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Secondary schools in France, Germany, Romania, and Spain were recruited. Originally, we estimated to enrol a total of 6000 students within 64 schools; that is, 16 schools per country. The IMPROVA programme is a multi-level intervention that provides tailored content for adolescents, families, and school staff. This content creates a unified and supportive framework that promotes mental health and social-emotional development among adolescents. A series of implementation strategies was planned to support the uptake of the programme into the education setting and among participants. Study outcomes were assessed at baseline, mid-term (during the intervention), postintervention (primary end point), and will be assessed at postintervention (secondary end-point; 6 months after postintervention). Overall mental health (Strengths and Difficulties Questionnaire) is the primary outcome. Secondary outcomes include: health-related quality of life, depression, anxiety, social isolation, and self-esteem. The trial will be evaluated regarding its effectiveness, cost-effectiveness, implementation, and social return on investment analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has received the approval of human research ethics committees in France (Comit\u00e9 de Protection des Personnes Ile-de-France VIII\u201d, No. 2024-A00201-46), Germany (Ulm University Ethics Committee, No. 186-24), Romania (The Research Ethics Subcommittee of the Babe\u0219-Bolyai University of Cluj-Napoca, No. 14.146\/23.09.2024), and Spain (CEIm Fundaci\u00f3 Sant Joan de D\u00e9u, No. PIC-61-24). Results will be disseminated through peer-reviewed open-access publications and presentations at national and international conferences. Non-technical summaries will be shared with public health authorities, participants, and stakeholder organisations. All findings will be reported in aggregate form, ensuring no individual participant can be identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06556576\">NCT06556576<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108674","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:31:00Z","timestamp":1777386660000},"page":"e108674","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Study protocol of the e-Intervention Enhancing Mental Health in Adolescents (IMPROVA) project: a randomised controlled trial to promote adolescents\u2019 mental health and well-being in four European countries"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06556576","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06556576","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06556576","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-2616","authenticated-orcid":false,"given":"Rodrigo Antunes","family":"Lima","sequence":"first","affiliation":[{"name":"Impact and Prevention of Mental Disorders Research Group, Institut de Recerca Sant Joan de D\u00e9u (IRSJD), Esplugues de Llobregat, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Baumeister","sequence":"additional","affiliation":[{"name":"Clinical Psychology and Psychotherapy, University 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