and Academic Adjustment: Effects from a Cluster Randomized Controlled Trial in Upper Secondary Schools in Norway

This cluster randomized controlled trial (RCT) examined the effect of a three year follow up of a multi-tier intervention aiming at improving the psychosocial environment in upper secondary schools in Norway. Two intervention conditions were tested: a universal single-tier intervention focused on improving the psychosocial school climate, the dream school program (DSP), and a multi-tier intervention combining the DSP with a targeted measure, the mental health support team (MHST). A total of 2203 students responded to the baseline survey. Of the 2203 pupils, 1884 responded to the first follow-up survey (year 1), 1287 pupils to the second (year 2), and 756 pupils to the third (year 3). The direct and indirect effects on school completion were analyzed using a multi-level linear mixed model. The results showed no significant effects of either the DSP or the DSP and MHST in combination on support, the school climate, mental health, or academic adjustment. We found no significant effect of the interventions on the proportion who had completed school or were in training (the three groups varied between 76.6% and 77.8%). Future similar studies should be attentive to the potential challenges of implementing RCTs in the school setting. Furthermore, the long-term effects of school interventions on the constructs included in this study could be difficult to capture due to the complexity of the phenomena. The implications of these findings are discussed.

Civic engagement and mental health trajectories in Norwegian youth

Introduction

Applying variable-centered analytical approaches, several studies have found an association between civic engagement and youth mental health. In the present study, we used a person-centered approach to explore whether civic engagement was related to optimal trajectories of mental health compared to other trajectories. We also examined how sociodemographic factors, such as socioeconomic status (SES), gender and age were related to youth mental health trajectories.

Methods

Our sample comprised 675 students (aged 16-22) who had participated in three waves of data collection (Mage = 18.85, SD = 0.55; 43% males) in the COMPLETE project, a cluster-randomized controlled trial that involved Norwegian upper secondary schools.

Results

The results revealed three trajectories of mental health (reflecting a combination of mental distress and mental well-being): optimal, intermediate, and sub-optimal. Contrary to our expectations, higher levels of civic engagement were not related to the optimal trajectory of mental health vs. other trajectories. However, we found that students who reported higher levels of SES and males were more likely to follow the optimal trajectory compared to other trajectories.

Discussion

While the findings on civic engagement could be due to our measurement's inability to capture the concept of "dugnad," a well-established civic activity in the Norwegian society, the findings regarding the influence of SES and gender suggest that there is still more work to be done concerning the assessment and advancement of factors that can address mental health inequalities across SES and gender.

Preventing Loneliness and Reducing Dropout: Results from the COMPLETE Intervention Study in Upper Secondary Schools in Norway

This study examines the impact of interventions aimed at improving psychosocial health on students' perception of a caring school climate, their feelings of loneliness, and school completion in Norwegian upper secondary education. Two intervention conditions were tested: a universal single-tier intervention focused on improving the psychosocial school climate: the Dream School Program, and a multi-tier intervention combining the Dream School Program with a targeted measure, the Mental Health Support Team. The direct and indirect effects of these interventions on school completion were analyzed using structural equation models (SEM), with data from 1508 students (mean age at Time 1: 17.02 (SD = 0.92); 60.7% girls; 72.1% Norwegian-born). The results indicated that loneliness levels did not differ significantly between the intervention conditions. However, students in the multi-tier intervention group reported a significantly higher perception of a caring school climate compared to those in the single-tier intervention group. The multi-tier intervention group had a lower rate of school completion compared to the control group and the single-tier intervention group. The SEM analysis revealed that the multi-tier intervention reduced loneliness in the second year of upper secondary school by promoting a caring school climate in the first school year. In contrast, the single-tier intervention was associated with increased loneliness due to a decrease in the perception of a caring school climate. The implications of these findings are discussed.

