here - SEYLE

SEYLE FINAL REPORT
1. Executive Summary
Saving and Empowering Young Lives in Europe (SEYLE) is a randomized controlled trial (RCT) aimed at promoting
mental health among adolescents in European schools. The SEYLE project was performed during January 2009 – December
2011, and comprised a consortium of 12 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel,
Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre. Its main objectives were to gather
information on health and well-being in European adolescents; to lead adolescents to better mental health through decreased
risk-taking and suicidal behaviours; evaluate outcomes of different preventive programmes; and recommend effective
culturally-adjusted models for promoting adolescent mental health in different European countries.
Epidemiological results
SEYLE generated a large epidemiological database containing information regarding sociodemographics, other risk factors,
lifestyles, and the mental health of adolescents in Europe. The database contains information regarding 366 variables for
12,395 cases, for a total of over 4.5 million observations. The analysis of this database is still in progress and the data will
be used for several studies in coming years. Preliminary prevalence regarding psychopathology, such as depressive and
anxiety symptoms, hyperactivity, suicidal ideation and behaviour and lifestyles such as substance abuse, including alcohol,
smoking and illegal drugs; sleep, nutrition and physical activity, and; Internet use is available
Outcome results
Longitudinal analysis has identified improvements following SEYLE interventions in several mental health outcomes.
Depressive symptoms in the whole sample significantly decreased in all RCT arms at 3 months follow-up, with a further
significant decrease observed at the 12 months follow-up. The most important and novel results of the SEYLE research
study are found when examining effects on suicide attempts. At 3 and 12 months follow-ups, a significant and sustainable
decrease in suicide attempters was present in the Awareness arm in comparison with the control group. At the 12 months
follow-up evaluation, a significant decrease in the number of those who attempted suicide in the previous two weeks was
observed among pupils in the QPR and Profscreen arms.
Impact of SEYLE and recommendations
The scientific and societal impact of these findings from SEYLE study are highly relevant. As previously noted, risk
behaviours and mental health problems among adolescents are a serious public health concern. The longitudinal results of
SEYLE revealed important effects of the interventions on the studied mental health related outcomes. These findings
support a series of recommendations regarding interventions for mental health promotion among adolescents.
The Awareness program had a significant influence on suicide attempts in both the short and the long term. The program
also significantly increased adolescent well-being. This program was well accepted by both pupils and school staff. It is,
therefore, our recommendation that a mental health and suicide preventive Awareness program be included in the syllabi of
schools across Europe. It would be important to determine at which ages this would be most efficacious.
The SEYLE results regarding the Professional Screening arm call for public mental health actions, as 12·4% of the
adolescents were identified as being in need of mental healthcare. Attention to risk-behaviours, in addition to
psychopathology, is critical in facilitating prevention and early intervention. Screening in schools for both risk-behaviour
and psychopathology can be a valuable approach in detecting students with psychological problems that require mental
healthcare. Strategies designed to increase compliance with clinical interviews are needed to improve the value of screening
procedures. Even if the feasibility of a large scale screening program can be problematic, as revealed by lower than
expected participation rates to this arm’s follow-up interviews, screening programs certainly have excellent value as a
means of assessing mental health needs and well-being in school-based populations.
The QPR intervention designed to ttrain teachers to recognize and support students at risk, also demonstrated efficacy for
certain outcomes. The most striking finding regarding teachers’ role in the life of adolescents is their interest and
opportunity to take action to improve students’ mental health and well-being. Our conclusions and recommendations are
that teachers in European schools, in general, are able to identify the most severe symptoms of mental disorders in their
students, but the observed level of mental health literacy is currently not adequate to fulfil their gatekeeper role; teachers
recognize their lack of knowledge and skills related to child mental health and expresses a desire to be better educated in
this area; mental health literacy differs significantly among the eleven European countries; information about mental health
should be included in the teachers’ educational curriculum.
Analysis of the SEYLE Control arm, where a minimal intervention including a component of the Awareness program was
implemented, yielded some important results concerning emotional symptoms. Even though the effects of the minimal
intervention were significantly smaller and appeared to be shorter in duration, the fact that an effect was present deserves
attention and suggests that a simple awareness increasing intervention can also be important. On the other hand the minimal
intervention had no effect on suicide attempts, which are an important predictive factor for completed suicide and the most
serious outcome of mental ill-health. Even if, from an economical point of view a minimal intervention could be
recommended, especially in settings where funds are limited, a longer and more structured intervention is necessary in order
to obtain positive outcomes regarding suicidal behaviour among adolescents.
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