Kyung Mi Sung

doi:10.4040/jkan.2012.42.7.984

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Original Article
Effects of a School-based Intervention Program for Middle School Adolescent Girls with Depression: As Part of the School Health Services: Kyung Mi Sung; Journal of Korean Academy of Nursing 2012;42(7):984-991.
DOI: https://doi.org/10.4040/jkan.2012.42.7.984
Published online: December 12, 2012

College of Nursing & Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Address reprint requests to : Sung, Kyung Mi College of Nursing, Gyeongsang National University, 816-15 Jinjudaero, Jinju 660-751, Korea Tel: +82-010-4234-0047 Fax: +82-55-772-8222 E-mail: sungkyungmi7@gmail.com

• Received: June 9, 2012 • Revised: July 10, 2012 • Accepted: November 16, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to evaluate the effects of a school-based intervention program for middle school adolescent girls with depression.
Methods
The study was a pretest–posttest repeated-measure design with a nonequivalent control group. Fifty eight students with depressive symptoms were recruited from two middle schools in Seoul, Korea. The data were collected from the intervention (n= 30) and the comparison group (n= 28). The research instrument was Reynolds Adolescent Depression Scale.
Results
The intervention group greatly improved from baseline to 10 weeks and then saw a slight positive change between 10 and 13 weeks.
Conclusion
The results of this research show that depression intervention programs are effective for young female adolescents. Thus the investigation has important school-based treatment implications, and should be integrated into school curriculums by school health nurses for early intervention of depressive symptoms in middle school adolescent girls.
Keywords: Adolescent; Female; Depression; School health services

Figure 1.

Participant flow chart.

Figure 2.

Changes in intervention and comparison groups of depressive symptoms.

Table 1.

The Contents of School-based Intervention Program for a Middle School Girls with Depression

Session	Contents	Teaching methods
1	Study instruction
	1. Greeting	− Explain the program
	2. Provide guidelines for study participation
2	Basic understanding about adolescent depression
	1. Nature of adolescent depression	− Lecture using PPT
	2. Cause of adolescent depression	− Self-exam about the experience of depression
	3. Early signs and symptoms of adolescent depression
	4. Diagnosis and treatments of depression
3-4	Self-evaluation
	1. Explore one’s life experience	− Self-reflection
	2. Obtain insight	− Group counseling
5-6	Management strategy for depressed mood
	1. How to handle depressed mood	− Lecture using PPT
	- Get regular exercise, sleep pattern & eating habit	− Case method
	- Get sunlight for at least 30 min. everyday	− Small group discussion
	- Discuss your problems with others(friends, family, etc.)
	2. How to ask for help from others
	- When experiencing sleep disturbance, loss of appetite, difficulty in school life & peer relationship, loneliness, etc. for at least 2 weeks
7-8	Prevention of depression and suicide
	1. Self-help behaviors for prevention of depression	− Lecture using PPT
	2. Meaning of adolescent suicidal behavior	− A short video
	3. Helping friends who are depressed or contemplating suicide	− Activity, Q & A
9-10	Practical coping strategies for depression
	1. Build a new daily schedule to overcome depression	− Chart for a daily schedule
	2. Keep a diary as a routine work	− A short video
	3. Find individual strength and connect it with a special activity	− Activity, Q & A
11-13	Support system
	1. Individual online counseling for follow-up	− Provide information for email counseling after the
	2. Construct support system on an individual basis	meeting

Table 2.

Homogeneity Test for Demographic Characteristics of the Participants (N=58)

