School Mental Health Promotion Research Articles

Effectiveness of the holistic primary school-based intervention MindMatters: study protocol for a cluster-randomised controlled trial

BackgroundThe prevalence of mental health problems in childhood and adolescence has increased significantly, not least due to the COVID-19 pandemic in Germany and other countries worldwide. Although holistic school interventions to promote mental health and prevent mental health problems are considered promising, there is currently uncertainty about their effectiveness due to evaluation studies with heterogeneous methodological quality. This paper presents the study protocol for the evaluation of the primary school module of MindMatters.MethodsAs part of a universal mental health intervention, the MindMatters primary school module ‘Learning Together with Emotions’ aims to promote social-emotional learning (SEL) in the classroom across five skill areas. In addition to classroom activities, the intervention includes a school development module to help primary schools create structures and processes to maintain and promote mental health. To evaluate the effectiveness of the intervention, a two-arm cluster-randomised controlled trial will be conducted, including schools implementing MindMatters over a 12-month period and a control group with no access to the intervention. Data will be collected before and 18 months after initiation of the intervention. Controlled for baseline conditions, multilevel regression analysis will be used to examine primary intervention outcomes at the pupil level (i.e. reductions in mental and behavioural problems). Further mediation and moderation analyses will examine whether proximal outcomes predict changes in mental health outcomes and whether school-level factors influence the effectiveness of the intervention.DiscussionThis study will contribute to strengthen the evidence base for holistic school (mental) health promotion interventions using a study design with high internal validity. Based on an intervention model, the results will not only provide insights into the relationship between proximal and distal outcomes, but will also allow conclusions to be drawn about how the implementation of the intervention affects its effectiveness. Finally, the findings also address the question of whether improved mental health has a positive effect on primary school pupils’ academic performance.Trial registrationGerman Clinical Trials Register DRKS00023762. Registered on 5 January 2021.

9.L. Workshop: Mental health literacy in schools: new insights from key European studies across populations

Abstract Background Good mental health is important for better population health outcomes and improved quality of life in societies, while poor mental health and mental disorders have not only negative health effects but are also responsible for increased health care costs and burden of disease. Increased prevalence rates of mental health problems, severity of mental illnesses and associated disability and mortality rates are considered alarming, making poor mental health a threat to population health and European public health. These circumstances together have resulted in an increased attention towards mental health in European and global public health. Mental health promotion in schools, at the workplace and everyday life has become an important tool to improve psychological and psychosocial health outcomes and increase mental well-being. In this context, mental health literacy, too, has become an important public health target. Mental health literacy is linked to health literacy but in addition includes an individual's capacities and resources that enable them to actively promote their mental health and mental well-being, including improved mental health knowledge, help-seeking strategies, and less stigmatizing attitudes. In particular it is defined as understanding how to sustain and maintain positive mental health, understanding mental disorders and their different treatments options, decreasing mental health related stigma, and enhancing people's help-seeking efficacy. As a concept, mental health literacy was coined in the 1990s, but in particular recent developments in digital communication technologies, digital health, the Internet and Social Media as well as the Covid-19 pandemic have accelerated its uptake in public health research, practice and policy. Workshop objectives The aim of this workshop is to: (1) present current research projects and their findings on mental health literacy in schools from 3 different European countries (Germany, Portugal, France), (2) shed light on the critical importance of mental health literacy promotion in all settings and (3) initiate a critical discussion on concepts, methods and intervention concerning mental health literacy. The 1st presentation will introduce the WhySchool project, a mental health training program for teachers, school health professionals, and students (Portugal). The 2nd presentation will present a mental health literacy school intervention for students and teachers, the Guide (Germany). The 3rd presentation will introduce a novel tool to measure child mental health literacy (France). The 4th presentation will introduce a digital tool to promote mental health literacy of school-children. The format of this workshop will be 4 x 7 minute presentations followed by a 20 minute interactive panel discussion with the presenters. Key messages • This workshop will shed light on mental health literacy promotion based on contemporary European studies. • Mental health literacy is important for positive mental health and should be addressed as early as in schools and supported by public health policy-making.

Perspectives of youth in Ireland on school-based mental health and suicide prevention: the MYSTORY study.

Anxiety, depression, and suicide are leading causes of disability and death among young people, globally. Schools are an ideal setting to target young people's mental health, yet young people's beliefs about and experiences with school mental health and suicide prevention are not well understood. This gap in knowledge contradicts both national and international youth mental health recommendations and the United Nations Convention on the Rights of the Child, which collectively advocate for understanding young people's perspectives on matters concerning them, including school mental health. Therefore, the Mental Health of Youth Story (MYSTORY) study explored young people's perspectives on school mental health and suicide prevention using a participatory-based approach incorporating photovoice. MYSTORY consisted of a community/university partnership involving young people as participants (n = 14) and advisors (n = 6). Experiential, reflexive thematic analysis (TA) within a critical approach generated three themes relating to young people's experiences with and beliefs about school mental health promotion and suicide prevention. Findings highlight the critical role of schools in impacting young people's mental health, with the need to amplify youth voice and involvement in school mental health evident. Our study addresses an important gap by employing participatory-based approaches to explore young people's perspectives on school mental health and suicide prevention. This is the first known study to explore young people's perspectives on their voice and involvement in school mental health. Findings have important implications for youth and school mental health and suicide prevention research, policy, and practice.

