School-based Mental Health Screening Research Articles

Early detection of students' mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization.

The implementation of school-based mental health screening offers promise for early detection of mental health issues in children; however, various barriers hinder its widespread adoption. This study aimed to investigate the predictive value of digital data obtained from an established daily health observation scheme in Japanese schools to identify later mental health issues in children. Data for the analysis were obtained from 2,433 students enrolled in five public schools. The data acquisition period spanned 76 school days, from September 1, 2022, to December 23, 2022, and student absences were recorded during this period. Depressive and anxiety symptoms were assessed in January 2023. The students' daily physical and emotional health status was recorded as "daily health issue" scores and group-based trajectory modeling was employed to classify the long-term trends in these scores. Additionally, rolling z-scores were utilized to capture variability in daily health issue scores, with z-scores above +1 considered unusual responses. After 4 months of daily health observations, students' response trends were classified into five trajectory groups. The group experiencing the highest number of daily health issues (Group 5; 5.4% of the sample) exhibited more subsequent depressive and anxiety symptoms compared to the group with fewer issues (Group 1; 47.5%) (incident rate ratio [IRR] = 5.17; 95% confidence interval [CI]: 3.82, 6.99). Group 5 also demonstrated significantly more days of absence than Group 1 (IRR = 2.14, 95% CI: 1.19, 3.85). The average daily health issue scores for the entire period were associated with both depressive/anxiety symptoms and the number of days absent from school (IRR = 1.59, 95% CI: 1.45, 1.73; IRR = 1.18, 95% CI: 1.04, 1.35, respectively). Furthermore, a higher number of unusual responses during the entire period was also associated with more depressive/anxiety symptoms (IRR = 1.10, 95% CI: 1.07, 1.12). The current study is the first to demonstrate the predictive capability of a traditional daily health observation scheme to identify mental health issues in children. This study highlights the scheme's potential to screen and safeguard children's mental health, emphasizing the importance of digitalization and collaboration with various stakeholders.

Adolescent school-based mental health screening: a best practice implementation project.

More than one in ten people globally live with a mental health illness. Adolescent mental health is a major contributor to that statistic, as 27% of adolescents have one or more mental, emotional, developmental, or behavioral problems. School-based health care clinics can provide mental health services for this age group. This project aimed to promote evidence-based practices regarding adolescent mental health screening in schools. This project used the JBI Evidence Implementation Framework to promote evidence-based practices for adolescent mental health screening in schools. The JBI framework is grounded in an audit and feedback process, along with a structured approach to identifying and managing barriers to compliance with best practices. Five audit criteria representing best practice recommendations were developed. A baseline audit was conducted, followed by the implementation of an improvement strategy. The project was finalized with a follow-up audit to determine any changes in compliance with best practice recommendations. The baseline survey of students revealed a 25% average compliance for audit criteria 1 and 2. The primary barrier to compliance was students' unawareness of the availability of mental health services. The improvement strategy included an educational presentation for students regarding mental health. The follow-up audit revealed an increase in compliance with best practices. The project achieved a 29% increase in compliance with best practices, although only 23% of the students were reached via the improvement strategy. http://links.lww.com/IJEBH/A189.

Potential mental health-related harms associated with the universal screening of anxiety and depressive symptoms in Australian secondary schools

BackgroundAnxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools.MethodsA total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models.ResultsParticipants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition.ConclusionsThe intensive screening procedure did not appear to adversely impact adolescents’ mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students.Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821.

Assessing Emotional Distress in Adolescents: Psychometrics of the Spanish Version of the Social Emotional Distress Scale-Secondary

