Predictors and outcomes of engagement in an online depression prevention program for final year secondary school students

Abstract

Although school-based delivery of online interventions can effectively prevent depression and other common mental disorders, little is known about the characteristics of students who engage with these programs. This study aimed to identify predictors of two indicators of adolescent engagement (program usage and skill enactment) with a school-based online depression prevention program. The study also explored the association between skill enactment and mental health outcomes. Participants were 204 final-year secondary school students (M = 16.7 years, SD = 0.51 years; 111 females) from the intervention condition of a cluster randomized controlled trial conducted in 10 selective and partially selective government schools in Australia between 2015 and 2016. Program usage was measured as number of modules completed and skill enactment was assessed using a self-report questionnaire at post-intervention to determine the frequency of implementing program strategies (e.g., cognitive restructuring, activity scheduling). Predictors of engagement included demographics, mental health-related variables, and psychological factors (e.g., mastery). Regressions indicated that possible history of depression predicted fewer modules completed, whereas higher baseline anxiety, mastery, and higher perceived level of learning from the program predicted greater skill enactment. Mixed models did not show a significant effect of skill enactment on symptoms of depression, generalized anxiety, social phobia, or personal stigma. Future work is needed to investigate whether the results apply to students enrolled in non-selective programs and examine the effects of skill enactment and other possible mechanisms on outcomes in order to guide the refinement of future interventions.