Ethical Considerations

2.5.1 Ethical approval.Ethical approval was granted by the Faculty of Medicine and Health Ethics Committee at the University of East Anglia (Appendix O). Guidelines from the British Psychological Society were followed, as research with adolescents requires careful consideration and involves various ethical issues. The Local Education Authority was informed, with an email being sent to the Suffolk County Council explaining the study and enquiring about approval. In correspondence responding to this email a representative from Suffolk County Council (S. Glazer, personal communication, March 8, 2014) permitted the study, explaining that

additional approval from Suffolk research governance was not required (Appendix P).

2.5.2 Informed consent. Upon receipt of ethical approval, information about the research was sent out in a letter to the headteachers of the schools; a follow- up telephone call was made to determine their interest in conducting the research within their school and to answer any questions. The headteachers were also offered the opportunity for the researcher to come into the school and to explain the study in further detail. The researcher obtained written consent from the headteacher of the schools that expressed interest to take part.

All potential participants from within the consenting schools were given an information sheet to read before deciding to give their assent (if under the age of 16 years) or consent (if aged 16 years or over) to take part. An information sheet was given to their parent or guardian, before deciding to give their parental/guardian consent. These were sent out at least two weeks before data collection to allow

sufficient time for their full consideration. The information sheets contained full details of the study, including the nature and purpose of the research. The language used to describe the study was checked for readability using the Gunning fog index (Gunning, 1952). Text for a near universal understanding requires an index score of less than 8, and text for a wide audience requires an index score of less than 12. The parent and young person information sheets scored 10.27 and 8.36 respectively; deeming them appropriate for the target audience and helping further ensure that consent was as informed as possible. Participants were asked to return an Expression of Interest Form along with their Guardian Consent Form if they felt they would like to take part in the study. It was emphasised that parental or guardian consent was needed for all participants, regardless of their age. Reasoning for this was from a risk management perspective; ensuring parents were aware that their child was taking part in the research and allowing a point of contact if the young people revealed

themselves to be above the cut-off score for depressive symptomatology. The contact details for the researcher and the research supervisors were provided in the

information sheets for both the young person and their parent or guardian, in order that any questions or concerns could be answered.

At the point of data collection, the researcher described the study to the pupils who had returned an Expression of Interest and Parental Consent Form. Prior to consent pupils were given the study information sheet again. Approximately five minutes were given for questions to be raised before written assent (if aged under 16 years) or consent (if aged 16 years or over) was collected (see Appendices Q and R). Assent or consent was obtained from all participants; only those who provided written assent or consent were able to participate in the study.

Participants and their guardians were informed that participation was

voluntary, did not affect their education in any way and they had the right to withdraw themselves or their data at any point during or after the study without the need for an explanation. This was stated within the information sheets in addition to being verbally explained before written assent or consent was collected from the participants.

2.5.3 Confidentiality and anonymity. To maintain anonymity and

confidentiality participant names were not entered on questionnaires. However, to identify participants’ data, for example if they met or exceeded the cut-off score of 16 on the CES-D or if their data needed to be withdrawn, each questionnaire was

uniquely coded with three digits. Participants were provided with a separate

demographic sheet containing this code, in which to write their name, gender, date of birth, and school name. The demographic information was stored securely and separately from the rest of the participants’ data.

Participants were informed that their individual data would not be shared with the school or their parents and only the researcher and the research supervisors would have access to this information. However, it was explained that if they exceeded the cut-off point for clinical depression on the CES-D their parents would be sent a letter by the researcher to inform them of these findings and to provide the contact details of relevant support agencies (Appendix S). They were notified that the questionnaires would be scored within 24 hours of administration to promptly identify any such individuals.

2.5.4 Data storage. The research adhered to the requirements of the Data

Protection Act 1998 (Office of Public Sector Information, 1998) and was in

stored in a locked filing cabinet, accessible only to the researcher and supervisors. The demographic information, specifying the names of the participants, was stored in a separate filing cabinet to ensure confidentiality. Upon completion of the research, data were stored in accordance with standard research procedures of the University of East Anglia.

2.5.5 Managing distress. One further ethical consideration was how to

appropriately manage distress should an adolescent experience this as a result of participating in the research. The researcher was aware of the sensitive nature of some of the questionnaires and it was clearly explained to participants in their information letter, in the initial briefing of the study, and also on each questionnaire, that they were free to stop participation at any point. Furthermore, participants were able to raise concerns with the researcher at any time point during data collection. During the study, no participants became visibly distressed or raised concerns. However, it was agreed that if a pupil were to become upset in anyway, the researcher would have stopped their participation in the study and the adolescent would have been given the opportunity to talk to the researcher, or the suitably skilled member of staff who was present during the research, in a separate confidential setting. Following this, if deemed to be appropriate and no further concerns had been raised, the pupil would have been advised to return and join their classmates who were not participating in the research. However, if this were not appropriate, a suitable staff member would have been identified (e.g. lead of Personal Health Social Education [PHSE], school nurse, head of pastoral care), and the pupil would have been taken into their care and able to seek additional support from them.

Following data collection, there was a verbal de-briefing from the researcher, and participants were encouraged to talk to their parents, teachers or family doctor if

the questionnaires raised any worries for them or if they felt upset in anyway. Participants were also given a written de-briefing sheet (Appendix T), detailing contact information of the researcher and related helplines.

Although no participants became visibly distressed during data collection, 36 (40% of the sample) adolescents scored above the cut-off score on the CES-D. As agreed with the Ethics Committee, a sensitively worded letter was sent to the parents of these pupils to inform them of this. Within this letter they were provided with the contact details of relevant support agencies and advised to contact their general practitioner if they had concerns.

2.5.6 Providing feedback. All participating schools were provided with a

written summary report of the findings of the study. The schools made this report available to all interested participants and their parents or guardians.