Preliminary Analyses
Of the 103 students who gave assent and whose parents signed informed consent documents, 102 (99%) completed the baseline questionnaires, 97 (94.2%) students completed the T2 questionnaires, and 99 (96%) completed the T3 questionnaires. The average participant age was 14.35 (SD = .52) and the sample was 45% female. The control group was comprised of a significantly higher number of students identifying as Asian-American or Pacific Islander, whereas the intervention group had a significantly higher number of students identifying as non-Hispanic White (Table 1). The control group reported greater depressive symptoms and perceived stress at baseline than the intervention group (p values < .05) (Table 2).
Feasibility and Acceptability
Students rated the sessions with moderate-to-high acceptability and feasibility. Combined across all sessions, students rated the sessions as both helpful (Median = 2.0, M = 1.75, SD = 0.69) and interesting (Median = 2.00, M = 1.68, SD = 0.63), on a scale from 0-3. Session 3, which taught positive reappraisal, was rated highest in helpfulness (Median = 2.0, M = 1.89, SD = 0.70) and interest (Median = 2.00, M = 1.92, SD = 0.73), though none of the session ratings were statistically different from one another (p > .05). Students identified mindfulness as their favorite skill (33%), followed closely by positive reappraisal (25%), then amplifying positive events (15%). The fewest students preferred identifying personal strengths and setting attainable goals (2% and 5%, respectively).
Student Feedback. Overall, students reported enjoying the sessions in the open-ended weekly surveys. They appreciated the engaging format of the sessions and articulated benefits from several of the specific skills. They appreciated aspects of the content as well as structure of the sessions.
“I liked talking about what makes me makes me stressed and hearing that everyone else
was going through it too.” (Session 1)
“I liked it because I could relate to so many of the situations people had when they were stressed.” (Session 1)
“It was nice to know that it was beneficial to be positive.” (Session 3)
“Realizing that I had a lot more strengths than I thought.” (Session 4)
Students’ least liked aspects of the intervention were around their perceived lack of hands-on and engaging activities during the sessions.
“We weren't involved enough and it got boring.” (Session 1)
“I didn't like that a lot of the material was repeated.” (Session 1)
“Talking/lectures for most of the time.” (Session 3)
“Sitting there for so long.” (Session 5)
Their suggestions included making the sessions more interactive and engaging through the use of games and other activities and tailoring the content even more to their lives.
“Games! games! too much lecturing and just sitting and talking” (Session 4)
“Relate it more to our lives” (Session 5)
“Do more activities…they are fun while just talking and sharing emotions is boring” (Session 5)
Within- and Between-Group Change in Outcomes from Pre- to Post-Intervention
Given the group difference in proportion of students identifying as AAPI, we control for race in the following analyses. Results from the uncontrolled analyses are in the supplementary table.
Intervention skill use. In mixed-factor ANCOVAS between the control and intervention group, controlling for the group difference in participants identifying as AAPI, there was a significant interaction between Time and Group, F(1, 100) = 4.367, p = .04. Specifically, only the intervention group experienced an increase in overall intervention skill use from pre- to post-intervention (Figure 2A). This Time by Group interaction persisted at the follow-up timepoint F(1, 101) = 4.06 (p = .047)
In analyses within the intervention group, the increase in overall positive emotion skill use was not statistically significant, from pre- (M = 2.31, SD = 1.47) to post-intervention (M = 2.78, SD = 1.58; F(1, 57) = 1.83, p = .18, ) or to follow-up (M = 2.77, SD = 1.48), F(1, 57) = 3.81, p = .06. There was no significant change in overall intervention skill use within the control group (p > .05 for all).
Looking separately at use of each of the 8 intervention skills, repeated measures ANCOVAs within the intervention group revealed that amplifying positive events significantly increased from pre- (M = 1.91, SD = 1.64) to post-intervention (M = 2.65, SD = 1.94), p = .03, and was maintained at follow-up (M = 2.51, SD = 1.67), p = .02. Gratitude marginally increased from pre- (M = 1.88, SD = 1.93) to post-intervention (M = 2.61, SD = 1.88), p = .108, and remained marginal at follow-up (M = 2.62, SD = 1.82), p = .07 (Figure 3). Identifying personal strengths, positive reappraisal, noticing positive events, acts of kindness, and attainable goals did not change significantly over time (ps > .05 for all).
Well-being Outcomes
Positive emotions. In mixed ANCOVAS including both the control and intervention group, there was a significant effect of time, F(1, 100) = 6.69, p = .01, indicating that both groups improved on positive emotion from pre- to post-intervention (Figure 2B). The interaction between Time and Group, however, was not significant, F(1, 100) = .51, p > .05 (Figure 2B), indicating that there was no difference in change over time between groups. This interaction remained non-significant at the follow-up timepoint (p > .05).
In analyses within the intervention group, there was a marginally significant change in positive emotions at post-intervention, (pre: M = 2.87, SD = .90; post: M = 2.98, SD = .97), F(1, 57) = 3.23, p = .08, which was not sustained at follow-up (p > .05). Similarly, there was a marginally significant increase in positive emotions for the control group (pre: M = 2.85, SD = 1.00; post: M = 3.02, SD = .95), F(1, 42) = 3.19, p = .08) that was not sustained at follow-up (p > .05).
Negative emotions. In mixed ANCOVAS comparing the control and intervention group, there was a significant effect of time, F(1, 100) = 21.38, p < .001, such that negative emotions decreased for both groups, but a nonsignificant interaction between Time and Condition, F(1, 100) = 1.70, p > .05 (Figure 2C). This interaction remained non-significant at the follow-up timepoint (p > .05).
In follow-up analyses within the intervention group, there was a significant decrease in negative emotions F(1, 57) = 17.29, p < .001, from pre- (M = 1.57, SD = .86) to post-intervention (M = 1.33, SD = .84). This decrease was sustained at follow-up (M = 1.32, SD = .80), F(1, 57) = 9.97, p = .003. There was a marginally significant decrease in negative emotions for the control group from pre- (M = 1.58, SD = .79) to post-intervention (M = 1.47, SD = .70; p= .06) and a significant decrease at follow-up (M = 1.53, SD = .80), F(1, 42) =5.25, p = .03.
Depressive Symptoms. In mixed ANCOVAS comparing the control and intervention group, there was a significant effect of time, F(1, 100) = 6.29, p = .01, such that there was a decrease in depressive symptoms overall, as well as a significant interaction between Time and Group, F(1, 100) = 6.62, p = .01 (Figure 2D). Specifically, contrary to our hypotheses, the control group demonstrated a steeper decline in depressive symptoms than the intervention group. The interaction between Time and Group was not significant from pre-test to follow-up (p > .05).
In follow-up analyses within the intervention group, there was not a significant change in depressive symptoms post-intervention, F(1, 57) =.40, p = .53 though there was a marginally significant decrease at follow-up, F(1, 57) = 3.38, p = .07). The control group experienced a significant reduction in depressive symptoms from pre (M = 17.07, SD = 9.58) to post-intervention (M =13.40, SD = 6.49), F(1, 42) = .67, p = .01, that was sustained at follow-up (M =14.79, SD = 7.25), p = .05.
Perceived Stress. In mixed ANCOVAS comparing the control and intervention group, there was a significant effect of time, F(1, 100) = 15.33, p < .001, such that perceived stress decreased overall, as well as a significant interaction between Time and Group, F(1, 100) = 6.57, p = .01 (Figure 2E). Specifically, the control group experienced a steeper decline in perceived stress than the intervention group. The interaction between Time and Group was not significant from pre-test to follow-up (p > .05).
In analyses within the intervention group, there was a significant change in perceived stress from pre- (M = 15.63, SD = 5.95) to post-intervention (M =15.21, SD = 6.23), F(1, 57) = 5.74, p .02, which was sustained at follow-up (M = 14.75, SD = 6.20), F(1, 57) = 6.43, p .01. The control group also experienced a decrease in perceived stress from pre- (M = 18.98, SD = 5.63) to post-intervention (M = 16.64, SD = 5.69), F(1, 42) = 6.44, p = .02, but this reduction did not persist to follow-up (p > .05).