Abstract
PURPOSE: We examined long-term mental health benefits of Fourth R, an intervention designed to teach healthy relationship skills and prevent adolescent relationship abuse. While we previously showed it to prevent relationship violence, the potential crossover effects on broader mental health outcomes, such as depression and anxiety, remain unexplored. METHODS: We randomized Texas middle schools to receive either Fourth R (n = 12; n = 1,332) or standard health curricula (n = 12; n = 1,533) and assessed racially/ethnically diverse participants at baseline and 5 years postintervention. RESULTS: After accounting for age, gender, race/ethnicity, adverse childhood experiences, and baseline distress, we found that students receiving the intervention were less likely to be depressed at the 5-year follow-up (odds ratio = 0.69, 95% confidence interval: 0.49, 0.97) compared to students in control schools. DISCUSSION: Findings suggest that promoting healthy relationship skills in middle school can have enduring benefits for mental health, offering schools a cost-effective way to address multiple behavioral health challenges.