BackgroundThe Social Emotional Distress Scale-Secondary (SEDS-S) is a short measure designed for comprehensive school-based mental health screening, particularly for using very brief self-reported measures of well-being and distress. Whereas prior studies have shown validity and reliability evidence for the English version, there is a lack of literature about its psychometric properties for Spanish-speaking youths.ObjectiveTo examine the psychometric properties of the SEDS-S in a large sample of Spanish adolescents, providing evidence of its reliability, structure, convergent and discriminant validity, longitudinal and gender measurement invariance, and normative data.MethodsParticipants were 5550 adolescents aged 12–18 years old. Test–retest reliability was examined using Cronbach’s alpha and McDonald’s omega coefficients, and evidence for convergent and discriminant validity was measured using Pearson’s correlation. Confirmatory factor analysis (CFA) was used to examine structure validity, while multigroup and longitudinal measurement invariance analysis was conducted for longitudinal and gender latent structure stability.ResultsThe CFA supported a unidimensional latent structure, which was also observed to be invariant between gender groups and over time. The scale showed evidence of reliability, with coefficients above .85. In addition, the SEDS-S score was positively related to measures assessing distress and negatively related to measures assessing well-being, thereby providing convergent/discriminant validity of the total scores.ConclusionThis study provides the first evidence of the reliability and validity of the Spanish version of the SEDS-S for assessing emotional distress among adolescents, cross-sectionally and longitudinally. Furthermore, findings indicated that SEDS-S could be a suitable assessment tool for screening and program evaluation purposes at different contexts beyond the school setting.

Examining the predictive utility of the self-report Strengths and Difficulties Questionnaire with middle school students

This study aimed to investigate the added value of universal mental health screening in school settings. A total of 1735 students were screened using the youth self-report version of Strengths and Difficulties Questionnaire (SDQ-SR). Non-parametric models were fit to data from the SDQ-SR Internalizing and Externalizing subscales to predict total ODRs by the end of the school year. Final models confirmed the positive predictive relationship between SDQ-SR externalizing scores and ODRs and consistently found internalizing scores to be a negative predictor of ODRs. Specifically, for every 1-point increase in the Externalizing score, ODRs increase by .09 standard deviations; for every 1-point increase in Internalizing scores, ODRs decrease by 0.02 standard deviations. Findings suggested that students with internalizing concerns were likely under-identified when examining patterns in ODRs alone. The implementation of school-based universal mental health screening in addition to examining patterns in academic and behavioral outcomes may assist school personnel in identifying students with emerging social-emotional difficulties.

From barriers to implementation: Advancing universal mental health screening in schools

AbstractIn light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.

Children’s mental health in different contexts: Results from a multi-informant assessment of Estonian first-grade students

The current study sought to investigate the agreement between teachers and parents about the mental health of first-grade students, the factors that affected this agreement and the associations between measures completed by students, parents and teachers. The investigation used baseline data collected during the PAX Good Behavior Game (PAX GBG) effectiveness study in 42 Estonian schools (N = 708). Information was collected about externalizing and internalizing difficulties and prosocial behaviour, and about inhibitory control. Our research showed higher agreement between parents and teachers about externalizing behaviour and lower agreement regarding prosocial behavior and emotional problems. Inhibition was correlated with teacher-rated questionnaires, but not with parents’ responses. Sociodemographic factors influenced the agreement between teachers and parents somewhat differently. This study highlights the importance of a multi-informant approach in students’ mental health assessments, as some problems might be less observable in certain environments or by some respondents. The practical implications of these findings are discussed and suggestions are provided for the development of a school-based mental health screening system.

Mental Health Literacy and Help-Seeking Preferences in High School Students in Ho Chi Minh City, Vietnam

A high prevalence of mental disorders in adolescents has been reported worldwide, but little is known about mental health literacy in this population, particularly in developing countries. The goal of this study was to evaluate mental health literacy level and help-seeking preferences in high school students in Ho Chi Minh City, Vietnam. These two variables were also compared between students who had stress, anxiety and depression with students who did not. A cross-sectional study was conducted with 1094 students across 27 classes at three high schools. Students completed a self-report questionnaire that included validated scales such as the Depression Anxiety Stress Scale (DASS-21), the Mental Health Literacy Scale (MHLS) and the General Help-Seeking Questionnaire. Based on the DASS-21, the prevalence of students reporting symptoms of stress, depression and anxiety was 36.1%, 39.8% and 59.8%, respectively. The mean MHLS score was 104.12 (SD = 10.09) and was significantly lower in students who had symptoms of depression. The most common help-seeking preferences for mental illness were friends, classmates and relatives or family members. Help-seeking preferences were almost identical among students with stress, anxiety or depression. While Vietnamese high school students had high levels of symptoms of stress, depression and anxiety and moderate levels of mental health literacy, non-professionals were preferred as their first help-seeking choice. Our findings revealed the need for routine school-based mental health screening and referral activities as well as mental health education programs for high school students in Vietnam.

