A Randomized Controlled Trial of a Healthy Lifestyle Intervention to Improve Mental Health among School-Going Adolescents
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Abstract
Objective: Despite growing evidence on the influence of lifestyle on adolescent mental health, structured educational interventions addressing multiple health dimensions remain limited. The objective of this study was to assess the effectiveness of a healthy lifestyle educational intervention in improving mental health results among secondary school students.
Method: A randomized controlled trial based on the Information, Motivation, and Behavioral Skills (IMB) model was carried out with 347 adolescents (182 in the intervention group and 165 in the control group) from twelve secondary schools in Tehran. Participants completed a set of questionnaires assessing knowledge and attitudes concerning diet, physical activity, and stress management. Additionally, assessments included measures of eating behavior, daily physical activity, and psychological state using the Beck Depression Inventory-Short Form (BDI-S, BDI-13), and the Depression, Anxiety, and Stress Scale [DASS-21]). The innovation is addressing multiple dimensions of adolescent health in a comprehensive way and targeting mental health outcomes. It consisted of eleven one-hour sessions delivered to the intervention group in their schools. Data were then analyzed using descriptive statistics, Chi-square (association between categorical variables) and two-way repeated measure ANOVA (difference in the means score at follow-up).
Results: In the intervention group, significant improvements were observed in knowledge about lifestyle factors, including diet, stress management and physical activity and, from baseline to post-intervention (P < 0.05). Attitudes toward stress management also showed significant positive changes. Behaviorally, there was an increase in physical activity, participation in relaxation activities, and eating breakfast, while unhealthy practices such as eating out, drinking sweetened beverages, and consuming fast food decreased (P < 0.05). Additionally, depression symptoms decreased by 1.9 points (mean ± SD) at the 6-month follow-up (P < 0.05).
Conclusion: This study demonstrates that a six-month healthy lifestyle educational intervention can effectively enhance adolescents’ knowledge, attitudes, and behaviors related to healthy lifestyle factors, leading to improved mental health outcomes.
2. Organization WH. Report of the eighth meeting of the WHO Strategic and Technical Advisory Group of Experts for Maternal, Newborn, Child and Adolescent Health and Nutrition, 14-16 November 2023: World Health Organization; 2024.
3. Uddin R, Lee EY, Khan SR, Tremblay MS, Khan A. Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective. Prev Med. 2020;131:105955.
4. Gu J. Physical Activity and Depression in Adolescents: Evidence from China Family Panel Studies. Behav Sci (Basel). 2022;12(3):71.
5. Organization WH. Global accelerated action for the health of adolescents (AA-HA!). Geneva: WHO. 2017.
6. Sappenfield O, Alberto C, Minnaert J, Donney J, Lebrun-Harris L, Ghandour R. Adolescent Mental and Behavioral Health, 2023. National Survey of Children’s Health Data Briefs [Internet]. 2018.
7. Control CfD, Prevention. Youth risk behavior survey data summary & trends report. CDC Available online at: https://www cdc gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508 pdf. 2023.
8. Mohammadi MR, Alavi SS, Ahmadi N, Khaleghi A, Kamali K, Ahmadi A, et al. The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. J Affect Disord. 2019;247:1-10.
9. Kuddus MA, Tynan E, McBryde E. Urbanization: a problem for the rich and the poor? Public Health Rev. 2020;41:1.
10. Arbabi K, Yeh CJ, Sangkar PR. Exploring the Lived Experiences of Iranian Adolescents Exhibiting Suicidal Behavior and Ideation. Res Child Adolesc Psychopathol. 2025.
11. Howells K, Coppinger T. The Forgotten Age Phase of Healthy Lifestyle Promotion? A Preliminary Study to Examine the Potential Call for Targeted Physical Activity and Nutrition Education for Older Adolescents. Int J Environ Res Public Health. 2022;19(10):5970.
12. Ferreira RJ, Nogueira T, Dias da Silva V, Liñan Pinto M, Sousa J, Pereira AM, et al. A school-based intervention for a better future: study protocol of Sintra Grows Healthy. BMC Public Health. 2020;20(1):1615.
13. Hayba N, Elkheir S, Hu J, Allman-Farinelli M. Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review. Int J Environ Res Public Health. 2020;17(17):6059.
14. Aguilar-Latorre A, Pérez Algorta G, Navarro-Guzmán C, Serrano-Ripoll MJ, Oliván-Blázquez B. Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care. Front Med (Lausanne). 2022;9:954644.
15. Zajkowska Z, Gullett N, Walsh A, Zonca V, Pedersen GA, Souza L, et al. Cortisol and development of depression in adolescence and young adulthood - a systematic review and meta-analysis. Psychoneuroendocrinology. 2022;136:105625.
