School-based intervention study examining universal approaches for depressive symptoms and mental health literacy of pupils in Year 9 in England (AWARE): A multi-school, parallel group, cluster randomised controlled trial

Deighton, J, Hayes, D, Thompson, A, March, A, Thornton, E, Santos, J, Patalay, P, Mansfield, R, Deniz, E, Knowles, C, Humphrey, N, Stallard, P, Ashworth, E ORCID: 0000-0002-5279-4514, Moltrecht, B, Nisbet, K, Mason, C, Stepanous, J and Boehnke, J School-based intervention study examining universal approaches for depressive symptoms and mental health literacy of pupils in Year 9 in England (AWARE): A multi-school, parallel group, cluster randomised controlled trial. BJPsych Open. ISSN 2056-4724 (Accepted)

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Abstract

Background
Mental health problems in adolescents are increasing. Universal school-based interventions may play an important preventative role.

Aims
The aim of the AWARE trial was to evaluate two universal, school-based interventions that previously yielded evidence of impact in other countries: Youth Aware of Mental Health (YAM) and The Guide.

Method
AWARE was a multi-school, parallel group, cluster randomised controlled trial in English secondary schools. Schools were allocated on a 1:1:1 ratio to one of two interventions or a usual practice control group, balanced on current levels of mental health provision within schools, school location, deprivation, and urbanicity. Eligible participants were pupils in schools across England in Year 9 (aged 13-14 years) at baseline. The statistician, quantitative data analyst and economist were masked. Primary outcomes were depressive symptoms measured with the Short Mood and Feelings Questionnaire for YAM and intended help-seeking, measured with the General Help Seeking Questionnaire for The Guide (both at 3-6 months).

Results
153 schools were randomised, including 12,166 pupils (NYAM = 4,028 pupils, Nguide= 3,997 pupils, Ncontrol= 4,141 pupils). We found that for YAM vs control (N=5,516) there was no improvement in depressive symptoms (SMD=0·02; 95% CI –0·05 to 0·10), and for The Guide vs control (N=5,409) we found increased intended help-seeking compared to the control group (SMD=0·10; 95% CI 0·02 to 0·19). A notable minority of schools were unable to deliver YAM due to challenges implementing it. Increased depressive symptoms scores were observed in both intervention conditions, compared to control at the longer term follow up.

Conclusions
The findings indicate that participating in The Guide is effective at improving intended help-seeking. However, due to the increases in depressive symptoms associated with each intervention at the long term follow up, further investigation of the potential negative impacts of these programmes is advised before further rollout in English schools.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; 1117 Public Health and Health Services; 3202 Clinical sciences; 4203 Health services and systems
Subjects:	B Philosophy. Psychology. Religion > BF Psychology L Education > LB Theory and practice of education > LB1603 Secondary Education. High schools
Divisions:	Psychology (from Sep 2019)
Publisher:	Cambridge University Press
Date of acceptance:	16 April 2026
Date of first compliant Open Access:	5 June 2026
Date Deposited:	05 Jun 2026 13:00
Last Modified:	05 Jun 2026 13:00
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28736

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