Effectiveness and Implementation of the SHIELD Integrated Multi-level Model to Reduce Adolescent Depression and Internet Addiction: A Cluster Randomized Waitlist-Controlled Trial in Wangchin District, Phrae Province

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Background: Adolescent depression and internet addiction represent significant comorbid mental health challenges in rural Thailand, where access to evidence-based interventions remains limited. Traditional single-modality approaches often fail to address the complex interplay between individual, family, and systemic factors contributing to these conditions. Objectives: To evaluate the effectiveness and implementation outcomes of the SHIELD (Screening & Surveillance, Health Literacy Enhancement, Internet Wellness Program, Empowering Families, Linkage to Care, Data-driven Monitoring) integrated multi-level intervention for reducing depression and internet addiction among at-risk adolescents in rural Thailand. Methods: A cluster randomized waitlist-controlled trial was conducted across eight secondary schools in Wangchin District, Phrae Province, between October 2024 and June 2025. Schools were randomized to immediate intervention (n=4) or waitlist control (n=4). Participants included 240 at-risk students aged 12-18 years with PHQ-9≥5 and IAT≥40. The 12-week SHIELD intervention integrated digital screening, psychoeducation, family therapy, internet wellness training, care coordination, and real-time monitoring. Primary outcomes were depression severity (PHQ-9) and internet addiction levels (IAT). Secondary outcomes included mental health literacy, family functioning, quality of life, and implementation metrics using RE-AIM framework. Data were analyzed using intention-to-treat mixed-effects models accounting for clustering, with economic evaluation conducted from societal perspective. Results: At 6-month follow-up, the intervention group demonstrated significantly greater improvements in PHQ-9 scores (mean difference: -3.1, 95% CI: -4.0 to -2.2, p Conclusion: The SHIELD integrated multi-level intervention demonstrated significant and sustained effectiveness in reducing adolescent depression and internet addiction with excellent implementation outcomes and favorable cost-effectiveness. These findings support the potential for scaling evidence-based, culturally-adapted interventions within Thailand's educational and mental health systems to address growing adolescent mental health needs in resource-constrained settings.

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Related topics: Digital Mental Health Interventions · Child and Adolescent Psychosocial and Emotional Development · COVID-19 and Mental Health