***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 There is limited prospect i ve research on the relation between school connectedness ( i.e. , the extent to which students feel accepted , valued , respected , and included in the school ) and mental health symptoms in adolescents . A sample of 2,022 students ( 999 boys and 1,023 girls ) ages 12 to 14 years were measured at 2 time points ( 12 months apart ) on school connectedness and mental health symptoms ( general functioning , depression , and anxiety symptoms ) . School connectedness correlated extensively with concurrent mental health symptoms at both time points ( between 38 % and 55 % covariation with depression , 26 % to 46 % with general functioning , and 9 % and 16 % for anxiety symptoms ) . Using hierarchical linear modeling , school connectedness also predicted depressive symptoms 1 year later for both boys and girls , anxiety symptoms for girls , and general functioning for boys , even after controlling for prior symptoms . The reverse , however , was not true : Prior mental health symptoms did not predict school connectedness 1 year later when controlling for prior school connectedness . Results suggest a stronger than previously reported association with school connectedness and adolescent depressive symptoms in particular and a predictive link from school connectedness to future mental health problems Abstract Objectives : To establish the relation between recurrent peer victimisation and onset of  self reported symptoms of anxiety or depression in the early teen years . Design : Cohort study over two years . Setting : Secondary schools in Victoria , Australia . Participants : 2680 students surveyed twice in year 8 ( aged 13 years ) and once in year 9 . Main outcome measures : Self reported symptoms of anxiety or depression were assessed by using the computerised version of the revised clinical interview schedule .  Incident cases were students scoring ≥12 in year 9 but not previously . Prior victimisation was defined as having been bullied at either or both survey times in year 8 . Results : Prevalence of victimisation at the second survey point in year 8 was 51 % ( 95 % confidence interval 49 % to 54 % ) , and prevalence of self reported symptoms of anxiety or depression was 18 % ( 16 % to 20 % ) . The incidence of self reported symptoms of anxiety or depression in year 9 ( 7 % ) was significantly associated with victimisation reported either once ( odds ratio 1.94 , 1.1 to 3.3 ) or twice ( 2.30 , 1.2 to 4.3 ) in year 8 . After adjustment for availability of social relations and for sociodemographic factors , recurrent victimisation remained predictive of self reported symptoms of anxiety or depression for girls ( 2.60 , 1.2 to 5.5 ) but not for boys ( 1.36 , 0.6 to 3.0 ) . Newly reported victimisation in year 9 was not significantly associated with prior self report of symptoms of anxiety or depression ( 1.48 , 0.4 to 6.0 ) . Conclusion : A history of victimisation and poor social relationships predicts the onset of emotional problems in adolescents . Previous recurrent emotional problems are not significantly related to future victimisation . These findings have implication s for how seriously the occurrence of victimisation is treated and for the focus of interventions aim ed at addressing mental health issues in adolescents . What is already known on this topic Being bullied is a common experience for many young people Victimisation is related to depression and , to a lesser extent , anxiety , loneliness , and general self esteem Debate remains as to whether victimisation precedes the onset of emotional problems or whether young people with emotional problems “ invite ” victimisation What this study adds A history of victimisation predicts the onset of anxiety or depression , especially in adolescent girls Previous recurrent emotional problems are not significantly related to future victimisation Reduction in bullying in schools could have a substantial impact on the emotional wellbeing of young This three-wave prospect i ve study investigated the reciprocal relationships among school-related stress , school-related social support  , and distress in a cohort of 767 secondary school students ( mean age 13.9 years ) .  Stress , support , and distress  were measured at three occasions with six-month lags between . Reciprocal relationships were analyzed with multivariate multilevel modeling ( MLwiN ) . Each of the three factors at baseline predicted change in one or two of the other factors at subsequent measurements , indicating a complex pattern of reciprocal relationships among stress , support , and distress across time . A high level of distress at baseline predicted a lower level of support and a higher level of stress six months later . High levels of stress at baseline predicted a higher level of distress and a lower level of support 12 months later . The results are consistent with a transactional and dynamic model of stress , support , and distress , and indicate the need to view school-related stress , support , and distress as mutually dependent factors Study objective : The aim of this study was to determine the effect of a multilevel school based intervention on  adolescents ’ emotional wellbeing and health risk behaviours . Design : School based cluster r and omised controlled trial . Students were surveyed using laptop computers , twice in the first year of intervention and annually thereafter for a further two years . Setting : Secondary schools . Participants : 2678 year 8 students ( 74 % ) participated in the first wave of data collection . Attrition across the waves was less than 3 % , 8 % , and 10 % respectively with no differential response rate between intervention and control groups at the subsequent waves ( 98 % v 96 % ; 92 % v 92 % , and 90 % v 89 % respectively ) . Main results : A comparatively consistent 3 % to 5 % risk difference was found between intervention and control students for any drinking , any and regular smoking , and friends ’ alcohol and tobacco use across the three waves of follow up . The largest effect was a reduction in the reporting of regular smoking by those in the intervention group ( OR 0.57 , 0.62 , and 0.72 at waves 2 , 3 , and 4 respectively ) . There was no significant effect of the intervention on depressive symptoms , and social and school relationships . Conclusions : While further research is required to determine fully the processes of change , this study shows that a focus on general cognitive skills and positive changes to the social environment of the school can have a substantial impact on important health risk behaviours OBJECTIVES We sought to test the efficacy of an intervention that was design ed to promote social inclusion and commitment to education , in reducing among students health risk behaviors and improving emotional well-being . METHODS The design was a cluster-r and omized trial in 25 secondary schools in Victoria , Australia . The subjects were 8th- grade students ( aged 13 to 14 y ) in 1997 ( n=2545 ) and subsequent 8th- grade students in 1999 ( n=2586 ) and 2001 ( n=2463 ) . The main outcomes were recent substance use , antisocial behavior , initiation of sexual intercourse , and depressive symptoms . RESULTS At 4-year follow-up , the prevalence of marked health risk behaviors was approximately 20 % in schools in the comparison group and 15 % in schools in the intervention group , an overall reduction of 25 % . In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models ( odds ratio [OR]= 0.69 ; 95 % confidence interval [CI]= 0.50 , 0.95 ) and adjusted models ( OR= 0.71 ; CI = 0.52 , 0.97 ) for potential confounders . There was no evidence of a reduction in depressive symptoms . CONCLUSION The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments BACKGROUND Depressive disorders are experienced by 3 - 5 % of the adolescent population at any point of time . They adversely affect adolescent development in a range of areas and greatly increase risk for suicide . The present study investigated the effectiveness of a universal intervention design ed to reduce depressive symptoms among students commencing high school . METHODS Twenty-five pairs of secondary schools matched on socio-economic status were r and omly assigned to either an intervention or a comparison group ( n = 5,634 Year 8 students ) . The intervention extended over a 3-year period and utilised a comprehensive classroom curriculum programme , enhancements to the school climate , improvements in care pathways , and community forums . A range of measures completed by students , average age at baseline = 13.1 years ( SD = .5 ) , and teachers was used to assess changes in depressive symptoms , risk and protective factors relevant to depression , and the quality of the school environment . RESULTS Changes in the level of depressive symptoms and in the levels of risk and protective factors experienced by students in the two groups did not differ significantly over the 3 years of the study . Furthermore , statistically significant differences in the ratings of school climate across this time period were found only for staff-rated assessment s. CONCLUSIONS Despite using an extensive , structured programme , based on best evidence to increase protective factors and reduce risk factors at the individual and school levels , the intervention did not reduce levels of depressive symptoms among participating adolescents . The results draw attention to the difficulties faced when implementing large-scale , school-based , universal preventive interventions . These include the need to develop methods to effectively train teachers across large geographical regions to deliver new interventions with fidelity , the difficulty of engaging young adolescents with prevention programmes , and the long period of time required to implement policy and practice changes at ' whole-school ' levels The Gatehouse Project is an innovative , comprehensive approach to mental health promotion in secondary schools . It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes . The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team ; the identification of risk and protective factors in each school ’s social and leaning environment from student surveys ; and , through the use of these data , the identification and implementation of effective strategies to address these issues . The project evaluation used a cluster-r and omized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children . This article describes and accounts for how system-level changes have been made in schools through a process of capacity building . This encourages teachers , parents , and students to view the core business of education differently In this prospect i ve study , we investigated the effects of socioenvironmental conditions on adjustment during early adolescence . Participants ( N = 339 ) were assessed at the beginning of the school year and at follow-up approximately 7 months later . Both stressful events and social support  made significant contributions to the prediction of psychological distress and conduct problems at follow-up , controlling for initial levels of adjustment in each of these areas . Conditions related to socioeconomic disadvantage predicted poorer academic performance and higher levels of absences and disciplinary problems at school . Youths who experienced multiple conditions of socioeconomic disadvantage were found to demonstrate heightened vulnerability to stressful events ( daily hassles ) as well as a greater potential to benefit from social support received from adults in the school setting The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials PURPOSE To investigate the effectiveness of a universal intervention design ed to reduce depressive symptoms experienced by adolescents at high school . The results from annual assessment s during the 3-year intervention and a 2-year follow-up are reported . METHODS Twenty-five pairs of secondary schools matched on socio-economic status were r and omly assigned to either an intervention or a comparison group ( n = 5,63 
    Output:
    
There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health .
Multilevel studies showed school effects were smaller than individual-level effects .
: There is limited evidence that the school environment has a major influence on adolescent mental health , although student perceptions of teacher support and school connectedness are associated with better emotional health .
R and omized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs