School-based mental health interventions reduce depression, anxiety and aggression

The mental health of children and adolescents is an area of ​​growing concern. Recent estimates suggest that one in six young people aged 5 to 16 currently experience mental health problems (Vizard et al, 2020), and only a quarter of those with a mental health problem come into contact with it. mental health services for children and adolescents (Sadler et al, 2018).

Since the majority of students will not have direct access to mental health services, schools have become a place of great interest for prevention (Patel et al, 2018).

As stated in the government’s green paper Transforming the mental health of children and youth (Department of Health, 2017), the school setting offers the possibility of reaching a large number of young people simultaneously. Educators spend a lot of time with young people, which gives them the opportunity to develop a relationship of trust and support (Fazel et al, 2014). School staff are also routinely consulted by parents and students on what to do with regards to mental health or behavioral issues. It is essential that we use reliable evidence to inform decisions made by policy makers and professionals about what should be provided in schools.

In the present study (Clarke et al, 2021), the authors set out to identify the latest evidence for the effectiveness of school-based interventions designed to meet the emotional and behavioral needs of youth aged 12 to 18.

One in six young people between the ages of 5 and 16 have experienced mental health problems. Schools can provide an accessible means of delivering mental health prevention programs.

Methods

The authors searched three databases (PsycINFO, SCOPUS, Web of Science) with clearly described search terms to identify school-based mental health interventions. The authors searched for meta-analyzes published between January 2010 and August 2020, and primary studies published between January 2017 and August 2020.

To be included, interventions had to be delivered in secondary schools to youth aged 12-18. Only empirical studies using quantitative methods were included. Interventions for people working with adolescents in secondary schools were included if the study reported student outcomes, rather than staff training or skills outcomes.

Experts in the fields were consulted and manual searches were performed on Google Scholar. The authors also searched the references contained in the identified review articles.

A narrative synthesis of the results was presented for the systematic reviews and the primary studies.

Results

The authors included a total of 34 review articles published since 2010 and 97 primary studies published in the past three years.

The main findings showed:

• The majority of prevention interventions were based on cognitive behavioral therapy (CBT). Interventions by external professionals have shown good evidence for reduction of symptoms of depression in young people with subclinical symptoms, in the short to medium term.
• Social and Emotional Learning Interventions (SEL) are comprehensive school and school programs focused on developing students’ emotional and social skills. SEL interventions have been shown to have a low to moderate impact on the social and emotional skills of young people and on symptoms of depression and anxiety in the short term.
• Mindfulness, positive psychology, and positive youth development interventions have shown limited evidence of effectiveness.
• Mental health literacy interventions have been shown to have a positive impact on young people’s knowledge of mental health. However, the evidence is limited as to whether these interventions have an impact on attitudes towards mental health, stigma, and help-seeking behavior.
• Interventions on suicide and self-injury prevention were limited, and studies of caregiver training were of low quality.
• School-wide interventions are particularly effective in reducing bullying behavior. However, none of the main studies examined the impact of interventions to prevent cyberbullying.
• Universal sexual violence prevention interventions have shown little positive impact on improving knowledge and attitudes, but minimal impact on perpetration and victimization. These interventions have had a greater positive impact when integrated into a whole school approach.
• Teachers have been shown to be effective program facilitators when delivering universal interventions. However, there is no evidence that the interventions offered by teachers are effective in meeting the needs of students with symptoms of depression or anxiety.

This review provides a high-level summary of the best school-based interventions to support the mental health of 12-18 year olds.

Conclusion

This review highlights that school-based mental and behavioral health interventions have the potential to address some of the greatest challenges facing children and youth today. More specifically, he points out that interventions using CBT and targeting symptoms of depression and anxiety, or reducing aggressive behavior, bullying and victimization were the most effective; with more pronounced effects in subclinical populations. However, it also highlights that interventions are not universally effective, require careful implementation, and in many cases more research is desperately needed – meaning that when it comes to mental health interventions in the setting school, a certain caution is always in order.

School-based interventions using a CBT approach to target symptoms of depression and anxiety are evidence-based.

Strengths and limitations

This synthesis document provides an in-depth synthesis of mental health interventions in schools. There are many mental health interventions available for schools, but due to limited resources, it can be difficult to decide which interventions to implement. This review bridges the gap and provides a comprehensive list of existing effective interventions.

However, by the authors’ own admission, there are a number of limitations to this review.

First, a meta-analysis of the primary studies was not performed, making it difficult to fully synthesize and assess the strength of the evidence. However, as the authors note, it is likely that the majority of relevant studies would have been included in the systematic reviews. Therefore, this decision may have a limited effect on the findings.

The possibility of publication bias should be carefully considered, as studies with more positive results are more likely to be published. There may be additional evidence pointing to the ineffectiveness of interventions that this review may not have captured, leading to biased results.

A final limitation: the current review did not extract intervention-specific data from systematic review studies, but rather reports the overall results of these reviews. Comparing components within and between interventions can further explain why an intervention was or was not effective.

There are many mental health interventions available for schools, but due to limited resources, it can be difficult to decide which interventions to implement.

Implications for practice

The current review presents key findings that have important implications for practice, policy and research. Schools should be supported and equipped with the necessary tools to successfully implement evidence-based interventions. This is likely to require additional and targeted investments in resources and training, including the development of school staff in the early identification of vulnerable learners.

This review reveals significant gaps in the existing evidence, which led the authors to identify key priority areas for future research. For example, limited interventions addressing cyberbullying, conduct issues, and self-harm have been identified. Evidence exploring the development and evaluation of targeted interventions for ‘at-risk groups’, including those from ethnic minorities, lower socioeconomic status and with special educational needs was among those that require further investigation. . We further recommend that interventions for people at risk of school exclusion should also be considered a research priority.

In addition, the authors identify that more longitudinal research is needed with a careful description of the dosage and adherence to the intervention. At present, it is difficult to understand whether the success or failure of a program is due to the intervention itself or to the way in which it was implemented.

How an intervention is implemented can be important. It is essential that the school and mental health communities continue to collaborate to generate new, high-quality evidence.

Declaration of interests

No conflicts of interest.

Connections

Primary paper

Clarke, A., Sorgenfrei, M., Mulcahy, J., Davie, P., Friedrich, C. & McBride, T. (2021). Adolescent mental health: a systematic review of the effectiveness of school-based interventions. Early Intervention Foundation.

Other references

Ministry of Health and Ministry of Education. (2017). Transforming the provision of mental health care for children and adolescents: a green paper.

Fazel, M., Hoagwood, K., Stephan, S. and Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1 (5), 377-387.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P.,… UnUtzer, J. (2018). The Lancet Commission on Global Mental Health and Sustainable Development. Lancet (London, England). doi: 10.1016 / s0140-6736 (18) 31612-x

Sadler K, Vizard T, Ford T, Marcheselli F et al. (2018). Child and youth mental health in England, 2020. Digital NHS.

Vizard T, Sadler K, Ford T, Newlove-Delgado T et al. (2020). Child and youth mental health in England, 2020. Digital NHS.

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