In recent years, the mental health of adolescents has garnered increasing attention, particularly regarding the onset and prevention of depressive disorders. Among vulnerable groups, adolescents attending special education – often facing cognitive, physical, behavioral, emotional, or learning disabilities – present unique challenges in both identifying and addressing depressive symptoms. A new pioneering study protocol outlines a comprehensive approach aimed at closing this critical gap in mental health intervention. By adapting an existing school-based cognitive-behavioral therapy (CBT) program specifically for adolescents in special education, researchers hope to substantially reduce depressive symptoms and associated risks such as suicidality within this underserved population.
This study, published in BMC Psychiatry, details a cluster randomized controlled trial (RCT) designed to rigorously evaluate the effectiveness of the adapted indicated prevention program named “At Full Force – Special Needs Education.” The trial seeks to provide robust evidence on whether a tailored prevention strategy can positively affect depressive symptom trajectories among adolescents who demonstrate elevated depressive symptoms, a group often overlooked by traditional school-based prevention initiatives. Approximately 7% of Dutch adolescents attend special education, yet prevention efforts have typically excluded or failed to reach this demographic. Given the complexity of their educational and social needs, this study’s focus marks a significant step toward equitable mental health care.
The research methodology embraces a cluster RCT format, where participating schools are randomly assigned to intervention or control conditions. At the core of the intervention lies an adapted version of the original “At Full Force” program, tailored to meet the special needs of this subgroup. The intervention consists of eight group sessions, each lasting 45 minutes, delivered during school hours. It employs CBT principles to equip adolescents with coping strategies to manage depressive symptoms. Meanwhile, the control group receives care as usual, allowing for a clear comparison to ascertain the program’s added value. Additionally, the study incorporates safety nets through trained gatekeepers in every school to ensure timely mental health referrals when necessary.
Screening procedures are meticulously designed to identify adolescents exhibiting heightened levels of depressive symptoms, enabling targeted inclusion in the trial. The assessments will be conducted at multiple time points: baseline, immediately post-intervention, and at 6- and 12-month follow-ups. Such longitudinal data collection is crucial for evaluating the durability of treatment effects and for detecting delayed impacts on depressive symptomatology. Secondary outcomes assessed include suicidality, anxiety, and somatic symptoms, broadening the understanding of the intervention’s influence across interrelated mental health domains.
The implications of this study extend beyond symptom reduction. Adolescents attending special education frequently face compounded life adversities linked both to their disabilities and to heightened mental health risks. By intervening early with preventive strategies calibrated for their specific needs, there is potential not only to alleviate immediate psychological distress but also to improve overall life trajectories, including educational attainment and social functioning. The trial’s findings could pave the way for scalable, evidence-based programs that promote mental health inclusivity within educational systems worldwide.
Furthermore, the study acknowledges the complex interface between comorbid conditions often present in special education populations and depressive symptoms. The CBT-based prevention program includes components designed to address anxiety and somatic complaints, recognizing the intertwined nature of these challenges. Such a holistic approach adds depth to conventional prevention models that mainly focus on depressive symptoms in isolation. By capturing a broader spectrum of mental health outcomes, researchers aim to provide a more nuanced picture of intervention efficacy.
This initiative also reflects contemporary trends in mental health research emphasizing indicated prevention, where resources focus on individuals already exhibiting early signs of psychopathology rather than on universal or selective prevention. This strategy increases the likelihood of meaningful intervention effects, especially in populations with elevated baseline risk. The adaption of an established program specifically for the special education context exemplifies innovation in fine-tuning mental health services to meet the heterogeneity of adolescent needs.
Conducted in the Netherlands with an anticipated start early 2024 and protocol updated as of May 2025, the trial advances methodological rigor through its cluster randomization, robust safety protocols, and comprehensive follow-up measures. The engagement of schools as clusters respects the ecological realities of education settings while minimizing contamination between intervention and control participants. Additionally, integrating actionable safety nets ensures ethical responsiveness, given the heightened risk for suicidality within this cohort.
Notably, this research also confronts the persistent challenge of accessing mental health care in populations with disabilities. Adolescents in special education often face systemic barriers including stigma, limited tailored services, and difficulties navigating referral pathways. By embedding prevention directly within the school environment, the “At Full Force – Special Needs Education” program mitigates some of these obstacles, offering a pragmatic and sustainable route for delivering psychological support where adolescents spend much of their time.
If proven effective, the trial will deliver critical evidence supporting policy and programmatic shifts toward inclusive mental health promotion in educational settings. It may stimulate further adaptations of evidence-based prevention tools across diverse subgroups of youth, reinforcing the importance of bespoke interventions that respect the unique lived experiences of adolescents with disabilities. Moreover, successful outcomes may encourage wider adoption at national and international levels, contributing to broader efforts to reduce the global burden of adolescent depression.
As mental health disorders remain among the leading causes of disability globally, and adolescence marks a crucial window for prevention, innovative and targeted approaches such as the one described could transform public health paradigms. By preventing the escalation of depressive symptoms early, such strategies hold promise for decreasing future mental health service utilization, enhancing quality of life, and averting the serious societal and personal consequences of untreated depression.
This protocol thus represents more than a research endeavor — it embodies a commitment to equity, scientific rigor, and translational impact. The potential ripple effects encompass improved clinical guidelines, tailored mental health education curricula, and stronger collaboration between educators and mental health professionals. Ultimately, the study aspires to empower adolescents with special needs toward resilience and well-being, ensuring that no young person remains unreached by vital depression prevention resources.
Researchers and clinicians worldwide will be keenly observing the outcomes of this trial, anticipating valuable insights into how best to adapt and implement indicated prevention programs within complex educational environments. The integration of rigorous trial methodology with practical mental health solutions highlights a promising path forward for addressing the intricate challenges of adolescent depression prevention in vulnerable populations.
This work, officially registered as ClinicalTrials.gov NCT06203899 and published under the protocol version updated in May 2025, is a testament to multidisciplinary collaboration and careful design aimed at making a meaningful difference. It stands as a beacon of hope for those seeking to safeguard the mental health of adolescents who often face exacerbated risk factors because of their educational context and associated disabilities.
Subject of Research: Evaluation of a school-based indicated prevention program for depressive symptoms among adolescents attending special education.
Article Title: Evaluation of a school-based depression prevention approach among adolescents with elevated depressive symptoms attending special education: study protocol of a cluster randomized controlled trial.
Article References:
Rongen, W.C.H., Creemers, D.H.M., Spijker, J. et al. Evaluation of a school-based depression prevention approach among adolescents with elevated depressive symptoms attending special education: study protocol of a cluster randomized controlled trial. BMC Psychiatry 25, 517 (2025). https://doi.org/10.1186/s12888-025-06955-5
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