Four-year trajectory of Korean youth mental health and impacts of school environment and school counselling: a observational study using national schools database

ObjectivesThis study aimed to investigate changes in the mental health status of South Korean adolescents at a school level and identify school-related factors affecting these changes.DesignA retrospective data analysis, population...

Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa

BackgroundSuicidal behaviors among adolescents is a major public health concern. Psychological factors have been extensively studied known risks linked to suicidal behaviors in the general population. However, the association between food insecurity and suicidal behaviors is less researched, particularly in low and middle-income countries. The present study sought to assess the link between food insecurity and suicide behaviors among in-school adolescents.MethodsThe present study was based on the secondary analysis of the first nationally representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The primary independent variable was food insecurity while the dependent variables of interest were suicide ideation and suicide attempt. Chi-square χ2 and multivariate logistic regression were used to ascertain the measure of statistical association. In all analyses, a p < 0.05 was considered statistically significant.ResultsOf the 3,793 in-school adolescents, 254 (6·7%) were food insecure. A significantly large proportion of adolescents with suicidal ideation and suicidal attempt were food insecure than their counterparts, respectively. In the adjusted multivariate model, food insecure adolescents were more likely to have experienced suicidal ideation and suicidal attempt: [AOR; 1·8 95% C. I; 1·3–2·5] and [AOR; 2·4, 95% C. I; 1·7–3·3]; p < 0.001, respectively.ConclusionFood insecurity was an independent predictor of suicidal behaviors among in-school adolescents. An intervention that targets food security at the school level may protect adolescents of food insecure household from suicidal behaviors. Nevertheless, school-based mental health screening, evaluation, and promotion may be needed for adolescents with suicidal behaviors.

Gender differences in Korean adolescents who died by suicide based on teacher reports

BackgroundWe investigated the characteristics of adolescents who committed suicide in South Korea, and how these characteristics differed by gender.MethodData from middle and high school students who committed suicide between 2014 and 2016 were analyzed. We evaluated differences in suicide method and place, personal characteristics, and school life characteristics by gender using the Chi square test and t test.ResultsJumping from a high place was the most common suicide method for both male and female students. A significantly greater proportion of female adolescents had experienced depressive symptoms, previous self-injury, previous suicide attempts, and had problems with school attendance and peers. Additionally, they were more likely to be classified as high risk according to a school-based mental health screening test and to utilize professional mental health treatment services.ConclusionOur results demonstrate that adolescents who committed suicide exhibited gender differences in personal characteristics and school life. These characteristics might aid in the development of adolescent suicide policies and intervention programs.

Factors Associated with Depression among School-going Adolescent Girls in a District of Northern India: A Cross-sectional Study.

Context:Depression among adolescents, especially among girls, is a rising public health problem worldwide. It has been associated with a profound negative impact on their physical, social, and mental well-being.Aim of the Study:To ascertain the factors associated with depression among school-going adolescent girls in district Barabanki of Uttar Pradesh.Settings and Design:School-based cross-sectional study.Subject and Methods:The study was conducted among 2187 school-going adolescent girls (10–19 years) in Barabanki district from September 2016 to September 2017 using multistage sampling. Sociodemographic characteristics such as age, residence, family background, and socioeconomic status were assessed through direct interview of the adolescent girl, with its reconfirmation from school records. Eleven-item Kutcher Adolescent Depression Scale was used for assessment of depression.Statistical Analysis Used:Probability (P) was calculated to test for statistical significance at 5% level of statistical significance. Association between risk factors and depression was determined using bivariate analysis followed by multivariate logistic regression.Results:The prevalence of depression was found to be 39.7%. Multiple logistic regression revealed that depression was significantly higher among those residing in rural areas [odds ratio (OR) 3.32; P < 0.001], those in early and mid-adolescent age group (OR 2.51; P < 0.001), those studying in private schools (OR 3.22; P < 0.001), and those with Hindi as the medium of instruction (OR12.50; P < 0.001). Depression was also found to be significantly higher among those whose mothers were educated up to primary (OR 3.19; P < 0.01) or up to intercollege (OR 1.59; P < 0.001) when compared with illiterate mothers. Similarly, depression was found to be more common among those girls whose fathers were educated up to intercollege (OR 1.29; P < 0.05) or were graduate and above (OR 1.58; P < 0.001).Conclusion:A significant proportion of school-going adolescent girls were suffering from depression, which reflects the need for reinforcement and strengthening of school-based mental health screening programs. Parents, teachers, and community health workers should work as a team to deal with the problem in a more effective way.