Academic Stress, Academic Self-efficacy, and Psychological Distress: A Moderated Mediation of Within-person Effects

Previous research has largely failed to separate the between- and within-person effects in the longitudinal associations between academic stress, academic self-efficacy, and psychological distress (symptoms of anxiety and depression). Filling this research gap, this study investigated if academic self-efficacy mediated the relationship between academic stress and psychological distress at the intraindividual level during 3 years of upper secondary school. Gender moderation was also examined in the hypothesised model. The present sample consisted of 1508 Norwegian adolescents (baseline M age = 16.42; 52.9% high perceived family wealth; 70.6% Norwegian-born). The random intercept cross-lagged panel model results indicated (1) positive and time-invariant direct effects from academic stress to psychological distress, (2) academic self-efficacy partially mediated these effects, and (3) psychological distress impacted later academic stress. Academic stress was more strongly related to academic self-efficacy and psychological distress at the interpersonal level for boys, while the intraindividual impact of academic stress on psychological distress was stronger for girls. The study findings might have implications for school-based implementation strategies and theoretical development.

Hello Darkness, My Old Friend: Moderating a Random Intercept Cross-lagged Panel Model of Loneliness and Symptoms of Anxiety and Depression

The present study investigated the trait- and state-like associations between loneliness and symptoms of anxiety and depression during three years in middle to late adolescence. The moderating effect of gender and social self-efficacy was examined on the hypothesised model. The sample consisted of 1508 Norwegian upper secondary school students (61% female; mean age at T1 = 16.33; 52.9% high socioeconomic position; 70.6% Norwegian-born). We found 1) strong and positive trait- and state-like associations between loneliness and symptoms of anxiety and depression, 2) that anxiety and depressive symptoms consistently predicted later loneliness but not the other way around, 3) that gender moderated parts of the state-like associations between loneliness and symptoms of anxiety and depression, and 4) that social self-efficacy had no moderating effect on the longitudinal relationship between loneliness and anxiety and depressive symptoms. The present study might inform future research, theory development, and intervention strategies in middle to late adolescent samples.

Loneliness as an active ingredient in preventing or alleviating youth anxiety and depression: a critical interpretative synthesis incorporating principles from rapid realist reviews

Loneliness is a relatively common problem in young people (14-24 years) and predicts the onset of depression and anxiety. Interventions to reduce loneliness thus have significant potential as active ingredients in strategies to prevent or alleviate anxiety and depression among young people. Previous reviews have focused on quantitative evidence and have not examined potential mechanisms that could be targets for intervention strategies. To build on this work, in this review we aimed to combine qualitative and quantitative evidence with stakeholder views to identify interventions that appear worth testing for their potential effectiveness in reducing loneliness, anxiety and depression in young people aged 14-24 years, and provide insights into the potential mechanisms of action. We conducted a Critical Interpretative Synthesis, a systematic review method that iteratively synthesises qualitative and quantitative evidence and is explicitly focused on building theory through a critical approach to the evidence that questions underlying assumptions. Literature searches were performed using nine databases, and eight additional databases were searched for theses and grey literature. Charity and policy websites were searched for content relevant to interventions for youth loneliness. We incorporated elements of Rapid Realistic Review approaches by consulting with young people and academic experts to feed into search strategies and the resulting conceptual framework, in which we aimed to set out which interventions appear potentially promising in terms of theoretical and empirical underpinnings and which fit with stakeholder views. We reviewed effectiveness data and quality ratings for the included randomised controlled trials only. Through synthesising 27 studies (total participants n = 105,649; range 1-102,072 in different studies) and grey literature, and iteratively consulting with stakeholders, a conceptual framework was developed. A range of 'Intrapersonal' (e.g. therapy that changes thinking and behaviour), 'Interpersonal' (e.g. improving social skills), and 'Social' Strategies (e.g. enhancing social support, and providing opportunities for social contact) seem worth testing further for their potential to help young people address loneliness, thereby preventing or alleviating depression and/or anxiety. Such strategies should be co-designed with young people and personalised to fit individual needs. Plausible mechanisms of action are facilitating sustained social support, providing opportunities for young people to socialise with peers who share similar experiences, and changing thinking and behaviour, for instance through building positive attitudes to themselves and others. The most convincing evidence of effectiveness was found in support of Intrapersonal Strategies: two randomised controlled studies quality-rated as 'good' found decreases in loneliness associated with different forms of therapy (Cognitive Behavioural Therapy or peer network counselling), although power calculations were not reported, and effect sizes were small or missing. Strategies to address loneliness and prevent or alleviate anxiety and depression need to be co-designed and personalised. Promising elements to incorporate into these strategies are social support, including from peers with similar experiences, and psychological therapy.

