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Background  Anxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the  CLIMATE Schools Combined  intervention, a universal approach to preventing substance use and mental health problems among adolescents.    Methods/design  Participants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i)  CLIMATE Schools Combined  intervention; (ii)  CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health , or (iv) Control (Health and Physical Education as usual).  The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.    Discussion  Compared to students who receive the universal  CLIMATE Schools - Substance Use , or  CLIMATE Schools - Mental Health  or the Control condition (who received usual Health and Physical Education), we expect students who receive the  CLIMATE Schools Combined  intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge.    Trial registration  This trial is registered with the Australian and New Zealand Clinical Trials registry,  ACTRN12613000723785 .

bmc psychiatry

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety