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Ten-session school-based mental health package reduces depressive and anxiety symptoms in Chinese adolescents compared to routine curriculumTen Classes Can Lower Teen Stress in China

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Key Takeaway
Consider low-intensity school-based mental health packages for reducing adolescent depressive and anxiety symptoms.

This cluster-randomised controlled trial investigated the efficacy of a school-based mental health intervention among Chinese adolescents. The study was conducted across public schools in ten provinces in China, involving a total sample of 5,222 participants. The population consisted of adolescents with a mean age of 13.6 years, comprising 51.5% girls and 48.5% boys. The study design utilized a cluster-randomisation approach, assigning entire schools to either the intervention or control arm rather than randomising individual students. The intervention phase was not reported, and the specific publication type was not reported in the available data.

The intervention consisted of ten weekly sessions, each lasting 40 minutes, delivered by trained school-based mental health teachers or counsellors. These sessions utilized the Adolescent Mental Health Service Package (AMHSP), which was delivered using standardised manuals and multimedia materials. The comparator group received the routine school curriculum without any additional mental health content. This design aimed to test the feasibility and impact of integrating mental health promotion directly into the existing school schedule without requiring external specialists.

The primary outcomes assessed included depressive symptoms, anxiety symptoms, subjective wellbeing, and emotion regulation. At the one-month follow-up, the intervention group demonstrated significantly lower depressive symptoms relative to the control group. The effect size was a Standardised Mean Difference (SMD) of -0.09, with a 95% confidence interval ranging from -0.14 to -0.04 and a p-value of 0.0013. Similarly, anxiety symptoms were significantly lower in the intervention group compared to controls, with an SMD of -0.11, a 95% CI of -0.16 to -0.05, and a p-value of 0.0002.

Regarding secondary outcomes, no statistically significant differences were observed between groups for subjective wellbeing. The effect size for subjective wellbeing was an SMD of 0.02, with a 95% CI of -0.03 to 0.08 and a p-value of 0.85. Furthermore, the intervention did not result in significant differences in emotion regulation measures. Specifically, cognitive reappraisal showed an SMD of 0.03 (95% CI -0.02 to 0.09, p=0.33), and expressive suppression showed an SMD of -0.08 (95% CI -0.14 to -0.01, p=0.10). No absolute numbers were reported for these outcomes.

Safety and tolerability findings indicated that no adverse events were reported during the study period. Data on serious adverse events, discontinuations, and specific tolerability metrics were not reported. The study was funded by UNICEF. The authors noted a key methodological limitation: neither the students nor the facilitators were masked to the group allocation. This lack of blinding may introduce bias, although the cluster-randomised design and the nature of the intervention mitigate some concerns. The certainty of the evidence was not formally reported.

These results support the potential of a low-intensity, curriculum-integrated approach to promoting adolescent mental health. The study demonstrates a scalable strategy for early mental health promotion within the school setting, which is particularly relevant given the high prevalence of mental health issues in adolescents. However, the lack of masking and the absence of long-term follow-up data beyond one month limit the ability to draw definitive conclusions regarding sustained efficacy. Questions remain regarding the long-term maintenance of symptom reduction and the generalisability of these findings to other cultural or educational contexts. Clinicians should consider these findings as evidence supporting school-based mental health initiatives, while acknowledging the inherent limitations of the trial design.

  • Ten weekly classes reduced depression and anxiety symptoms in teens.
  • Trained school staff delivered the program, not outside experts.
  • Results are real, but the program is still in testing.

One Powerful Sentence

A simple, ten-week mental health course taught by regular teachers can help Chinese teenagers feel less sad and less worried.

A Heavy Burden on Young Minds

Imagine a teenager sitting alone in a crowded classroom. They feel heavy in their chest. Their mind races with worry. They might feel sad without knowing why. This is not just a movie scene. It is a daily reality for millions of young people around the world.

In China, this problem is growing fast. Schools are full of bright students, but many are struggling silently. Depression and anxiety are becoming common among teens. Suicide rates are a serious concern for parents and doctors everywhere.

Current help is hard to find. Most schools do not have enough counselors. Waiting lists are long. Many families cannot afford private therapy. Students often feel alone with their pain. They need help right where they are.

The Old Way vs. The New Way

For years, experts believed only big clinics could fix these problems. They thought you needed expensive therapists and long waiting rooms. The idea was that schools were just for math and science. Mental health was a separate, hard-to-reach world.

But here is the twist. A new study shows that regular classrooms can be the place for healing. Instead of waiting for a specialist, trained teachers can lead the way. They use a special plan called the Adolescent Mental Health Service Package.

This plan fits into the normal school day. It does not take away from math or history. It adds ten short, forty-minute sessions. These sessions teach skills to handle stress. They help students understand their feelings better.

How It Works: A Mental Toolkit

Think of your mind like a car. Sometimes the engine overheats. You feel stressed and anxious. You need a way to cool it down. This program gives students a toolkit for that.

It works like a lock and key. Sadness and worry are the locked doors. The program gives students the right key. The key is called "emotion regulation." It teaches them to change how they think about a problem.

Imagine you trip and fall. The old way is to cry and feel terrible. The new way is to say, "I am okay. I will get up." The program teaches students to talk to themselves kindly. It stops them from hiding their feelings. It helps them express what they feel safely.

