School-based Mental Health Promotion Research Articles

Assessing the Evidence Base for School-Based Promotion and Prevention Interventions: Introduction to the Series.

Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) Series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB Series used the rating criteria derived from the 2014 AEB Series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.

Sustaining mental health and wellbeing programmes in schools: recommendations from an online roundtable

Despite recent investments in school-based mental health and wellbeing promotion in England, the sustainability of mental health interventions remains a substantial challenge. This article brings together potential solutions to sustaining interventions in schools, drawing on insights from an online roundtable discussion held in July 2022. Facilitated by researchers and informed by recent research on barriers and facilitators to sustaining school-based mental health interventions, 16 participants came together to discuss challenges and solutions. Participants included school staff, policy makers, educational psychologists, researchers and mental health intervention developers. The discussion explored the need for accountability at all levels (e.g., from school leaders to policy makers and Ofsted) and the potential value of engaging schools more consistently with academic evidence. Participants also discussed the importance of creating a healthy and sustainable ecosystem for interventions (underscoring the significance of staff wellbeing, adequate resourcing, and longer-term funding commitments), and moving beyond separate, isolated interventions. The findings offer a range of recommendations for school decision makers, mental health researchers, intervention developers, and those working in the wider system around schools.

A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Developing a School-Based Mental Health Promotion Program Through Co-creation Approach

School setting is an effective environment for primary mental health care for students. There have been many mental health support programs in schools for students, most of which are predesigned. The objectives of this paper are: i) To introduce the co-creation approach; and ii) To narratively describe the process of co-creating a mental health promotion program for 04 secondary schools and 04 high schools in Nghe An and Khanh Hoa, Vietnam. Students, teachers, parents and local authorities were the involved stakeholders. Mixed methods including narrative research, observations, open-ended and closed-ended questionnaires were used. The results show that using co-creation approach to develop a mental health promotion program is feasible and applicable in Vietnam. Challenges, learnt lessons and discussion about feasibility of the co-creation process to develop the school-based mental health promotion program are also mentioned in the paper.

School-based Psychosocial interventions on mental health among Chinese rural children with traumatic experiences: a protocol using cluster randomized controlled trial

BackgroundThe first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions.MethodsThis study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks.DiscussionThis study would develop school-based mental health promotion policy recommendations to improve Chinese rural children’s mental health. This study can provide solid evidence for the promotion of school-based intervention in general.Trial registrationChiCTR2300069405, Registered on 15 March 2023.

School-based mental health promotion: A global policy review.

Schools are increasingly recognized as important settings for mental health promotion, but it is unclear what actions schools should prioritize to promote student mental health and wellbeing. We undertook a policy review of global school-based mental health promotion policy documents from United Nations (UN) agencies to understand the frameworks they use and the actions they recommend for schools. We searched for guidelines and manuals from UN agencies through the World Health Organization (WHO) library, the National Library of Australia and Google Scholar, from 2000 to 2021, using various combinations of search terms (e.g., mental health, wellbeing, psychosocial, health, school, framework, manual, and guidelines). Textual data synthesis was undertaken. Sixteen documents met inclusion criteria. UN policy documents commonly recommended a comprehensive school-health framework aimed at integrating actions to prevent, promote, and support mental health problems within the school community. The primary role of schools was framed around building enabling contexts for mental health and wellbeing. Terminology was relatively inconsistent across different guidelines and manuals, particularly around how comprehensive school health was conceptualized, which included aspects of scope, focus, and approach. United Nations policy documents are oriented toward comprehensive school-health frameworks for student mental health and wellbeing that include mental health within wider health-promoting approaches. There are expectations that schools have the capabilities to deliver actions to prevent, promote and support mental health problems. Effective implementation of school-based mental health promotion requires investments that facilitate specific actions from governments, schools, families, and communities.

An innovative process for sustaining and scaling up a school-based mental health promotion and anxiety prevention programs: The example of the HORS-PISTE program

An innovative process for sustaining and scaling up a school-based mental health promotion and anxiety prevention programs: The example of the HORS-PISTE program

School-based universal mental health promotion intervention for adolescents in Vietnam: Two-arm, parallel, controlled trial.

The aim of this study was to evaluate the effects of Happy House, a universal school-based programme, in reducing adolescents' depressive symptoms and improving their mental well-being, coping self-efficacy and school connectedness. This was a school-based, two-arm parallel controlled trial. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale. Data were collected at recruitment, and at 2 weeks and 6 months post-intervention. Mixed-effect models were conducted to estimate the effects of the intervention on the outcomes. A total of 1,084 students were recruited. At 2 weeks post-intervention, the effect size on depressive symptoms was 0.11 (p=0.011) and the odds of having clinically significant depressive symptoms were lower in the intervention compared to the control (0.56, p=0.027). Both of these were no longer significant at 6 months post-intervention. Psychological well-being mean scores in the intervention were significantly higher than in the control at 2 weeks post-intervention (effect size 0.13). Coping self-efficacy mean scores were significantly higher in the intervention group at both 2-week and 6-month post-intervention (effect sizes from 0.17 to 0.26). Data support the potential of Happy House to reduce the prevalence of adolescent mental health problems and to promote positive mental health in the school context in Vietnam.

