BACKGROUND Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief self-referral stress workshop programme for sixth-form students aged 16-18 years old. OBJECTIVE This study conducted a secondary analysis on the outcomes of participants with elevated depressive symptoms at baseline. METHODS This is an England-wide, multicentre, cluster randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of a brief cognitive-behavioural therapy workshop (DISCOVER) compared with treatment-as-usual (TAU) (1:1). The primary outcome was depression symptoms (Mood and Feelings Questionnaire (MFQ)) at 6-month follow-up, using the intention-to-treat (ITT) population and analysed with a multilevel linear regression estimating a between-group adjusted mean difference (aMD). Cost-effectiveness, taking a National Health Service (NHS) and personal social services perspective, was explored using quality-adjusted life years (QALYs). FINDINGS Between 4 October 2021 and 10 November 2022, 900 adolescents at 57 schools were enrolled. 314 students were identified as having elevated symptoms of depression at baseline (>27 on MFQ). In this prespecified subgroup, the DISCOVER arm included 142 participants and TAU included 172. ITT analysis included 298 participants. Primary analysis at 6 months found aMD to be -3.88 (95% CI -6.48, -1.29; Cohen's d=-0.52; p=0.003), with a similar reduction at 3 months (aMD=-4.00; 95% CI -6.58, -1.42; Cohen's d=0.53; p=0.002), indicating a moderate, clinically meaningful effect in the DISCOVER arm. We found an incremental cost-effectiveness ratio of £5255 per QALY, with a probability of DISCOVER being cost-effective at between 89% and 95% compared with TAU. CONCLUSIONS AND CLINICAL IMPLICATIONS DISCOVER is clinically effective and cost-effective in those with elevated depressive symptoms. This intervention could be used as an early school-based intervention by the NHS. TRIAL REGISTRATION NUMBER ISRCTN90912799.

中文翻译：

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中学简短教育研讨会试验 (BESST)：一项整群随机对照试验。对抑郁症状加重的人进行二次分析。


背景技术抑郁和焦虑在青少年中越来越普遍。中学简短教育研讨会试验调查了针对 16-18 岁六年级学生的简短自我推荐压力研讨会计划的有效性。目的 本研究对基线时抑郁症状加重的参与者的结果进行了二次分析。方法 这是一项英格兰范围内的多中心、整群随机对照试验，旨在评估简短的认知行为治疗研讨会 (DISCOVER) 与常规治疗 (TAU) (1:1) 相比的临床效果和成本效益。主要结局是 6 个月随访时的抑郁症状（情绪和情感问卷（MFQ）），使用意向治疗（ITT）人群，并通过多级线性回归进行分析，估计组间调整后的平均差异（ MD）。从国家卫生服务 (NHS) 和个人社会服务的角度出发，使用质量调整生命年 (QALY) 来探讨成本效益。调查结果 2021 年 10 月 4 日至 2022 年 11 月 10 日期间，57 所学校的 900 名青少年入学。 314 名学生被确定在基线时抑郁症状加重（MFQ 上的 >27）。在这个预先指定的亚组中，DISCOVER 组包括 142 名参与者，TAU 包括 172 名参与者。ITT 分析包括 298 名参与者。 6 个月时的初步分析发现 aMD 为 -3.88（95% CI -6.48，-1.29；Cohen's d=-0.52；p=0.003），3 个月时也有类似的降低（aMD=-4.00；95% CI -6.58） ，-1.42；Cohen's d=0.53；p=0.002），表明 DISCOVER 组具有中等、有临床意义的效果。 我们发现每个 QALY 的增量成本效益比为 5255 英镑，与 TAU 相比，DISCOVER 的成本效益概率在 89% 到 95% 之间。结论和临床意义 DISCOVER 对于抑郁症状加重的患者具有临床效果和成本效益。 NHS 可以将这种干预措施用作早期基于学校的干预措施。试用注册号 ISRCTN90912799。