The Study Snapshot

Researchers looked at real schools in China. They picked 18 public schools across ten provinces. These schools had 120 classrooms. Inside were 5,222 students. The average age was 13.6 years.

Half the classrooms got the new program. The other half continued with normal lessons. The teachers who led the program were trained specifically for this. They used simple guides and digital tools. They did not hide who was in which group. The students knew they were learning new skills.

The study lasted about a year. They checked in with students at the start. They checked again right after the ten classes. They checked one month later. They checked three months later. This timeline shows if the help lasts.

The results were clear and hopeful. After three months, the students in the program felt better. Their scores for depression went down. Their scores for anxiety also went down.

The drop was small on paper, but huge in real life. It means fewer students felt hopeless. It means fewer students felt trapped by worry. The program worked for both boys and girls. It worked in different cities and towns.

However, there was a catch. The program did not change how happy students felt. Their sense of general wellbeing stayed the same. They also did not get better at controlling their emotions in every way. Some skills stayed unchanged. This is important to understand.

But There Is a Catch

This doesn't mean this treatment is available yet.

The study is done, but the program is not ready for everyone. It is still in the research phase. Schools need to train their teachers first. They need to buy the right materials. It takes time to set up.

Also, this study happened in China. Other countries might need to adapt the plan. Every culture is different. What works in one place might need changes elsewhere. We cannot copy and paste this solution everywhere.

If you are a parent or teacher, this is good news. It shows that help can come from your own school. You do not need to wait for a miracle. Small steps can make a big difference.

Talk to your doctor about mental health. Ask if your school has similar programs. If you are a student, remember that feeling sad is okay. You can learn tools to handle it. Do not be afraid to ask for help.

Scientists will now look at how to spread this program. They want to see if it works in other countries. They will also study if the benefits last longer than three months.

More trials are coming. We need to know if this works for older teens too. We need to know if it helps with eating disorders or other issues. Research takes time. Patience is key.

Would You Consider This?

If a simple ten-week course could help your teen feel less stressed, would you support it? Is this something you would discuss with your doctor?

Early symptoms of anxiety in teens How schools can support mental health Signs of depression in children

Study Details

Study typeRct
Sample sizen = 2,620
EvidenceLevel 2
Follow-up1.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Mental health problems, including depression, anxiety, and suicide, pose a substantial burden on adolescents worldwide, making prevention a priority. In China, major challenges remain in implementing and evaluating school-based mental health programmes. The Adolescent Mental Health Service Package (AMHSP) is a multicomponent, culturally adapted, evidence-informed curriculum that is grounded in Positive Youth Development and designed to reduce depressive and anxiety symptoms and enhance mental wellbeing. The aim of this study was to evaluate the AMHSP for improving adolescent mental health in routine school settings. METHODS: This cluster-randomised controlled trial included public schools across ten provinces in China, with participants nested within schools and classrooms within each school randomly assigned 1:1 to either ten weekly 40-min AMHSP sessions (intervention), delivered by trained school-based mental health teachers or counsellors (facilitators) using standardised manuals and multimedia materials, or routine curriculum without additional mental health content (control). Given the nature of the school-based intervention, neither students nor facilitators were masked to group allocation, but all statistical analyses were done by an independent statistician masked to group allocation, and student self-report data were collected anonymously using secure, standardised platforms. The four primary outcomes were depressive symptoms (measured by nine-item Patient Health Questionnaire), anxiety symptoms (seven-item Generalized Anxiety Disorder Scale), subjective wellbeing (WHO Five-item Well-Being Index), and emotion regulation (ten-item Emotion Regulation Questionnaire, assessing both cognitive reappraisal and expressive suppression), which were self-reported at baseline, immediately after intervention, and at 1-month and 3-month follow-up. The primary outcome analysis of change from baseline at 3 months' follow-up in the four coprimary outcomes was analysed by linear mixed-effects models in the intention-to-treat population, which included all participants who completed at least one assessment. To control for multiple testing, we prespecified the use of the Benjamini-Hochberg false discovery rate (FDR) correction of p values. This trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2300076956) and has been completed. FINDINGS: Between Oct 12, 2023 and Oct 10, 2024, 5222 students from 120 classrooms in 18 public schools (mean age 13·6 years [SD 1·7]; 2687 [51·5%] girls and 2535 [48·5%] boys) were randomly assigned to the AMHSP intervention (n=2620) or control (n=2602), completed the baseline assessments, and were included in the primary outcome analysis. At 3 months, the AMHSP intervention group showed lower depressive symptoms (standardised mean difference [SMD] -0·09 [95% CI -0·14 to -0·04], p=0·0013) and anxiety symptoms (-0·11 [-0·16 to -0·05], p=0·0002) relative to the control group. No differences were seen in subjective wellbeing (SMD 0·02 [-0·03 to 0·08], p=0·85) or emotion regulation (cognitive reappraisal SMD 0·03 [-0·02 to 0·09], p=0·33; expressive suppression -0·08 [-0·14 to -0·01], p=0·10) at 3 months. No adverse events were reported. INTERPRETATION: The reduction in depression and anxiety symptoms 3 months after completing ten AMHSP sessions indicates a slow but meaningful benefit of the programme and supports the potential of a low-intensity, curriculum-integrated approach to promoting adolescent mental health. Delivery of the AMHSP by trained school-based mental health teachers demonstrates a scalable strategy for early mental health promotion in schools. FUNDING: UNICEF.
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