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The study aims to examine the effectiveness of internet-based Parent-Adolescent Joint Interventions in improving the mental health outcomes of participants, specifically by reducing symptoms of depression, anxiety, and PTSD, as measured by the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder-7 scale (GAD-7), and the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Adolescents will be recruited from middle schools and randomly assigned to one of three groups: (a) psychoeducation, (b) psychoeducation + emotional skills enhancement, or (c) psychoeducation + emotional skills enhancement + positive childhood experience promotion. The school-based intervention will consist of 4-8 sessions, with assessments conducted at baseline, post-treatment, and a 3-month follow-up. Investigators will conduct multilevel models (MLMs) and structural equation models (SEMs) to investigate the impact of Adverse Childhood Experiences (ACEs), Positive Childhood Experiences (PCEs), alexithymia, and emotion regulation abilities on mental health outcomes in adolescents.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Psychoeducation group （PsyE） | Active Comparator | Psychoeducation consists of parent and adolescent psychoeducation. The content includes an introduction to stress, emotional distress and mental disorders. |
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| Psychoeducation + Emotional Skills (PsyE+EmoS) | Experimental | Psychoeducation includes sessions for both parents and adolescents, offering the same content as the control group, which introduces stress, emotional distress, and mental disorders via online programe. In addition, the emotional skills enhancement sessions provide online materials focused on emotional awareness and emotion regulation strategies, along with tasks related to the content. Participants will also be required to complete a weekly writing assignment, upload their written contents, and assess their level of subjective discomfort following each writing exercise. |
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| Psychoeducation + emotional skills + PCE (PsyE+EmoS+PoCE) | Experimental | In comparison to the PsyE+EmoS group, this group additionally requires parents to complete a weekly parent-child communication task via online programe aimed at fostering positive childhood experiences. Parents are also expected to document and upload the details of these tasks each week. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PCE promotion | Behavioral | The intervention requires parents to complete a weekly parent-child interaction task online designed to foster positive childhood experiences. Parents will engage in structured activities with their children and document the interactions. Each week, they are expected to upload a report. |
| Measure | Description | Time Frame |
|---|---|---|
| Alexithymia | A 36-item Peking alexithymia scale measures thoughts and behaviors that prevent people from feeling or recognizing negative emotions on a 5-point Likert scale (1 to 5, and total scores vary from 36 to 180). A higher score represents more severe alexithymia. | baseline, post treatment(1 month), 3 month follow-up |
| Irritability | A 17-item irritability measurement scale, the Peking irritability scale, measures impulsive emotions, thoughts, and behaviors on a 5-point Likert scale (score from 1 to 5, and total score varies from 17 to 85). A higher score represents higher irritability. | baseline, post treatment(1 month), 3 month after post treatment |
| PTSD for adolescents | The Child PTSD Symptom Scale for DSM-5 (CPSS-5) for adolescents and children (scores from 0 to 4, and total scores vary from 0 to 80). A higher score represents worse PTSD symptoms. | baseline, post treatment(1 month), 3 month after post treatment |
| Resilience | A 10-item resilience measurement scale, the Connor-Davidson resilience scale, measures resilience on a 5-point Likert scale (score from 0 to 4, and total score varies from 0 to 40). A higher score represents better resilience . | baseline, post treatment(1 month), 3 month after post treatment |
| Emotion awareness | A 30-item Emotion awareness questionnaire measures emotion awareness on a 3-point Likert scale (1 to 3, and total scores vary from 30 to 90). A higher score represents better emotion awareness. | baseline, post treatment(1 month), 3 month after post treatment |
| Emotion regulation |
| Measure | Description | Time Frame |
|---|---|---|
| Self-esteem | A 10-item self-esteemmeasurement scale, Rosenberg self-esteem scale, measures self-esteem on a 4-point Likert scale (score from 0 to 3, and total score varies from 0 to 30), with higher scores indicating greater self-esteem. | baseline, post treatment(1 month), 3 month after post treatment |