Perspectives of education and mental health professionals on adolescent school-based mental health promotion: a qualitative exploration

BackgroundInterdisciplinary interventions for school-based mental health promotion (SBMHP) for adolescents (10–19 years old) provide a unique opportunity to address the urgent mental health needs across this population. EspaiJove.net, a SBMHP programme, has delivered mental health workshops to over 24118 adolescents in Barcelona, Spain, since 2012. This study aimed to explore the perspectives from professionals involved in EspaiJove.net regarding the needs, challenges, and opportunities for adolescent SBMHP, to guide future interventions. MethodsFollowing an interpretivist approach rooted in social constructionism, semi-structured online interviews were conducted with six mental health professionals and five education professionals recruited through purposeful sampling from four schools participating in EspaiJove.net in Barcelona, Spain. Data collection was done between November and December, 2021. An interview guide and ongoing researcher reflexivity contributed to attaining data saturation. Bracketing, member checking, and debriefing were used to ensure rigour. Data were analysed through thematic content analysis. The University of Liverpool's Ethics Committee approved this study. FindingsData showed that: (1) there is a shared understanding among education and mental health professionals towards mental health and its promotion; (2) there is an urgent need for adolescent mental health promotion; and (3) participants' perceived roles and responsibilities in SBMHP varied, but favourable views towards the implementation of SBMHP were unanimous. There was perceived urgency towards adolescent mental health promotion, partly attributed to the effects of the COVID-19 pandemic. The link established between schools and mental health centres through EspaiJove.net fostered an interdisciplinary collaboration that spanned well beyond the intervention. The major challenge affecting the feasibility of SBMHP unanimously described was the scarcity of resources and political will to invest in mental health promotion. InterpretationPerspectives arising from EspaiJove.net reveal favourable views towards SBMHP among participants. Although limited by size, the consistency of the findings add strength to the study. Given the similarities between the UK and Spain's Education and Health Systems, these findings could contribute to the advancement of SBMHP in the UK. Despite current challenges, such as the scarcity of resources and political will identified in this study, capitalising on schools as health-promoting assets and fostering interdisciplinary collaboration through SBMHP could be a cost-effective way to address the current global mental health crisis. FundingNone.

Moderators of pre-post changes in school-based mental health promotion: Psychological stress symptom decrease for adolescents with mental health problems, knowledge increase for all.

BackgroundSchool-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge.MethodsParticipants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12–18 years (M = 13.88, SD = 1.00; grade levels 7–10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included.ResultsIn the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher.ConclusionPsychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.

Contributions of universal school-based mental health promotion to the wellbeing of adolescents and preadolescents: a systematic review of educational interventions

PurposeThe study aims to determine the contributions of universal school-based educational programs to the current and future worldwide youth mental health condition.Design/methodology/approachA systematic search was conducted in accordance with the PRISMA 2020 guidelines. Academic education and health databases including ERIC, Education Database, APA PsycInfo, APA PsycArticles, Psychology Database, and PubMed were used. Characteristics and outcomes of educational interventions developed in school settings and education potential for mental health promotion were examined.FindingsUniversal school-based mental health educational programs positively affect preadolescents and adolescents. The study review provided further insight into educational programs' characteristics and identified two primary curricula foci: mental health education and development of resiliency traits and skills.Originality/valueResearch on mental health promotion using a pedagogical approach is rare as most studies focus on mental health symptomatology and psychotherapy techniques training.

Mental health and emotional wellbeing education in school nursing practice

The emotional health and wellbeing (EHWB) of children and young people (C&amp;YP) are of particular significance to specialist community public health nurses (SCPHN) in the field of school nursing practice as they are key contributors to the health and development of children. This paper will discuss the findings of a strategy critique and a small literature review, aimed at determining if school-based mental health promotion positively influences C&amp;YP's EHWB and how this can affect school nursing practice in Wales.

