Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Problems

Study Overview
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Brief Summary
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Depression and anxiety are common mental health problems among adolescents worldwide. In Hong Kong, one in every four secondary school students reports clinical-level depression or anxiety symptoms. Extant research has found that a fixed mindset on intelligence and emotions and failure-is-debilitating belief are closely related to more depression and anxiety symptoms, hopelessness and suicidality. At the same time, recent research also points to the importance of parental mindset. Parents are the primary social support of adolescents; parental belief systems can strongly influence children's affect, behaviour and mental health. However, the effects of parent-child mindset interventions on a child's internalising problems have not yet been empirically examined. As emerging evidence has shown the promise of single-session interventions on reducing and preventing youth internalising problems, this project develops and examines a parent and child single-session intervention on mindsets of intelligence, failure and emotion (PC-SMILE) - to tackle depression and anxiety in young people and promote parental well-being. Using a two-arm randomised controlled trial, the proposed study will examine the effectiveness of PC-SMILE on reducing depression and anxiety symptoms among children, reducing parental anxiety, enhancing perceived control and parent-child relationships. A total of 366 parent-child dyads will be recruited from eight secondary schools and randomly assigned to either the PC-SMILE intervention group or the no-intervention waitlist control group. The PC-SMILE is approximately 45 minutes in length. Parent and child mental health and family relationship will be assessed at three time points: baseline before intervention (T1), within two weeks post-intervention (T2) and three months post-intervention (T3). A pilot test (n = 9) has supported the feasibility and acceptability of the PC-SMILE intervention. We hypothesise that the PC-SMILE intervention will significantly improve child depression and anxiety and parent anxiety (primary outcome) and significantly improve secondary outcomes, including child perceived control over emotion, children's and parents' hopelessness, psychological wellbeing, and parent-child relationships. The intention-to-treat principle and linear-regression-based maximum likelihood multi-level models will be used for data analysis. The project brings together experts in mindset research, family therapy, statistics, youth depression, and psychiatry. The Principal Investigator's strong connection with schools ensures the feasibility of the study. This study will not only provide evidence on parent-child growth mindset intervention for adolescent internalising problems but can also serve as a scalable and accessible intervention for improving the well-being of young people and their parents.

Official Title
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Effects of Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Problems: A Two-Arm Waitlist Randomised Controlled Trial

Conditions
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Depression, Anxiety

Intervention / Treatment
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* Behavioral: The Parent-Child Single-Session-intervention of Mindset Intelligence, Failure and Emotion (PC-SMILE)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The inclusion criteria for adolescent participants are: aged between 11-16 (inclusive) with one parent willing to participate; Chinese youth who can read and write in Chinese; sufficient visual and auditory abilities to complete the intervention and assessment; ability to give consent to participate in the study. The inclusion criteria for parent participants are: living with the child participant; Chinese-language proficiency and comfort with completing computer-based activities; sufficient visual and auditory abilities to complete the intervention and assessment; ownership of personal internet-equipped devices. Exclusion Criteria: Exclusion criteria for adolescent participants are: no parental consent; inability to remain focused to complete the intervention and the survey, which take approximately 45 and 25 minutes respective; intellectual disability or severe illness or pain that would lead to significant bias in students' health and mental health situation. Exclusion criteria for parent participants are: having a mental illness; inability to remain focused to complete the intervention and the survey, which take approximately 45 and 25 minutes respective; intellectual disability or severe illness or pain that would lead to significant bias in students' health and mental health situation.

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The Parent-Child Single-Session-intervention of Mindset Intelligence, Failure and Emotion (PC-SMILE)<br>The PC-SMILE integrates the growth mindsets of intelligence, failure and negative emotions. The interventions for both students and parents consist of five components: (a) an introduction to brain functions regarding the potential of neuroplasticity and the possibility of changes in intelligence and emotions; (b) stories and testimonials from high-school-aged youths who describe their beliefs-in-change; (c) short videos with stories of improving intelligence and emotions and of failure-is-enhancing; (d) common questions and misconceptions about growth mindset; and (e) self-persuasion writing exercises in which the participants write notes to young students/others about the growth mindsets. The interventions for parents and students are different in terms of narrative and content. A total of 10 weekly booster messages with core intervention content will be sent to the intervention group between the two-week post-test and the three-month follow-up survey. | Behavioral: The Parent-Child Single-Session-intervention of Mindset Intelligence, Failure and Emotion (PC-SMILE)<br>* This study will be a two-arm cluster-randomised controlled trial to examine the efficacy of the PC-SMILE for adolescents and their parents by comparing to a no-intervention waitlist control group.<br>|
| No Intervention: Waitlist control group<br>The waitlist control group will continue with normal education activities and do the pre- and post- intervention surveys at the same timeframe as the intervention group. Participants in waitlist group will be invited to complete the PC-SMILE after the three-month post-intervention survey. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Children's depression and anxiety symptoms | 25-item Revised Children's Anxiety and Depression Scale (RCADS-25) | baseline | 
| Children's depression and anxiety symptoms | 25-item Revised Children's Anxiety and Depression Scale (RCADS-25) | two weeks post-intervention | 
| Children's depression and anxiety symptoms | 25-item Revised Children's Anxiety and Depression Scale (RCADS-25) | three months post-intervention | 
| Parental anxiety | the anxious rearing subscale of the Egna Minnen Betraffande Uppfostran Scale (EMBU) | baseline | 
| Parental anxiety | the anxious rearing subscale of the Egna Minnen Betraffande Uppfostran Scale (EMBU) | two weeks post-intervention | 
| Parental anxiety | the anxious rearing subscale of the Egna Minnen Betraffande Uppfostran Scale (EMBU) | three months post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Children's perceived control | the four-item Emotion Control subscale of the Anxiety Control Questionnaire | baseline | 
| Children's perceived control | the four-item Emotion Control subscale of the Anxiety Control Questionnaire | three months post-intervention | 
| Children's hopelessness | the four-item Hopelessness Scale | baseline | 
| Children's hopelessness | the four-item Hopelessness Scale | three months post-intervention | 
| Children's attitude towards seeking help | it will be measured by a single-item scale | baseline | 
| Children's attitude towards seeking help | it will be measured by a single-item scale | three months post-intervention | 
| Children's psychological well-being | the Warwick-Edinburgh Mental Well-Being Scale | baseline | 
| Children's psychological well-being | the Warwick-Edinburgh Mental Well-Being Scale | three months post-intervention | 
| Parents' psychological well-being | the Warwick-Edinburgh Mental Well-Being Scale | baseline | 
| Parents' psychological well-being | the Warwick-Edinburgh Mental Well-Being Scale | three months post-intervention | 
| Parent-child relationships | the cohesion subscale of the Family Adaptation and Cohesion Evaluation Scales II - Chinese Version | baseline | 
| Parent-child relationships | the cohesion subscale of the Family Adaptation and Cohesion Evaluation Scales II - Chinese Version | three months post-intervention |