| Subjective Happiness Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Suicide | The suicidal behaviors questionnaire-revised (SBQ-R) for adolescents and children (total scores vary from 3 to 18). A higher score represents a higher suicide risk. | baseline, post treatment(1 month), 3 month after post treatment |
| Social support |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Diannan middle school | Baoding | Hebei | China |
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| ID | Term |
|---|---|
| D013315 | Stress, Psychological |
| D013313 | Stress Disorders, Post-Traumatic |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
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| Psychoeducation | Behavioral | Psychoeducation includes sessions for both parents and adolescents, covering key topics such as stress, emotional distress, and mental disorders. The content provides foundational knowledge to help participants understand and manage these challenges. |
|
| Emotiaonl skill enhancement | Behavioral | This intervention combines online material with practical, emotion-focused activities. Participants will receive training online on emotional awareness and emotion regulation strategies, along with completing weekly writing assignments. These assignments focus on recent negative events and the emotions associated with them, encouraging emotional expression and processing. |
|
An 18-item cognitive emotion regulation questionnaire measures the ability of emotion regulation on a 5-point Likert scale (1 to 5, and total scores vary from 18 to 90). A higher score represents better emotion regulation. |
| baseline, post treatment(1 month), 3 month after post treatment |
| Depression | The 9-item patient health questionnaire (PHQ-9) for adults (score from 0 to 3, and total score varies from 0 to 27). A higher score represents worse depression symptoms. | baseline, post treatment(1 month), 3 month after post treatment |
| Generalized anxiety disorder | The Generalized Anxiety Disorder-7 scale (GAD-7) for adults, adolescents, and children (scored from 0 to 3, and total score from 0 to 21). A higher score represents worse anxiety symptoms. | baseline, post treatment(1 month), 3 month after post treatment |
A 4-item subjective happiness scale measures happiness (score from 1 to 7, and total score vary from 4 to 28). A higher score represents a happier state. |
| baseline, post treatment(1 month), 3 month after post treatment |
| Seeking for help | A 10-item help-seeking scale measures on a 7-point Likert scale (score from 1 to 7, and total score varies from 10 to 70), with higher scores indicating greater willingness to seek help from others. | baseline, post treatment(1 month), 3 month after post treatment |
| Insomnia Severity | The severity of insomnia symptoms will be assessed using the Insomnia Severity Index (ISI). This 7-item self-report measurement evaluates the severity of insomnia symptoms, the level of satisfaction with sleep, interference with daily functioning, noticeability of impairment attributed to sleep problems, and the level of distress caused by sleep disturbance (score from 0 to 4, and total score vary from 0 to 32). Each item is rated on a 5-point scale, providing a comprehensive measure of insomnia severity. | baseline, post treatment(1 month), 3 month after post treatment |
The 12-item Multidimensional Scale of Perceived Social Support (score from 1 to 7, and total score varies from 12 to 84). A higher score represents better social support.
| baseline, post treatment(1 month), 3 month after post treatment |
| Positive Childhood Experiences | A questionnaire measuring positive childhood experiences with 13 items(total scores vary from 0 to 64). A higher score represents a more positive childhood experiences. | baseline, post treatment(1 month), 3 month after post treatment |
| Behavior performances | A 22-item behavior performance questionnaire measures various behavior performances such as study time, phone use, school performance, drinking alcohol, smoking, stealing, fighting, and lying. | baseline, post treatment(1 month), 3 month after post treatment |
| Adverse events | A 6-item questionnaire asks about adverse events since last month, including self-harm, experiencing emotional abuse, experiencing physical abuse, feeling severe distress, mental illness events (e.g., panic attack), and physical injury. | baseline, post treatment(1 month) |
| Non-suicidal self-injury | The non-suicidal self-injury assessment tool (NSSI-AT-Severity) for adolescents and children (total scores vary from 5 to 16). A higher score represents a worse self-injury situation. | baseline, post treatment(1 month), 3 month after post treatment |
| Game Addiction Scale | A 7-item game addiction scale, measures game addiction on a 5-point Likert scale (score from 1 to 5, and total score varies from 7 to 35), with higher scores indicating worse game addiction. | baseline, post treatment(1 month), 3 month after post treatment |
| D001523 | Mental Disorders |