Subtypes of suicidal ideation in Korean adolescents: A multilevel latent profile analysis.

This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies.

The impact of psychological problems and adverse life events on suicidal ideation among adolescents using nationwide data of a school-based mental health screening test in Korea.

The aim of this study was to investigate the risk factors for suicidal ideation in adolescents by gender and age. This study used 2013 nationwide school-based mental health screening test data from 591,303 seventh grade students and 618,271 tenth grade students in Korea. Suicidal ideation, four psychological problems, and three adverse life events were evaluated using the Adolescents Mental Health and Problem Behavior Screening Questionnaire-II. Of all students, 12.9-14.7% of the boys and 17.1-23.2% of the girls had suicidal ideation. Mood had the greatest impact on the risk for suicidal ideation and other factors also significantly increased the risk of suicidal ideation. Distractibility was positively related to suicidal ideation only in seventh grade students and behavioral problems increased suicidal ideation more in girls than in boys. Violence constituted the most powerful factor for suicidal ideation among the events; however, bullying constituted the most important event that increased suicidal ideation in seventh grade girls. All factors except 'Distractibility' increased the risk of severe suicidal ideation. The risk factors for suicidal ideation in adolescents differed by gender and age. Interventions should be made according to these characteristics to reduce suicidal ideation in adolescents.

Initial Validation of the Social Emotional Distress Survey–Secondary to Support Complete Mental Health Screening

Contemporary mental health assessment conceptualizations focus on both well-being and distress. This study presents initial validation information for the Social Emotional Distress Survey–Secondary (SEDS-S), which was designed for school-based complete mental health screening that employs brief self-report measures of well-being and distress. The SEDS-S structure was investigated using two independent samples of U.S. high school students ( N = 3,780). Findings from exploratory and confirmatory factor analyses suggested a one-factor model of distress with good model fit. Path analyses revealed significant positive relations of the SEDS-S distress factor with symptoms of anxiety and depression, and a significant negative relation with life satisfaction and strengths scores. Future research directions and use in school-based screening applications are discussed.

Effects of mischievous responding on universal mental health screening: I love rum raisin ice cream, really I do!

Student surveys are often used for school-based mental health screening; hence, it is critical to evaluate the authenticity of information obtained via the self-report format. The objective of this study was to examine the possible effects of mischievous response patterns on school-based screening results. The present study included 1,857 high school students who completed a schoolwide screening for complete mental health. Student responses were reviewed to detect possible mischievous responses and to examine their association with other survey results. Consistent with previous research, mischievous responding was evaluated by items that are legitimate to ask of all students (e.g., How much do you weigh? and How many siblings do you have?). Responses were considered "mischievous" when a student selected multiple extreme, unusual (less than 5% incidence) response options, such as weighing more than 225 pounds and having 10 or more siblings. Only 1.8% of the students responded in extreme ways to 2 or more of 7 mischievous response items. When compared with other students, the mischievous responders were less likely to declare that they answered items honestly, were more likely to finish the survey in less than 10 min, reported lower levels of life satisfaction and school connectedness, and reported higher levels of emotional and behavioral distress. When applying a dual-factor mental health screening framework to the responses, mischievous responders were less likely to be categorized as having complete mental health. Implications for school-based mental health screening are discussed. (PsycINFO Database Record

