UTHealth Houston study reveals long-term mental health benefits of healthy relationship skills program for adolescents

Teaching healthy relationship skills to middle school students can help prevent adolescent relationship abuse and lead to better mental health outcomes — including reduced depression —  years later, according to researchers at UTHealth Houston. 

The study was published today in the Journal of Adolescent Health. 

Using a program called the Fourth R, which is designed to teach healthy relationship skills and reduce various forms of violence among adolescents, researchers led by Jeff Temple, PhD, associate dean for clinical research at UTHealth Houston School of Behavioral Health Sciences, assessed the long-term mental health benefits of the program.

The Fourth R stands for “relationships,” emphasizing that relationship knowledge and skills are as essential as reading, writing, and arithmetic.

These researchers previously found that the Fourth R program prevents violence among adolescents, while this new study finds that students who participated in the program were less likely to suffer from depression five years after completing the intervention, compared to those who did not receive the intervention. 

“That this program helps prevent adolescent relationship abuse wasn’t necessarily surprising,” said Temple, who is the first author on the study and professor with the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth Houston. “The secondary benefit that we showed, that it helps these kids with depression, is just incredible.”

The Fourth R curriculum was implemented by trained health teachers in 12 middle schools across southeast Texas in 2018. Educators focused on teaching healthy relationships skills to reduce teen dating violence and show students how to identify risk behaviors like bullying and substance misuse. Students who participated in the study were then assessed five years later.

Although not directly focused on preventing depression and anxiety, the results of the study suggest that youth mental health can be bolstered with the program — through developing healthy, nonviolent relationships.

According to Temple, about a third of youth will experience some form of relationship abuse by the time they graduate from high school. Additionally, about 20% of high school students will suffer from major depression by the time they graduate.

“We have high rates of violence in society and unhappy relationships,” he said. “This study shows that programs like Fourth R can prevent bad things from happening to our kids. If we had the resources to implement this throughout more classrooms, we could not only make our kids happier and healthier, we wouldn’t have to worry as much about the downstream effects of violence and depression.”

Additional UTHealth Houston authors with the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School include Elizabeth Baumler, PhD, and Leila Wood, PhD, MSSW.

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