Table 1.
Some of the novel multimodal approaches utilized in EMPATHY program.
Fig 1.
Consort flow chart demonstrating allocation of students.
The figure shows how many students entered the study and (on the left-hand side) how many were allocated to the CBT treatment as well as (on the right-hand side) how many completed both baseline and 12-week follow-up ratings and formed the study population.
Table 2.
List of questions asked.
Fig 2.
Algorithm for determining which students were in the “actively suicidal” group.
The figure shows how scores on the three questions regarding suicide risk determined if the student was in the high suicide risk group or the medium suicide risk group. Together, these students were considered the “actively suicidal" group, and were interviewed individually within 2 days for the high suicide risk group or within 5 days for the medium suicide risk group.
Fig 3.
Algorithm for determining which students were in the “low suicide risk” group.
The figure shows how scores on the three questions regarding thoughts of suicide determined if the student was in the low suicide risk group. These students were not interviewed individually, but were offered participation in a guided internet-based cognitive behavioural therapy (CBT) program.
Table 3.
Variation by Grade and by School: change from baseline to 12-week follow-up.
Table 4.
Correlations between the scores on the 5 subscales in the combined EMPATHY scale score, using Spearman’s rank correlation coefficient.
Table 5.
Change in scores from baseline to follow-up for those scoring in top 25% of combined EMPATHY scale scores.
Fig 4.
Difference in outcome in High Risk group depending if they had guided internet-based CBT.
There were a total of 409 individuals who were identified as being in the High Risk group who had ratings at both baseline and at 12-week follow-up. Of these 151 took part in the guided internet-based cognitive behavioural therapy (CBT) program. The figure shows the mean change in score for the EMPATHY scale and each of the 5 subscales (depression, anxiety, drugs, alcohol, and tobacco (DAT), self-esteem, and quality-of-life (QoL)) for the 151 who took part compared to changes in score in the 258 who did not. It can be seen that the group who took part had significantly better reductions in EMPATHY and depression scores. There were also smaller, but significant, reductions in self-esteem and quality of life in the group who had the CBT program. The following symbols indicate the degree of statistical significance, * p<0.05, ** p<0.001, *** p<0.0001
Fig 5.
Distribution of depression scores at baseline.
The distribution of depression scores is shown for all 7 Grades (average ages at start of study are 11.3 for Grade 6, 12.3 for Grade 7, 13.3 for Grade 8, 14.3 for Grade 9, 15.3 for Grade 10, 16.4 for Grade 11, and 17.4 for Grade 12). Although not directly comparable to previous studies, as the depression score was not directly comparable to PHQ-A scores, and do not have diagnostic validity, we indicate the distribution of students into the ranges that in previous PHQ-A studies have been proposed to indicate the presence of a depressive disorder. These are not depressed (0–4), minor symptoms (5–9), mild depression (10–14), moderate depression (15–19), and severe depression (>20). It can be seen that the distribution of symptoms shows that scores compatible with mild depression are seen most frequently in Grade 9, whereas scores compatible with severe depression occur relatively equally across all Grades from 7–12.
Table 6.
Level of suicide risk at 12-week follow-up in students who completed both ratings (n = 2,790).
Table 7.
Number of students in different risk levels for suicide at baseline and at 12-week follow-up for total population.
Fig 6.
Distribution of anxiety scores at baseline.
The distribution of anxiety scores is shown for all 7 Grades (average ages at start of study are 11.3 for Grade 6, 12.3 for Grade 7, 13.3 for Grade 8, 14.3 for Grade 9, 15.3 for Grade 10, 16.4 for Grade 11, and 17.4 for Grade 12). While these scores do not have diagnostic validity, we indicate the distribution of anxiety scores that in previous studies have been proposed to indicate the presence of an anxiety disorder. These are not anxious (0–7), possible anxiety disorder (8–10), and anxiety disorder (>11). It can be seen that there more than 30% of students in Grades 9, 11, and 12 how scored 11 or more, suggesting frequent anxiety symptoms. Even in the younger Grades more than 15% of students in every grade had frequent anxiety symptoms. This finding is consistent with previous research regarding the frequency of anxiety disorders in youth.
Fig 7.
Distribution of drugs, alcohol, and tobacco scores at baseline.
The distribution of scores for the use of drugs, alcohol, and tobacco is shown for all 7 Grades (average ages at start of study are 11.3 for Grade 6, 12.3 for Grade 7, 13.3 for Grade 8, 14.3 for Grade 9, 15.3 for Grade 10, 16.4 for Grade 11, and 17.4 for Grade 12). While these scores do not have diagnostic validity, we indicate the distribution of these scores. It can be seen that at all scores the distribution is that the oldest youth have more use of drugs, alcohol, and tobacco, and have been involved in more significant activities that may put them at risk. It is consistent with previous studies that less than 30% of youth in Grade 12 have not used drugs, alcohol, or tobacco in the previous 12-months, compared to more than 95% of those in Grade 6.