Characteristics	Categories	Total	Intervention group (n=30)	Comparison group (n=28)	χ² or t (p)
Characteristics	Categories	n (%)	n (%)	n (%)	χ² or t (p)
Birth order	First	27 (46.6)	13 (48.1)	14 (51.9)	0.26 (.793)
	Not first	31 (53.4)	17 (54.8)	14 (45.2)
Marital status of parents	Married	43 (74.1)	22 (51.2)	21 (48.8)	0.02 (.999)
	Divorce/separate	15 (25.9)	8 (53.3)	7 (46.7)
School satisfaction	Yes	29 (50.0)	16 (55.2)	13 (44.8)	0.73 (.694)
	No	26 (44.8)	12 (46.2)	14 (53.8)
	No response	3 (5.2)	2 (66.7)	1 (33.3)
Economic status	High	6 (10.3)	2 (33.3)	4 (66.7)	1.44 (.486)
	Moderate	41 (70.7)	21 (51.2)	20 (48.8)
	Low	11 (19.0)	7 (63.6)	4 (36.4)
Income resources	Both parents	18 (31.0)	12 (66.7)	6 (33.3)	3.46 (.326)
	Father	21 (36.2)	8 (38.1)	13 (61.9)
	Mother	16 (27.6)	8 (50.0)	8 (50.0)
	Others	3 (5.2)	2 (66.7)	1 (33.3)
Middle school grades	High	8 (13.8)	4 (50.0)	4 (50.0)	0.07 (.964)
	Moderate	22 (37.9)	11 (50.0)	11 (50.0)
	Low	28 (48.3)	15 (53.6)	13 (46.4)
Physical problems	Yes	23 (39.7)	14 (60.9)	9 (39.1)	1.28 (.294)
	No	35 (60.3)	17 (45.7)	19 (54.3)
Depressed mood	Frequently	18 (34.0)	10 (55.6)	8 (44.4)	1.93 (.381)
	Sometimes	23 (43.4)	13 (56.5)	10 (43.5)
	Rarely	12 (22.6)	4 (33.3)	8 (66.7)
Hobby	Yes	20 (34.5)	13 (65.0)	7 (35.0)	2.16 (.174)
	No	38 (65.5)	17 (44.7)	21 (55.3)
Negative life events	Many	18 (31.0)	10 (55.6)	8 (44.4)	1.73 (.409)
	Moderate	25 (43.1)	13 (52.0)	12 (48.0)
	No	15 (25.9)	6 (40.0)	9 (60.0)

Table 3.

Comparison of Depressive Symptoms between Intervention and Comparison Groups (N=58)

Variables	Test point	Intervention group (n=30)	Comparison group (n=28)	t (p)	Factor	F (p)
Variables	Test point	M±SD	M±SD	t (p)	Factor	F (p)
Depression	Pre	85.47±7.97	83.68±5.87	0.97 (.338)	Time	19.29 (<.001)
	Post	77.00±11.75	83.18±10.31	−2.47 (.017)	Group	5.56 (.022)
	F/u	74.23±10.82	84.86±10.51	−3.79 (<.001)	Time×Group	29.39 (<.001)
Dysphoric	Pre	24.47±3.22	24.68±2.75	−0.27 (.789)	Time	11.37 (<.001)
	Post	21.03±4.69	23.93±3.86	−2.56 (.013)	Group	7.77 (.007)
	F/u	20.60±4.25	24.18±3.63	−3.44 (.001)	Time×Group	5.90 (.004)
Anhedonia/ negative affect	Pre	16.57±3.34	16.29±2.97	0.34 (.737)	Time	2.04 (.135)
	Post	16.40±3.77	17.46±3.02	−1.19 (.240)	Group	1.57 (.215)
	F/u	16.00±3.53	18.18±3.42	−2.38 (.021)	Time×Group	6.43 (.002)
Negative	Pre	23.17±2.88	22.07±3.45	1.32 (.194)	Time	18.74 (<.001)
self-evaluation	Post	19.67±3.85	21.46±3.35	−1.19 (.240)	Group	1.81 (.183)
	F/u	19.37±3.68	21.82±3.52	−2.38 (.021)	Time×Group	14.40 (<.001)
Somatic	Pre	21.27±3.26	20.64±2.23	0.85 (.402)	Time	17.33 (<.001)
	Post	19.13±3.84	20.32±3.30	−1.26 (.213)	Group	1.56 (.216)
	F/u	18.30±3.50	20.61±3.14	−2.64 (.011)	Time×Group	16.51 (<.001)

Pre=Pretest before intervention; Post=Posttest after 10th intervention; F/u=Follow-up test after third follow-up counseling.