School-based health promotion to improve mental health literacy: a comparative study of peer- versus adult-led delivery

Background School-based youth mental health promotion is increasingly recognised as a useful tool to improve mental health knowledge and help-seeking among adolescents. Peer-led initiatives are emerging as a potentially viable mode of delivering this material. Yet, there is limited evidence on the effectiveness of these initiatives compared to more traditional, adult-led, forms of mental health promotion. Aims This study aimed to compare improvements in students’ mental health knowledge and help-seeking after attending either a peer- or adult-led youth mental health promotion workshop. It also sought to examine differential effects by gender. Method A within- and between-group comparative design was used to examine secondary school students’ (N = 536) mental health knowledge and help-seeking intentions before and after attending a school-based mental health promotion workshop. Results Students’ mental health knowledge and help-seeking intentions significantly improved in both peer- and adult-led groups. Outcomes did not differ across modes of delivery, although the impact of adult-led workshops on mental health knowledge was moderated by gender. Conclusions Peer-led youth mental health promotion appears to be as effective as traditional adult-led delivery, and seems to be particularly beneficial for male students who respond more favourably to content communicated through their peers.

School-Based Mental Health Promotion and Early Intervention Programs in New South Wales, Australia: Mapping Practice to Policy and Evidence

Limited empirical evidence is available regarding the uptake and effectiveness of school-based mental health and wellbeing programs implemented in Australian schools. This study aimed to characterise the delivery of programs in primary (elementary) schools across New South Wales, Australia, and to assess this information against published ratings of program effectiveness. Delivery of programs in four health-promoting domains—creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties—were reported by 597 school principals/leaders via online survey. Although three quarters of principals reported implementing at least one program, many of these programs were supported by little or no evidence of effectiveness. There was also variability in the use of evidence-based programs across the four domains. Findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health.

A Local Review on the Use of a Bio-Psycho-Social Model in School-Based Mental Health Promotion.

Background: Schools are a key setting for student well-being promotion. Various school-based mental health programs have been implemented worldwide, with greater emphasis placed on psychological and social aspects. The bio-psycho-social model provides a holistic and integrated view of mental health based on theory and research evidence. Given the importance of considering all three dimensions in mental health promotion, this study explored reasons for the relative neglect of this approach by studying the early phase of school well-being program development and implementation.Method: In total, 77 Hong Kong government-funded student well-being programs implemented in 2000–2009 were reviewed for the use of biological, psychological, and social interventions. Questionnaires and interviews were conducted to explore program leaders' usage and views regarding theoretical frameworks and evidence-based practice and program evaluation. Challenges encountered in the initial stage of school well-being program development and implementation were identified and analyzed.Results: Of the 77 programs reviewed, only 5 addressed all three bio-psycho-social factors of mental health. A significantly greater number of programs addressed psychological (n = 63) and social (n = 40) factors compared to those that covered biological factors of mental health (n = 13). Of 24 program implementers who responded to the online survey, 75% claimed to have studied or applied a theoretical framework yet only 41.7% considered evidence-based practices to be important. The majority of interviewed participants valued their own practical experience over theory and research evidence. Many programs lacked rigorous evaluation of clear objectives and measurable outcomes, thus the mechanisms of change and program effectiveness were uncertain. Perceived barriers to program adoption and continuation were identified.Conclusion: This study highlighted a neglect of the biological contribution to mental health in school well-being promotion initiatives, possibly due to lack of theoretical knowledge and evidence-based practice among program leaders and implementers in the early phase of school mental health promotion. The bio-psycho-social model should therefore be recommended for student well-being programs as a holistic and integrated theory of mental health underpinning program objectives, mechanisms of change, and measurable outcomes. To develop effective practices in student well-being promotion, more thorough documentation, a rigorous evaluation framework, and support for frontline educators to evaluate their practices were recommended.

School professionals committed to student well-being

ABSTRACT The northern provinces of Finland are mostly not densely populated, with long distances to healthcare services. This creates a challenge for how to reach all children and adolescents with mental health services. In order to assess the effectiveness of school-based mental health promotion interventions, it is essential to understand the views of school professionals on student well-being and mental health promotion activity in schools. This study was carried out in urban area comprehensive schools where psychiatric nurses delivered additional mental health promotion interventions. The data were collected using a questionnaire, and a mixed-methods approach was utilised in the analysis. School professionals perceived that students are more unwell than before; they exhibit a general disregard for their well-being and more mental health problems. The respondents regarded the promotion of students’ mental health as a basic function of schools. Teachers need adequate support with this work.

