Strengthening adolescent well-being—controlled feasibility from two Swedish upper secondary schools

BACKGROUND: Positive mental health refers to a state of well-being in which children and young people realize their own abilities, learn to cope with the everyday stresses of life, develop a positive sense of identity, learn to manage thoughts and emotions, build social relationships, and acquire education that fosters active citizenship. There is a need for a stronger evidence base regarding mental health promotion to address mental health issues in the young generation. To further help bridge this gap, this study compared and evaluated a universal health-promoting intervention facilitated by Student Health Care Teams (SHCTs) for Grade 12 students at two schools, and assessed its effects on students' self-reported well-being, resilience, strengths and difficulties, and mental health. Furthermore, the study aimed to qualitatively evaluate the intervention from students' and facilitators' perspectives. METHOD: This non-randomized feasibility study used an explanatory sequential mixed-methods design (MRC), which exploratory compared pre- and post-outcomes between boys and girls, and qualitative, deductive content analysis to make sense of the data. Comparisons between the experimental (n = 44) and control groups (n = 41) were made in terms of several self-reported measurements: the WHO-5, a short and generic global rating scale, which measures psychological well-being as the primary outcome; the Resilience Scale (RS); strength, which is measured by the Strengths and Difficulties Questionnaire (SDQ); and mental health, which is measured by the Hospital Anxiety and Depression Scale (HADS). Furthermore, there were nine focus group interviews (42 students in 5 groups; 10 SHCT members in 4 groups). RESULTS: Controlling for pre-intervention values (WHO-5, RS, HADsA, HADsD, and SDQ), the intervention increased the OR scores of the girls above post-intervention values on the WHO-5 (OR = 9.0; 1.4-56). The intervention did not improve the OR of higher scores in boys during follow-up (OR = 0.1; 0.09-1.4). Students and SHCTs generally found the intervention feasible. CONCLUSION: Girls appeared to benefit more from the intervention than boys, suggesting a need for gender-specific approaches. Despite time demands, school health teams valued the model for supporting interprofessional, school-based health promotion. However, larger studies are needed to confirm these findings.