16. Aday LA, Cornelius LJ. Designing and conducting health surveys: a comprehensive guide: John Wiley & Sons; 2011.
17. Eslami AA, Rabiei L, Afzali SM, Hamidizadeh S, Masoudi R. The Effectiveness of Assertiveness Training on the Levels of Stress, Anxiety, and Depression of High School Students. Iran Red Crescent Med J. 2016;18(1):e21096.
18. Tajik E, Latiff LA, Yit Siew C, Awang H, Adznam SNA. Designing and Validating a Questionnaire on Healthy Lifestyle to Reduce Depressive Symptoms among Adolescents. Iran J Psychiatry. 2020;15(1):27-40.
19. Chin Y, Mohd Nasir M. Eating behaviors among female adolescents in Kuantan district, Pahang, Malaysia. 2009.
20. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, et al. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021;2021:5924040.
21. Kelishadi R, Rabiei K, Khosravi A, Famouri F, Sadeghi M, Rouhafza H, et al. Assessment of physical activity of adolescents in Isfahan. 2001.
22. Hojat M, Shapurian R, Mehryar AH. Psychometric properties of a Persian version of the short form of the Beck Depression Inventory for Iranian college students. Psychol Rep. 1986;59(1):331-8.
23. Rajabi GR. Psychometric properties of beck depression inventory short form items (BDI-13). Journal of Iranian Psychologists. 2004.
24. Lovibond PF, Lovibond SH. Depression anxiety and stress scales. Behav Res Ther. 1995.
25. Kakemam E, Navvabi E, Albelbeisi AH, Saeedikia F, Rouhi A, Majidi S. Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study. BMC Health Serv Res. 2022;22(1):111.
26. Choi J, Park YC, Choi S. Development of a mobile-based self-management health alarm program for obese children in South Korea and a test of its feasibility for metabolic outcomes: A study based on the information-motivation-behavioral skills model. Child Health Nurs Res. 2021;27(1):13-23.
27. Bakır E, Çavuşoğlu H, Mengen E. Effects of the Information-Motivation-Behavioral Skills Model on Metabolic Control of Adolescents with Type 1 Diabetes in Turkey: Randomized Controlled Study. J Pediatr Nurs. 2021;58:e19-e27.
28. Jacob CM, Hardy-Johnson PL, Inskip HM, Morris T, Parsons CM, Barrett M, et al. A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. Int J Behav Nutr Phys Act. 2021;18(1):1.
29. Luciano M, Sampogna G, Amore M, Bertolino A, Dell'Osso L, Rossi A, et al. Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial. Psychiatry Res. 2022;317:114818.
30. Rodrigues F, Morouço P, Santos T. Testing the Associations between Coping, Mental Health, and Satisfaction with Life in Portuguese Workers. Eur J Investig Health Psychol Educ. 2023;13(7):1245-56.
31. Lukoševičiūtė-Barauskienė J, Žemaitaitytė M, Šūmakarienė V, Šmigelskas K. Adolescent Perception of Mental Health: It's Not Only about Oneself, It's about Others Too. Children (Basel). 2023;10(7):1109.
32. Guzek D, Gła Bska D, Groele B, Gutkowska K. Fruit and Vegetable Dietary Patterns and Mental Health in Women: A Systematic Review. Nutr Rev. 2022;80(6):1357-70.
33. Eini-Zinab H, Shoaibinobarian N, Ranjbar G, Norouzian Ostad A, Sobhani SR. Association between the socio-economic status of households and a more sustainable diet. Public Health Nutr. 2021;24(18):6566-74.
34. Thurlow J, Holtemeyer B, Kassim Y, Kurdi S, Randriamamonjy J, Raouf M, et al. Investing in the agri-food system for post-COVID-19 recovery: An economywide evaluation of public investments in Egypt: Intl Food Policy Res Inst; 2020.Mahindru A, Patil P, Agrawal V. Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus. 2023;15(1):e33475.
35. Jasim SA, Singh M, Al-Dhalimy AMB, Zwamel AH, Jawad IA, Shalaby NS. The impact of chronic exercise on cognitive function: an overview of reviews. Iran J Psychiatry. 2024.
36. Damián Núñez EF, Soria Villanueva LM, Tejada Mendoza MA, Alcoser SDI, Garay JPP, Hernández-Vásquez R. Perfectionism as a Paradoxical Factor in Sport and Exercise Performance: An Umbrella Review. Iran J Psychiatry. 2024;19(2):247-54.
37. da Silva JM, Castilho Dos Santos G, de Oliveira Barbosa R, de Souza Silva TM, Correa RC, da Costa BGG, et al. Effects of a school-based physical activity intervention on mental health indicators in a sample of Brazilian adolescents: a cluster randomized controlled trial. BMC Public Health. 2025;25(1):539.
38. Francisquini MCJ, Dos Santos GC, de Souza Silva TM, Dias PHG, Dos Santos CF, Pinzon G, et al. Effects of a 12-Week Physical Activity Intervention on Psychological Symptoms in Adolescents. Int J Environ Res Public Health. 2024;21(12):1558.
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