Effects of a mental health promotion intervention on mental health of Iranian female adolescents: a school-based study

BackgroundPoor mental health is common among adolescents. Given the increasing burden of poor mental health among adolescents in developing countries, it seems necessary to identify the effective interventions. The main purpose of this study was to investigate the effects of a school-based mental health promotion program (SMHPP) on mental health parameters among female adolescents in Tabriz, Iran.MethodIn this experimental study, a random sample of female high-school students of grade nine was recruited. The subjects were then randomly allocated to intervention (n = 145) and control (n = 139) groups. The three-stage SMHPP was designed based on the shortages and unmet needs of the students as reported in the pretest stage. All subjects in the intervention group were provided with a stress management skill training program of six sessions using McNamara Model. Coincided with making environmental changes, a joyful intervention program was carried out. After 2 months, post-test data were collected.ResultsA total of 284 students completed their participation in the study. The groups did not differ in none of socio-demographic characteristics and mental health parameters, at baseline. The number of subjects reporting medium-level of happiness was increased by 32.6% among intervention group. Moreover, upon sign test and pre-post comparison, the group-wise distribution changed between the intervention and control groups for the parameters of life satisfaction (p ≤ 0.001) and psychological well-being (p ≤ 0.01).ConclusionThe implementation of SMHPP as a low-cost, needs-based and multifaceted program, showed promise in promoting adolescents’ mental health, particularly in the parameters of happiness, life satisfaction and psychological well-being. This was an important evidence for the development and implementation of interventions and policies in the field of mental health promotion among adolescents. Our work provided means for reducing burden of poor mental health among adolescents in a non-western cultural context. Further larger studies are required to evaluate the effectiveness of such school-based mental health promotion interventions in students.

Development and acceptability testing of a mental health promotion intervention using the Medical Research Council framework

ABSTRACT Young people are at a high risk of developing mental health disorders or illnesses. Mental health promotion (MHP) interventions can reduce this risk. Using the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, this study designed and acceptability tested a methodologically robust school-based mental health promotion intervention. A scoping review and focus groups with stakeholders were conducted during the development phase of the MRC framework. The scoping review involved identifying evidence for effective school-based MHP interventions. Focus groups were then used to determine the acceptability of components identified by the scoping review and to clarify the target or goal of taking part in the intervention. A logic model, showing the theory of change underpinning an intervention designed on the basis of this development phase, was subsequently developed. The scoping review established that MHP interventions typically focus on stigma and stereotypes, mental health literacy and knowledge and help-seeking, and use these foci to determine impact. Common intervention components include group discussion, videos, presentations, storytelling and handouts. Testing of these commonly occurring components targeting knowledge and attitudes towards mental health and stigma and stereotypes suggested all were acceptable to stakeholders. Using the MRC framework to guide the development and test the acceptability of a MHP intervention, this study has produced a complex evidence-based health promotion intervention using interactive activities and videos. Further phases will involve a process evaluation of the intervention fidelity and feasibility testing.

Influence of coping strategies on the efficacy of YAM (Youth Aware of Mental Health): a universal school-based suicide preventive program.

The school-based mental health promotion and suicide prevention universal program Youth Aware of Mental Health (YAM) significantly reduces incident suicide attempts and severe suicidal ideation. This paper aims at elucidating psychological mechanisms underlying YAM's efficacy. Our hypothesis is that YAM operates through interactions with coping strategies (CS) on the reduction of suicidal ideation (SI). In the Saving and Empowering Young Lives in Europe (SEYLE) study, five coping strategies were assessed at baseline (T0) and 12-month follow-up (T12): "learning", "help-seeking", "arts", "sports" and "fight". We analyzed interactions between the YAM intervention, coping strategies and SI in the YAM group (N = 1693) and the minimal intervention group (N = 1909), after excluding prevalent cases with SI and previous suicide attempts from our total sample (N = 5654). General Linear Mixed Model regressions were performed. The present study confirms that coping strategies play an influential role on suicidal ideation. Our results showed that YAM acts whatever the prevailing coping strategies used. It is particularly efficient for pupils insufficiently using adaptive coping strategies such as LEARN and HELP-SEEKING or using maladaptive coping strategies, such as ARTS and FIGHT. The socialization induced by the YAM intervention seems to be a strong component of its efficiency.

The Hopeful Minds Programme: A Mixed-method Evaluation of 10 School Curriculum Based, Theoretically Framed, Lessons to Promote Mental Health and Coping Skills in 8–14-year-olds

ABSTRACT This study is the first evaluation of Hopeful Minds: a novel school-based mental health promotion programme designed for children and pre-adolescents. Ten hope theory-based lessons were assessed. A mixed-methodology design was used with a sample of 127 participants (88 pre/post; 39 focus groups), aged 8–13 years. In the pre/post-study, there were significant improvements in anxiety and emotional regulation levels (primary school), coping and resilience levels (post-primary). Focus groups were conducted with three post-primary groups. The key overarching qualitative themes included developing a hopeful mind; increased emotional insight and awareness; improved resilience, confidence, self-belief, and developing new coping skills and a request to provide the programme to all transitioning primary school children. Outcomes provide preliminary evidence indicating that the Hopeful Minds programme, which utilises ‘Hope theory’ as it's foundation, has potential in preventing the development of mental health issues in pre and early adolescent children. Recommendations include adopting a whole school approach, include additional lessons on rumination and academic failure.