***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Schools have been identified as an important place in which to support adolescent emotional health  , although evidence as to which interventions are effective remains limited . Relatively little is known about student and staff views regarding current school-based emotional health provision and what they would like to see in the future , and this is what this study explored . Methods A r and om sample of 296 English secondary schools were surveyed to quantify current level of emotional health provision . Qualitative student focus groups ( 27 groups , 154 students aged 12 - 14 ) and staff interviews ( 12 interviews , 15 individuals ) were conducted in eight schools , purposively sample d from the survey respondents to ensure a range of emotional health activity , free school meal eligibility and location . Data were analysed thematically , following a constant comparison approach . Results Emergent themes were grouped into three areas in which participants felt schools did or could intervene : emotional health in the curriculum , support for those in distress , and the physical and psychosocial environment . Little time was spent teaching about emotional health in the curriculum , and most staff and students wanted more . Opportunities to explore emotions in other curriculum subjects were valued . All schools provided some support for students experiencing emotional distress , but the type and quality varied a great deal . Students wanted an increase in school-based help sources that were confidential , available to all and sympathetic , and were concerned that accessing support should not lead to stigma . Finally , staff and students emphasised the need to consider the whole school environment in order to address sources of distress such as bullying and teacher-student relationships , but also to increase activities that enhanced emotional health . ConclusionS taff and students identified several ways in which schools can improve their support of adolescent emotional health , both within and outside the curriculum . However , such changes should be introduced as part of a wider consideration of how the whole school environment can be more supportive of students ' emotional health . Clearer guidance at policy level , more rigorous evaluation of current interventions , and greater dissemination of good practice is necessary to ensure adolescents ' emotional health needs are addressed effectively within schools BACKGROUND Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity . To prevent these outcomes , school-based cognitive-behavioral therapy ( CBT ) has been developed , but few studies include active control conditions . We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up . METHODS One thous and one hundred and thirty-nine children from Grade s 3 - 6 from a diverse sample of schools , were screened with the Multidimensional Anxiety Scale for Children and Children 's Depression Inventory . Those with t>60 on either measure were offered participation in a r and omized 12-week trial , school-based group CBT versus a structured after-school activity group of equal duration . We explored several therapeutic elements as potential predictors of change . RESULTS One hundred and forty-eight children participated ( 84 boys , 64 girls ; 78 CBT , 70 contrast ; 57 % Caucasian ) and 145 completed the program . Self-reported anxious and depressive symptoms decreased significantly over time ( η(2)=.15 and .133 , respectively ) , with no group by time interaction . There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-contrast ( 6/76 versus 12/69 ) . Positive reinforcement of child behavior was associated with change in anxiety symptoms ; checking homework was understood with change in depressive symptoms . CONCLUSIONS Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and structured activity programs . Replication , longer follow-up , and further studies of therapeutic elements in child CBT are indicated . IS RCT N Registry identifier : IS RCT N88858028 , url : A controlled trial was conducted to evaluate a prevention program aim ed at reducing depressive and anxious symptoms in rural school children . Seventh- grade children with elevated depression were selected . Nine primary schools ( n = 90 ) were r and omly assigned to receive the program , and 9 control schools ( n = 99 ) received their usual health education classes .  Children completed question naires on depression , anxiety , explanatory style , and social skills . Parents completed the Child Behavior Checklist ( T. M. Achenbach , 1991 ) . No intervention effects were found for depression . Intervention group children reported less anxiety than the control group after the program and at 6-month follow-up and more optimistic explanations at postintervention . Intervention group parents reported fewer child internalizing and externalizing symptoms at postintervention only A cluster , stratified r and omized design was used to evaluate the impact of universal , indicated , and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression  among 13- to 15-year-olds initially reporting elevated symptoms of depression . None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms , anxiety , externalizing problems , coping skills , and social adjustment .  All high-symptom students , irrespective of condition , showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up . There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions OBJECTIVE To conduct a placebo-controlled study of the effectiveness of a universal school-based depression prevention program . METHOD Three hundred ninety-two students age 13 to 15 from two schools were r and omized to intervention ( RAP-Kiwi ) and placebo programs run by teachers . RAP-Kiwi was an 11-session manual-based program derived from cognitive-behavioral therapy . The placebo was similar but with cognitive components removed . Outcomes were self-rated depression scales , the Reynolds Adolescent Depression Scale ( RADS ) , and the Beck Depression Inventory II ( BDI-II ) . Follow-up was to 18 months . Analysis was done on an intent-to-treat basis . RESULTS Immediately after the intervention , depression scores were reduced significantly more by RAP-Kiwi than by placebo , with a mean difference in change from baseline between groups of 1.5 on BDI-II ( CI > 0.38 , p = .01 ) and 2.24 on RADS ( CI > 0.22 , p = .04 ) . Categorical analysis confirmed significant clinical benefit with an absolute risk reduction of 3 % ( 95 % CI , 1 - 11 % , McNemar chi , p = .03 ) , with the " number needed to treat " for short-term benefit of 33 . Group differences in depression scores averaged across time to 18 months were significant on