The first version of the Mental Health Awareness Programme for adolescents was initially tested in nine countries, distributed over five continents. The study was carried out under the auspices and support of the World Psychiatric Association (WPA), the World Health Organization (WHO) and the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP), showing significant improvements in attitudes and behaviours of children, parents and teachers exposed to the program (Hoven CW et al., 2009). An updated version of the program, the Youth Aware of Mental Health (YAM) programme, was evaluated in a EU-wide Randomized Controlled Trial (RCT), namely the Saving and Empowering Young Lives in Europe (SEYLE) research project. The SEYLE-RCT research project was performed to evaluate and compare the effectiveness of different interventions for mental health promotion, suicide prevention and help-seeking behaviour among adolescents (Wasserman D et al., 2010; Carli et al., 2013; Wasserman D et al., 2015). The interventions included three different preventative approaches designed to empower key actors, namely: mental health professionals (Profscreen), teachers and other school staff (Question, Persuade, Refer: QPR, a gatekeeper training programme) and the pupils themselves (Youth Aware of Mental Health, YAM ).
The three interventions were compared with a control group, which, for ethical reasons, comprised a minimal intervention. Structured evaluation questionnaires contained well-established psychometric scales, demographics, peer relationships, values, etc., which were administered to pupils at baseline, and at a 3-month and 12-month follow-up. A total of 12,395 pupils (mean age: 14.9) were recruited from 179 schools randomly selected in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre.
The SEYLE-RCT provided comprehensive information about the prevalence of risk behaviours and psychopathology among European adolescents. In more than 12,000 adolescents it was found that 8.1% of them suffer from moderate to severe depressive symptoms; 4.7% reported severe to extreme anxiety; 10.3% had conduct problems. Hyperactivity was present in 9.4% of the sample; 4.2% reported a lifetime suicide attempt. Regarding risk behaviours: 8.2% of adolescents reported drinking alcohol more than once a week; 10.2% reported smoking at least five cigarettes per day; 10.1% of the adolescents reported spending at least 5 hours per day using media for reasons not related to school or work (Carli et al. 2014); 4.4% showed pathological Internet use (Durkee et al. 2012), which was associated with depression, anxiety, conduct problems and suicidal behaviour (Kaess et al. 2014). Furthermore, the prevalence of all risk behaviours increased with age and most were significantly more frequent among boys. However, girls were more frequently affected by psychiatric symptoms (Carli et al., 2014). Other SEYLE-RCT publications showed that 29.2% of European adolescents had symptoms of subthreshold depression (Balazs et al., 2013), 27.6% displayed some kind of self-injurious behaviour in their lifetime (Brunner et al., 2014); 12.6% of adolescents who underwent screening by a mental health professional required subsequent mental health care (Kaess et al., 2013). It was also shown that 15.5% of adolescents sleep less than six hours per night and that reduced sleep is associated with emotional and behavioural difficulties, anxiety and suicidal ideation (Sarchiapone et al., 2014). A full list of publications reporting SEYLE findings can be found here.
Longitudinal analyses showed significant improvements in adolescent mental health with the active Youth Aware of Mental Health programme compared to the other two interventions and the control group, by effectively reducing depression, and negative emotional symptoms, The most important results were the significant reductions in incident suicide attempts, severe suicidal ideation and suicide plans, which are the utmost consequences of stress and mental health problems (Wasserman D et al., 2015). Furthermore, the YAM programme engendered understanding between pupils, encouraged peer support and allowed the pupils to get to know each other better, helping them to understand that they were not alone with their problems and thus they were more likely to seek help when needed. It was also very well received and appreciated by the adolescents, who found it a useful and inspiring experience (Wasserman C et al., 2012). YAM also helped adolescents who had existing mental health problems as the programme included facilitation of clinical evaluation and help.