REFERENCES

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Birndorf S., Ryan S., Auinger P., Aten, M. 2005;High self-esteem among adolescents: Longitudinal trends, sex differences, and protective factors. Journal of Adolescent Health. 37(3):194–201. http://dx.doi.org/10.1016/j.jadohealth.2004.08.012Article
Cole D. A., Jacquez F. M., Truss A. E., Pineda A. Q., Weitlauf A. S., Tilghman -Osborne C. E., et al. 2009;Gender differences in the longitudinal structure of cognitive diatheses for depression in children and adolescents. Journal of Clinical Psychology. 65(12):1312–1326. http://dx.doi.org/10.1002/jclp.20631Article PubMed PMC
Costello E. J., Mustillo S., Keeler G., Angold, A. 2004.Children and adolescents. In: Levin B.L., Petrila J., Hennessy K., editors. Mental Health Services: A public health perspective. New York: Oxford University Press.
Collins K. A., Westra H. A., Dozois D. J. A., Burns D.D. 2004;Gaps in accessing treatment for anxiety and depression: Challenges for the delivery of care. Clinical Psychology Review. 24(5):583–616. http://dx.doi.org/10.1016/j.cpr.2004.06.001Article PubMed
Daughters S. B., Reynolds E. K., MacPherson L., Kahler C. W., Danielson C. K., Zvolensky M., et al. 2009;Distress tolerance and early adolescent externalizing and internalizing symptoms: The moderating role of gender and ethnicity. Behaviour Research and Therapy. 47(3):198–205. http://dx.doi.org/10.1016/j.brat.2008.12.001Article PubMed
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Fergusson D. M., Horwood L. J., Ridder E. M., Beautrais A.L. 2005;Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry. 62(1):66–72. http://dx.doi.org/10.1001/archpsyc.62.1.66Article PubMed
Frydenberg, E. 2008.Adolescent Coping: Advances in theory, research and practice. Routledge; New York.
Health P. A., Camarena P.M. 2002;Patterns of depressed affect during early adolescence. Journal of Early Adolescence. 22(3):252–276. http://dx.doi.org/10.1177/02731602022003002Article PDF
Hess S. G., Cox T. S., Gonzales L. C., Kastelic E. A., Mink S. P., Rose L. E., et al. 2004;A survey of adolescents’ knowledge about depression. Archives of Psychiatric Nursing. 18(6):228–234. http://dx.doi.org/10.1016/j.apnu.2004.09.005Article PubMed
Jaycox L. H., Asarnow J. R., Sherbourne C. D., Rea M. M., LaBorde A. P., Wells K.B. 2006;Adolescent primary care patients’ preferences for depression treatment. Administration and Policy in Mental Health and Mental Health Services Research. 33(2):198–207. http://dx.doi.org/10.1007/s10488-006-0033-7Article PubMed PDF
Kowalenko N., Rapee R. M., Simmons J., Wignall A., Hoge R., Whitefield K., et al. 2005;Short-term effectiveness of a school-based early intervention program for adolescent depression. Clinical Child Psychology and Psychiatry. 10(4):493–507. http://dx.doi.org/10.1177/1359104505056311Article PDF
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Reynolds, W. 2002.Reynolds Adolescent Depression Scale: Professional manual. 2nd ed.Odessa, FL: Psychological Assessment Resources, Inc., Odessa, FL.
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Effects of a School-based Intervention Program for Middle School Adolescent Girls with Depression: As Part of the School Health Services

J Korean Acad Nurs. 2012;42(7):984-991. Published online December 12, 2012

DOI: https://doi.org/10.4040/jkan.2012.42.7.984

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Effects of a School-based Intervention Program for Middle School Adolescent Girls with Depression: As Part of the School Health Services

Figure 1. Participant flow chart.

Figure 2. Changes in intervention and comparison groups of depressive symptoms.

Figure 1.

Figure 2.

Effects of a School-based Intervention Program for Middle School Adolescent Girls with Depression: As Part of the School Health Services

Session	Contents	Teaching methods
1	Study instruction
	1. Greeting	− Explain the program
	2. Provide guidelines for study participation
2	Basic understanding about adolescent depression
	1. Nature of adolescent depression	− Lecture using PPT
	2. Cause of adolescent depression	− Self-exam about the experience of depression
	3. Early signs and symptoms of adolescent depression
	4. Diagnosis and treatments of depression
3-4	Self-evaluation
	1. Explore one’s life experience	− Self-reflection
	2. Obtain insight	− Group counseling
5-6	Management strategy for depressed mood
	1. How to handle depressed mood	− Lecture using PPT
	- Get regular exercise, sleep pattern & eating habit	− Case method
	- Get sunlight for at least 30 min. everyday	− Small group discussion
	- Discuss your problems with others(friends, family, etc.)
	2. How to ask for help from others
	- When experiencing sleep disturbance, loss of appetite, difficulty in school life & peer relationship, loneliness, etc. for at least 2 weeks
7-8	Prevention of depression and suicide
	1. Self-help behaviors for prevention of depression	− Lecture using PPT
	2. Meaning of adolescent suicidal behavior	− A short video
	3. Helping friends who are depressed or contemplating suicide	− Activity, Q & A
9-10	Practical coping strategies for depression
	1. Build a new daily schedule to overcome depression	− Chart for a daily schedule
	2. Keep a diary as a routine work	− A short video
	3. Find individual strength and connect it with a special activity	− Activity, Q & A
11-13	Support system
	1. Individual online counseling for follow-up	− Provide information for email counseling after the
	2. Construct support system on an individual basis	meeting