RADS but not on BDI-II . Retention rates were 91 % at 6 months and 72 % at 18 months . CONCLUSIONS The RAP-Kiwi program is a potentially effective public health measure . Confirmation of effectiveness measuring episodes of depressive illness and broader measures of adjustment is warranted OBJECTIVE To report experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on change over 1 school year in 3rd- grade children 's social-emotional , behavioral , and academic outcomes . METHOD This study employed a school-r and omized , experimental design and included 942 3rd- grade children ( 49 % boys ; 45.6 % Hispanic/Latino , 41.1 % Black/African American , 4.7 % non-Hispanic White , and 8.6 % other racial/ethnic groups , including Asian , Pacific Isl and er , Native American ) in 18 New York City public elementary schools . Data on children 's social-cognitive processes ( e.g. , hostile attribution biases ) , behavioral symptomatology ( e.g. , conduct problems ) , and literacy skills and academic achievement ( e.g. , reading achievement ) were collected in the fall and spring of 1 school year . RESULTS There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined . These include children 's self-reports of hostile attributional biases ( Cohen 's d = 0.20 ) and depression ( d = 0.24 ) . As expected based on program and developmental theory , there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32 - 0.59 ) on 4 other outcomes : children 's self-reports of aggressive fantasies , teacher reports of academic skills , reading achievement scaled scores , and children 's attendance . CONCLUSIONS This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better underst and ing of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding . The first-year impacts , combined with our knowledge of sustained and exp and ed effects after a second year , provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) A school-based intervention for preventing and reducing  children 's posttraumatic stress-related symptoms , somatic complaints , functional impairment , and anxiety due to exposure to terrorism was evaluated . In a quasi-r and omized controlled trial , elementary school students were r and omly assigned to an eight-session structured program , " Overshadowing the Threat of Terrorism " or to a waiting list control comparison group . Two months postintervention , the study group reported significant improvement on all measures . The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- ( PTSD- ) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism The effectiveness of a school-based primary prevention psychological program is assessed in the present study . The program was design ed to ( a ) improve students ' distress-coping , ( b ) prepare them as " gatekeepers " with regard to self-destructive behavior of peers and ( c ) assess the program 's face validity and social validity . The program was primarily based on cognitive-behavioral modification principles , procedures and techniques . Two hundred and thirty-seven students , drawn from six homeroom grade eight classes were r and omly assigned to experimental and control ( no intervention ) conditions . The program consisted of seven units passed during twelve weekly one-hour sessions . Overall , the program had a positive effect on attitudes , emotions , knowledge and awareness of distress coping skills . In addition , it had some degree of face validity and social validity from the students ' vantage point . These results lend support to the feasibility of a  cognitive-behavioral , school-based prevention program for students ' distress-coping enhancement Regular physical activity is associated with a reduced risk of all-cause mortality , and mortality due to cardiovascular disease and cancer . Among adolescents , physical activity is associated with benefits in the prevention and control of emotional distress , and improvement of self-esteem . Countries in transitional epidemiological scenarios , such as Chile , need to develop effective strategies to improve physical activity as a way to face the epidemic of chronic diseases . The objective of this study was to evaluate the effects of a school-based physical activity program on physical fitness and mental health status of adolescents living in a low socioeconomic status area in Santiago , Chile . A quasi-experimental design was used to evaluate the effects of the program over one academic year . The study included 198 students aged 15 years old . Two ninth grade classes were r and omly selected as the  intervention group , with two classes of the same grade as controls . A social planning approach was used to develop the intervention . The program was design ed and implemented based on student preferences , teachers ' expertise and local re sources . Changes in physiological and mental health status were assessed . After the intervention , maximum oxygen capacity achieved a significant increase of 8.5 % in the intervention versus 1.8 % in the control group ( p < 0.0001 ) . Speed and jump performance scores improved significantly more in the intervention versus the control group ( p > 0.01 ) . Anxiety score decreased 13.7 % in the intervention group versus 2.8 % in the control group ( p < 0.01 ) , and self-esteem score increased 2.3 % in the intervention group and decreased 0.1 % in the control group after the end of the program ( p < 0.0001 ) . No significant change was observed in the depressive score . Student participation and compliance with the program was > 80 % . To conclude , a school-based program to improve physical activity in adolescents of low socioeconomic status , obtained a high level of participation and achieved significant benefits in terms of physical fitness and mental health status BACKGROUND As part of a longitudinal study , prevalence findings of DSM-IV disorders are presented for a r and om sample of 3021 respondents aged 14 to 24 , with response rate 71 % . METHOD Assessment included various subtypes of disorders , subthreshold conditions and disorders that have only rarely been studied in other epidemiological surveys . The computer-assisted Munich-Composite International Diagnostic Interview ( M-CIDI ) was used to derive DSM-IV diagnoses . RESULTS Substance disorders were the most frequent ( lifetime 17.7 % ; 12-month 11.4 % ) , with abuse being considerably more frequent than dependence . Other mental disorders had a lifetime prevalence of 27.5 % ( 12-month , 17.5 % ) with depressive disorders ( 16.8 % ) being more 
    Output:
    
The majority of the review ed school-based interventions shows effectiveness in reducing or preventing mental disorders in adolescents .
However , effect size computation revealed only small-scale effectiveness .