Today, high school students worldwide face unprecedented levels of stress as they navigate academic pressures, issues with social identity, and future career decisions. In Japan, researchers have found that depressive symptoms affect a large portion of high school students, with many scoring above clinical cutoff points for depression. These symptoms not only increase the risk of developing major depressive disorders but also negatively impact students' educational outcomes, future employment prospects, and their economic well-being throughout their lives.
Recognizing this vulnerability, numerous school-based programs have been developed and implemented, aimed at preventing and mitigating depressive symptoms in students. These interventions often target cognitive and behavioral risk factors associated with depression. However, many of these universal programs showed limited long-term effectiveness, particularly in high school settings. Skills learned in these programs often fail to generalize to the broader school environment, and the program content may not always resonate with the specific challenges faced by students. On top of this, existing research has mostly focused on younger adolescents, leaving a gap in our understanding of effective interventions for older high school students.
Against this backdrop, a research team led by Professor Akiko Ogata from Hiroshima University, Japan, developed and tested an innovative year-long intervention specifically designed for high school students. Their study, which was made available online on May 17, 2025, and will be published in Volume 174 of the journal Children and Youth Services Review on July 1, 2025, examined the effectiveness of the Mastery of Interpersonal Relationships and Emotional Skills (MIRaES) program among 120 students enrolled in part-time courses at a Japanese high school. The project was implemented by Dr. Kohei Kambara from Doshisha University, and co-authored by Dr. Yugo Kira from Kurume University, as well as Mr. Misuzu Matsumoto and Dr. Suzuka Hako from Hiroshima University.
The MIRaES program addressed previous shortcomings through several key innovations. Unlike typical short-term interventions lasting only weeks or months, this program extended across an entire school year with 12 sessions. The curriculum focused on four core skill areas identified as particularly relevant for Japanese part-time high school students: assertiveness training, cognitive reconstruction, anger management, and problem-solving techniques. The program was delivered through collaboration between graduate students in clinical psychology and classroom teachers, ensuring that skills could be reinforced and generalized throughout students' daily school experiences.
To assess the effectiveness of the program, the researchers employed a mixed-methods approach, measuring students' depressive symptoms, social skills, and emotional regulation at three time points throughout the year. They also collected qualitative feedback through free-text descriptions to understand students' experiences with the program. Rather than using a traditional control group—which proved logistically impossible due to curriculum constraints—the team compared outcomes between students who attended sessions frequently (11 or more times) versus those with lower attendance (10 or fewer times).
The results revealed a striking pattern: students who attended sessions regularly showed no increase in depressive symptoms over the school year, whereas those with poor attendance experienced significant worsening of symptoms. Moreover, qualitative analysis of student feedback provided additional insights into the program's mechanisms. Frequent attendees consistently mentioned applying learned skills in their daily lives and showed particular engagement with emotional regulation techniques. Students who attended regularly used terms like 'daily life,' 'useful,' and 'control' when describing their experiences, suggesting a successful integration of program content into their everyday interactions. "Collectively, our findings show that generalizing learned skills across school environments and aligning universal school-based prevention programs in the specific school context can prevent the worsening of depressive symptoms among high school students," remarks Dr. Kambara.
Worth noting, this study's implications extend beyond Japan's educational system and might be applicable in other countries with different educational settings. The program's design addresses practical constraints that have historically limited mental health interventions in high schools, such as rigid curriculum requirements and limited time availability. "This highly feasible universal prevention approach for school settings may contribute to improving mental health among high school students in grades 10 to 12, a population that is often underrecognized in mental health promotion efforts," concludes Dr. Kambara.
Overall, this work represents a significant step forward in addressing the mental health crisis among high school students, offering a practical model that schools could adapt to their specific contexts and student populations.
About Assistant Professor Kohei Kambara from Doshisha University, Japan
Dr. Kohei Kambara joined Doshisha University as an Assistant Professor in 2022, after studying and working at Hiroshima University for over a decade. He specializes in clinical psychology, with a particular interest in processing modes, depression prevention, cognitive-behavioral therapy, and rumination, especially in adolescents. He has over 30 scientific publications to his name.
Funding information
This work was supported by Public Interest Incorporated Foundation Nippon Life Insurance Foundation and the Grant-in-Aid for Scientific Research (C) (grant number: 18K03138).
