The effect of peer education based on adolescent health education on the resilience of children and adolescents: A cluster randomized controlled trial

adolescents’ target focus (β = 0.893, P = 0.002), emotional adjustment (β = 1.766, P < 0.001), interpersonal assistance (β = 1.722, P = 0.016) and total mental resilience (β = 5.391, P < 0.001), and the effect was greater for boys than for girls. Conclusions Peer education based on adolescent health education is effective for improving adolescents’ target focus, emotional adjustment, interpersonal assistance, and total resilience, especially for males. Future research should devote more attention to positive cognition and family support as well as gender differences. Introduction In China, with the rapid development of social economy and the change of social structure in recent decades, social pressure and competition have gradually increased. For adolescents, higher academic requirements and psychological pressure lead to the increase of negative emo- tions, and mental health problems are becoming increasingly prominent [1, 2]. It is estimated that more than 100 million of China’s 1.3 billion people suffer from mental disorders, of which about 16 million are seriously ill [3]. Another national epidemiological study has found that 15% of children in China suffer from mental health problems, and the prevalence of anxiety and other diseases is rising [4]. With the development of positive psychology, researchers have devoted more attention to the positive effect of negative events on the mental health of adolescents [5, 6]. In other words, not all individuals in adversity will experience negative outcomes such as anxiety and depres-

sion, and some individuals will instead experience better positive outcomes as a result of nega- tive circumstances [7]. Therefore, some experts have proposed the term “resilience”, which is defined as the ability to withstand and recover from adverse environments in an effective man- ner [8]. As one of the protective factors of mental health [9], it can protect individuals from negative psychological problems such as stress and anxiety, and promote high self-esteem to reduce depressive symptoms [10, 11]. Previous studies have shown that resilience is influenced by a large number of influencing factors, including protective factors such as harmonious fam- ily relationships, friendly peer relationships, and positive coping skills [12, 13]. Adolescents are at a critical point in the transition from child to adults, involving a variety of physiological, psychological, and social function upheavals (e.g., genital development and pubic hair growth) that are stressful events for them [14, 15]. A robust body of research indi- cates that pubertal status is a key predictor of various internalizing and externalizing problems for adolescents that influence the resilience of adolescents [16, 17]. For instance, a study with 1,420 subjects, conducted by Angold et al. [18], showed that girls at Tanner 3 were over three times more likely to contact depressive disorders than girls in the earlier Tanner stages, inde- pendent of the age at which they entered stage 3. A growing body of literature implies that

pubertal timing of adolescents occurs earlier [19, 20]. Earlier pubertal timing will increase the risk of internalizing and externalizing problems, aggravating the negative influence of adoles- cent changes on the mental health of adolescents [21–23]. For example, Mendle found that ear- lier pubertal timing had a significant association with depression and anxiety [24]. Therefore, we consider improving resilience by increasing positive adolescence-related knowledge, atti- tudes and behaviors. PLOS ONE The effect of peer education based on adolescent health education on resilience of children and adolescents PLOS ONE | https://doi.org/10.1371/journal.pone.0263012 February 2, 2022 2 / 18 Competing interests: The authors have declared that no competing interests exist.