A Systematic Review of Mental Health Interventions in Rural High Schools

Background and Purpose

Approximately 12% of adolescents meet the criteria for major depression or dysthymia and 30% meet the criteria for an anxiety disorder. If untreated, these adolescents are at risk for social and educational impairments, risk behaviors, school drop-out, elevated suicide risk, and substance abuse. Although rural and urban adolescents report similar rates of depression and anxiety, rural areas have less access to mental health care.

Schools are well-positioned to improve access to care for rural adolescents with mental disorders. School-based mental health services result in improved referral success and engagement of multiple support and social systems (i.e., teachers, parents, peers). However, due to limited resources, rural schools lack capacity to provide these services, and there is little research to inform service delivery in rural schools. This systematic review describes the state of the existing research evaluating treatments for depression and anxiety in rural high schools.

Methods

The authors searched PubMed, PsychINFO, and ERIC with no date limitations for articles related to treatment of depression and anxiety in rural schools. Studies were included if they involved a rural high--school setting, used valid and reliable depression and/or anxiety measures, and measured at least twice (e.g. pre- and post-test). Studies focusing on academic outcomes, suicidal ideation and/or crisis were excluded.

After the final studies were identified, the following data were extracted: participant details for test and control groups, intervention provider, intervention details, statistically and/or clinically significant differences in depression or anxiety in test and control groups, and intervention effect size.

Authors used the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool to assess the strength of studies based on selection bias, study design, confounder management, blinding, data collection, and withdrawals/dropouts. Scores for these categories were aggregated into an overall assessment of strong, moderate, or weak for each study.

Results

The search revealed 753 relevant abstracts, with only two articles meeting eligibility criteria. Both studies were uncontrolled, one cohort pre- and post-test design.  One study employed an in-class coping skills program (10-modules) to evaluate coping skills for students at risk for depression (n = 159 total; n = 14 students with high risk for depression; M = 14.5 years-old).  Pre- and post-test results indicate the program was successful in altering the coping skills of participants who were at high risk for depression.  The other study included in the systematic review utilized school-based psychotherapy services (N = 64 students; M = 16.3 years-old).  Specifically, the study evaluated non-manualized cognitive-behavioral therapy (M = 15 sessions) to examine pre- and post-intervention overall symptomology.  At post-treatment, 78% of participants had lower symptomology; 45% “recovered” and 8% “improved” according to the reliable change index (RCI) guidelines. 

Conclusions and Implications

Addressing the gap in research on mental health interventions in rural high schools calls for partnerships between universities and rural communities that aim to reduce barriers to delivering and evaluating school-based mental health services. There is also a need for funding that incentivizes these partnerships and research evaluating mental health services in rural schools.