A cluster-randomised waitlist-controlled trial in eight schools in Wang Chin, Phrae, enrolled 240 at-risk students aged 12–18. The 12-week SHIELD programme reduced depression and internet-addiction scores, improved response and remission, and was cost-effective under the study threshold. The evidence is stronger than an observational study but needs replication across provinces and longer follow-up.
Key findings
- At six months, adjusted mean differences were −3.1 PHQ-9 points (95% CI −4.0 to −2.2; d=0.68) and −11.2 IAT points (95% CI −14.8 to −7.6; d=0.67). A ≥50% PHQ-9 response occurred in 64.8% versus 25.5% (OR 5.4; NNT 3), and remission in 35.2% versus 11.8% (OR 4.1; NNT 5). Fidelity was 88.4%, school adoption 100%, and ICER 12,830 THB per depression-free year versus the study threshold of 34,400 THB.
Why this matters globally
SHIELD demonstrates how mental health and digital well-being can be integrated in resource-constrained schools while measuring outcomes, implementation and economics. Scaling requires referral capacity and should not replace individual clinical care.
Thai researcher contribution
Seubtrakul Tantalanukul of Boromarajonani College of Nursing Uttaradit, Praboromarajchanok Institute, and Amornpan Samorn of Wang Chin Hospital developed and tested the programme directly in rural Thailand.
Limitations to consider
Only eight schools in one district were included, with few clusters and a waitlist rather than active control. Six-month follow-up does not establish long-term durability, and economic results depend on costing assumptions and the selected threshold.