Positive Youth Development and Mental Well-Being in Late Adolescence: The Role of Body Appreciation. Findings From a Prospective Study in Norway

Although a vulnerable period, adolescence is a time of great potential for healthy development. Understanding factors that contribute to mental well-being in this period is of great importance to facilitate for healthy development. During the adolescence period the body goes through rapid and considerable changes, and the focus on body appearance and perfection is substantial at societal, media, and peer level. In this study, we investigated the association between dimensions characterizing positive youth development, and mental well-being among Norwegian adolescents 16-17 years 1 year later, and whether this association was mediated by degree of body appreciation. We further tested whether the indirect and direct paths between positive youth development dimensions and mental well-being were moderated by gender. We used data from the first and second follow-up of the control arm of the COMPLETE study, a cluster randomized controlled trial in upper secondary schools in Norway. Findings showed that positive youth development in grade 1, as measured by both a combined global PYD and the dimensions competence, and connection were significantly associated with mental well-being in grade 2 in models adjusted for mental well-being in grade 1, gender and perceived family affluence. Also, body appreciation in grade 1 significantly predicted mental well-being in grade 2 in models including each of global PYD, competence, connection, character, and caring dimensions. Contrary to our hypothesis, no mediating effects of body appreciation were observed, and no moderation of indirect effects by gender were observed.

The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial

Background

Concussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students’ intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social support to a peer. Secondary aims include assessing the implementation fidelity and acceptability of the intervention.

Methods

This longitudinal study will use a cluster randomized trial design. Three high schools from six randomly selected Canadian school boards will participate and be randomized to three study arms: (1) You-CAN led by school staff; (2) You-CAN led by school staff and research team; and (3) untreated comparison group. Intervention arms 1 and 2 will deliver the You-CAN program and create a Concussion Council at their school. The Concussion Council will deliver a concussion awareness campaign and participate in an online showcase with other participating schools. In addition, arm 2 will have monthly video-calls with the research team. A survey based on the Theory of Planned Behaviour will be administered school-wide with all arms (1, 2, 3) at two time points (beginning {T₀} and end {T₁} of the school year). Exit interviews will be completed with the Concussion Councils and participating school staff.

Discussion

This study will provide evidence of the effectiveness of a school-based peer-led concussion program on increasing concussion knowledge, attitudes, subjective norms, perceived behavioural control, intent to report a concussion to an adult, and intent to provide social support to a peer amongst Canadian high school students. It will also provide important information about the implementation and acceptability of the You-CAN program for high school students and staff.

Trial registration

This trial is registered with the ISRCTN registry (ISRCTN64944275, 14/01/2020, retrospectively registered).

Indicators of positive youth development can be maladaptive: The example case of caring

INTRODUCTION

Research on positive youth development typically takes a more-is-better approach in which higher scores on measures of positive youth development indicate better outcomes. We question the validity of this assumption and describe how an imbalance among the Five Cs of Positive Youth Development can lead to a situation where "more" is actually "less." We then provide an empirical illustration using cross-sectional data.

METHODS

We examined conditional associations between indicators of thriving and the C of caring using survey data obtained from a sample of 2,386 students in Norway (mean age 16.60 years [SD = 1.98]; 44.8% girls). Multilevel models assessed whether associations between caring and the thriving indicators (here defined as greater mental well-being and lower anxiety and depressive symptoms) differed when versus when not controlling for overall positive youth development.

RESULTS

When positive youth development was not included as a covariate, caring was positively associated with mental well being and anxiety but not significantly associated with depressive symptoms. After adding positive youth development to the model, caring became less strongly associated with mental well-being, more strongly associated with anxiety, and significantly (positively) associated with depressive symptoms.

CONCLUSIONS

Our results indicate that, after controlling for a set level of positive youth development, caring does not predict adaptive outcomes in a monotonic more-is-better way. These findings illustrate an instance where developmental regulations benefit the context at the cost of the individual and therefore speak to a growing acknowledgement in the literature-young people may suffer if they "care too much."