Characteristics	Categories	Total	Intervention group (n=30)	Comparison group (n=28)	χ² or t (p)
Characteristics	Categories	n (%)	n (%)	n (%)	χ² or t (p)
Birth order	First	27 (46.6)	13 (48.1)	14 (51.9)	0.26 (.793)
	Not first	31 (53.4)	17 (54.8)	14 (45.2)
Marital status of parents	Married	43 (74.1)	22 (51.2)	21 (48.8)	0.02 (.999)
	Divorce/separate	15 (25.9)	8 (53.3)	7 (46.7)
School satisfaction	Yes	29 (50.0)	16 (55.2)	13 (44.8)	0.73 (.694)
	No	26 (44.8)	12 (46.2)	14 (53.8)
	No response	3 (5.2)	2 (66.7)	1 (33.3)
Economic status	High	6 (10.3)	2 (33.3)	4 (66.7)	1.44 (.486)
	Moderate	41 (70.7)	21 (51.2)	20 (48.8)
	Low	11 (19.0)	7 (63.6)	4 (36.4)
Income resources	Both parents	18 (31.0)	12 (66.7)	6 (33.3)	3.46 (.326)
	Father	21 (36.2)	8 (38.1)	13 (61.9)
	Mother	16 (27.6)	8 (50.0)	8 (50.0)
	Others	3 (5.2)	2 (66.7)	1 (33.3)
Middle school grades	High	8 (13.8)	4 (50.0)	4 (50.0)	0.07 (.964)
	Moderate	22 (37.9)	11 (50.0)	11 (50.0)
	Low	28 (48.3)	15 (53.6)	13 (46.4)
Physical problems	Yes	23 (39.7)	14 (60.9)	9 (39.1)	1.28 (.294)
	No	35 (60.3)	17 (45.7)	19 (54.3)
Depressed mood	Frequently	18 (34.0)	10 (55.6)	8 (44.4)	1.93 (.381)
	Sometimes	23 (43.4)	13 (56.5)	10 (43.5)
	Rarely	12 (22.6)	4 (33.3)	8 (66.7)
Hobby	Yes	20 (34.5)	13 (65.0)	7 (35.0)	2.16 (.174)
	No	38 (65.5)	17 (44.7)	21 (55.3)
Negative life events	Many	18 (31.0)	10 (55.6)	8 (44.4)	1.73 (.409)
	Moderate	25 (43.1)	13 (52.0)	12 (48.0)
	No	15 (25.9)	6 (40.0)	9 (60.0)

Variables	Test point	Intervention group (n=30)	Comparison group (n=28)	t (p)	Factor	F (p)
Variables	Test point	M±SD	M±SD	t (p)	Factor	F (p)
Depression	Pre	85.47±7.97	83.68±5.87	0.97 (.338)	Time	19.29 (<.001)
	Post	77.00±11.75	83.18±10.31	−2.47 (.017)	Group	5.56 (.022)
	F/u	74.23±10.82	84.86±10.51	−3.79 (<.001)	Time×Group	29.39 (<.001)
Dysphoric	Pre	24.47±3.22	24.68±2.75	−0.27 (.789)	Time	11.37 (<.001)
	Post	21.03±4.69	23.93±3.86	−2.56 (.013)	Group	7.77 (.007)
	F/u	20.60±4.25	24.18±3.63	−3.44 (.001)	Time×Group	5.90 (.004)
Anhedonia/ negative affect	Pre	16.57±3.34	16.29±2.97	0.34 (.737)	Time	2.04 (.135)
	Post	16.40±3.77	17.46±3.02	−1.19 (.240)	Group	1.57 (.215)
	F/u	16.00±3.53	18.18±3.42	−2.38 (.021)	Time×Group	6.43 (.002)
Negative	Pre	23.17±2.88	22.07±3.45	1.32 (.194)	Time	18.74 (<.001)
self-evaluation	Post	19.67±3.85	21.46±3.35	−1.19 (.240)	Group	1.81 (.183)
	F/u	19.37±3.68	21.82±3.52	−2.38 (.021)	Time×Group	14.40 (<.001)
Somatic	Pre	21.27±3.26	20.64±2.23	0.85 (.402)	Time	17.33 (<.001)
	Post	19.13±3.84	20.32±3.30	−1.26 (.213)	Group	1.56 (.216)
	F/u	18.30±3.50	20.61±3.14	−2.64 (.011)	Time×Group	16.51 (<.001)

Table 1. The Contents of School-based Intervention Program for a Middle School Girls with Depression

Table 2. Homogeneity Test for Demographic Characteristics of the Participants (N=58)

Table 3. Comparison of Depressive Symptoms between Intervention and Comparison Groups (N=58)

Pre=Pretest before intervention; Post=Posttest after 10th intervention; F/u=Follow-up test after third follow-up counseling.