Making the case for universal school-based mental health screening

Mental health difficulties affect 1 in 10 children and adolescents, and up to half of adult cases begin during the school years. The individual and societal impacts of such difficulties are huge, and include poorer quality of life, lost economic productivity, destabilisation of communities, and high rates of health, education and social care service utilisation. Using early intervention and prevention in schools as a central component of a co-ordinated response to this emergent public health crisis makes good sense. Schools play a central role in the lives of children and their families, and their reach is unparalleled. It has been argued that truly comprehensive and effective mental health promotion in schools requires a universal screening component, but this is a controversial proposition. In this article we explore some of the opportunities and challenges posed by such a system. In doing so, we critically assess international literature on social validity (e.g. acceptability, feasibility and utility), definition and conceptualisation (e.g. what do we mean by ‘mental health’ and related terms?), design and implementation (e.g. planning, tool selection, linking to referral and intervention systems), psychometric considerations (e.g. are available instruments reliable and valid?), diversity (e.g. taking into account cultural variation) and costs and benefits (e.g. are the human, financial and material costs of universal screening justified by the improvements in provision and outcomes they bring?). We conclude by presenting a vision for a school-based system that takes into account these important factors.

Conducting Universal Complete Mental Health Screening via Student Self-Report

Universal screening is increasingly becoming part of prevention and early intervention best practice in schools. Although the number of schools engaging in universal screening has increased over the past decade, emotional and behavioral problems are often their primary focus. Problem-focused screening, however, does not address positive contributions to mental health and is useful for only a small percentage of students. Conversely, the information obtained when assessing for strengths is relevant for all students. The inclusion of a strength-based approach in school-based universal mental health screening serves to broaden educators’ understanding of mental health and can inform reactive and proactive interventions that address problems and enhance strengths. This article discusses the knowledge and skills needed to implement universal complete mental health screening, that is, screening that assesses for students’ strengths and problems. A detailed description of complete mental health screening is provided, followed by a step-by-step implementation guide with specific considerations for practitioners who wish to engage in complete mental health screening as part of comprehensive efforts to promote the well-being of all students. Finally, the process of complete mental health screening is illustrated with a case example.

Exploring the Relative Contributions of the Strength and Distress Components of Dual-Factor Complete Mental Health Screening

Early school-based mental health screeners were informed by a deficit paradigm that aimed to identify psychological distress symptoms. In comparison, following a whole-child perspective, a dual-factor approach has been proposed that assesses complete mental health using both positive dispositions and distress symptoms. Applying the dual-factor approach, the current study involved 118 students from 10th grade and examined how strongly subjective well-being (SWB) was associated with measures of positive psychological dispositions (Social Emotional Health Survey [SEHS]) and psychological distress (Behavioral and Emotional Screening System [BESS]). Results indicated that the strength-based SEHS explained 32% of the variance in the students’ global SWB with the deficit-based BESS adding an additional 8% of explained variance. Implications for school-based mental health screening are discussed.

Non-medical use of prescription drugs among Mississippi youth: Constitutional, psychological, and family factors

ObjectiveThe non-medical use of prescription drugs (NMUPD) among youth is a significant public health concern, ranking as the second most frequently used class of drug in youth after marijuana. Given the complex and multiple pathways that may lead to NMUPD in youth, this study examines predictors of NMUPD across constitutional, psychological, and family/peer domains. MethodAn ethnically diverse sample of 6790 youth in the 6th–12th grades enrolled in public schools throughout Mississippi completed a battery of questionnaires as part of a broader school-based mental health screening initiative in Mississippi (Behavioral Vital Signs Project). ResultsThe lifetime prevalence rate of NMUPD in our sample was 6.5%. Pain medications were the most commonly used (57%), followed by benzodiazepines (44%), prescription stimulants (e.g., Ritalin, Concerta, Focalin, Dexedrine; 37%), SSRIs (29%), and antipsychotics (24%). Almost a quarter of NMUPD youth used these drugs for 10days or more during the 30-day period prior to completing the survey, and 8% reported daily use. Binary logistic regression analyses revealed that race; grade level; anxiety, mood, and suicide-related symptoms; and substance use involvement significantly increased risk for NMUPD in youth. ConclusionsNMUPD among youth is a clinically-relevant and multi-determined phenomenon. Findings from this study identify factors relevant to understanding youth NMUPD and also highlight the need for additional research and targeted prevention and intervention programs for NMUPD among youth.