Evaluation of a school-based depression prevention approach among adolescents with elevated depressive symptoms attending special education: study protocol of a cluster randomized controlled trial

BMC Psychiatry. 2025 May 22;25(1):517. doi: 10.1186/s12888-025-06955-5.

ABSTRACT

BACKGROUND: Adolescents are at risk of developing depressive symptoms and suicidality. Those attending special education, because of cognitive, physical, behavioral, emotional or learning disabilities, form a particularly vulnerable subgroup concerning the development of depressive disorders. Despite the fact that school-based prevention programs effectively reduce the risk of developing a depressive disorder in adolescents, approximately 7% of Dutch adolescents attend special education and remain unreached. There is also a lack of knowledge about effectiveness of depression and suicide prevention in this group. This study aims to evaluate the effectiveness of the adapted indicated prevention program ‘At Full Force – Special Needs Education’ for adolescents attending special education presenting elevated depressive symptoms.

METHODS: We will perform a cluster randomized controlled trial (RCT) to test the effectiveness of an indicated prevention program ‘At Full Force – Special Needs Education’. Participating schools will randomly be assigned to the intervention or control condition. A safety net consisting of gatekeepers will be realized at every school. Adolescents will be screened for depressive symptoms. Those with heightened levels of depressive symptoms can participate in the RCT. Participants in the intervention condition will receive a CBT-based prevention group training during school hours, comprising eight meetings of 45 min each. The training is a modified version of a previously studied training in general education called At Full Force (in Dutch: Op Volle Kracht). The control condition consists of care as usual. All participants and their parents will complete assessments at baseline, post-intervention and 6- and 12 months follow-up. At all times, adolescents will be guided to mental health care if necessary. The primary outcome will be depressive symptoms. Secondary outcomes will be suicidality, anxiety and somatic symptoms. Additional exploratory analyzes will be conducted.

DISCUSSION: Adolescents in special education usually encounter numerous challenges. Adolescents participating in the preventive training are expected to show lower levels of depressive symptoms at follow-up compared to the control condition. Depression prevention can favorably impact pre-existing psychopathology trajectories and can avert additional life challenges associated with depression.

TRIAL REGISTRATION: Clinicaltrials.gov NCT06203899 on January 2nd 2024.

PROTOCOL VERSION: May 6th 2025 (v2.1).

PMID:40399869 | DOI:10.1186/s12888-025-06955-5