School Shooting in Serbia – A Huge Collective Trauma and Challenge for Public Mental Health

Traumatic experiences are frequent and may cause serious consequences, affecting an individual, a larger group of people, or a whole society. Collective trauma might be a cataclysmic event that shatters the basic fabric of society leaving the profound acute and long-lasting effects. In addition to the loss of lives, huge injuries, collective trauma, or “social wounds,” often arouses a crisis of meaning. Unfortunately, school shootings causing most tragic collective trauma have become frequent in many countries. The one that recently occurred in Serbia with mass victims was unprecedented and unique experience that affected the whole population. The causes might be multiple and should be thoroughly assessed, with an integrative, biopsychosocial approach (genetic predisposition, developmental problems, parenting, media, i.e., social influences, relationship with peers, and personality structure). The consequences of such horrific traumatic experience are profound, and a challenge for public mental health, with a whole spectrum of psychological effects, both on individual and collective level. In addition to mental health consequences and potential long-term trauma and grief, school shootings can have significant consequences for society and the law. There is an urgent need for public health approach to trauma, prevention, and mental health promotion in schools and the whole society.

Evaluating the Efficacy of School Mental Health Promotion Program in Iranian Schools: A Qualitative Study

Objectives Considering the importance of identifying the mental health problems among school students and their proper management by offering specialized services to them, the present study aims to evaluate the efficacy of school mental health (SMH) program in Iranian schools, identify its shortcomings and provide recommendations for it improvement. Methods This is a qualitative study using conventional content analysis method. A semi-structured in-depth interview was used to collect information from 35 participants who included teachers, principals, and developers of the SHM Program in Iran. Results Based on the results, four themes (strengths, weaknesses, barriers, and recommendations) and 14 subthemes were extracted. Overall, 50 codes were obtained. The results showed the effectiveness of the SMH program. Conclusion The SMH program is effective and has opened a new perspective to school-based interventions. However, expecting the full implementation and continuation of this program in the short term and with limited resources does not seem logical. Therefore, it is first recommended to improve the infrastructure for implementing this program, use trained personnel, upgrade the counseling departments of schools, and remove the time limit of teachers and legal limitations. Then, this project should be implemented at the national level for all schools in Iran.

Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong.

Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities. This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong. Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use. Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools. This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.

The implementation of a whole school approach to mental health and well-being promotion in the Irish primary school context

Background: Schools are well recognised as critical contexts for the promotion of mental health and well-being and offer the potential to reach a large number of children at an early age, at a time when they are developing important attitudes and behaviours that may influence their future health. Ensuing from a number of large-scale epidemiological studies which have found that young Irish people are significantly struggling with their mental health and well-being, the Government of Ireland has committed to prioritising mental health promotion in schools through a multicomponent, preventive, whole school approach. Objectives: To obtain a detailed and integrated account of the implementation of a whole school approach to mental health and well-being promotion in the Irish primary school context. Method: A qualitative case study approach was undertaken employing in depth semi-structured interviews, document analysis and field notes. Thematic analysis was applied to all interview data and emerging themes were mapped on to the Theoretical Domains Framework (TDF) domains. Setting: Three Irish primary schools. Results: Facilitators and barriers that emerged from the data related primarily to the schools’ economic and political context, organisational context, and internal and external partnerships and relationships. Conclusion: This study has demonstrated that the implementation process in ‘real-world’ practice settings, such as schools, is dynamic, complex and exists within a multi-level system and requires careful consideration of the numerous ecological factors that can influence implementation.

The dangers of mental health promotion in schools

Much of Western media has promoted the idea that we are facing an epidemic of mental illness and psychiatric emergencies in contemporary Western society and worldwide, and that young people are a particularly vulnerable group. Schools have become a prominent site of concern and focus for this discourse as mental health problems are said to start early in life; thus, targeting intervention at people in their early years and greater mental health awareness amongst staff and pupils are perceived as important mental disorder prevention strategies. However, the belief that mental disorders can be classified and investigated using the same tools as physical health has led to a system of knowledge that lacks validity being constructed. This ideology, far from leading to enlightened progress that will prevent and/or ameliorate future mental health problems, inadvertently sets young people on a path towards alienation from, and suspicion of, their emotional lives and a lack of curiosity about, or tolerance of, suffering. This article explores how a lack of understanding about what sort of ‘thing’ a mental health problem/disorder/diagnosis/illness is leads to confusion about the meaning and consequences of experiencing mental distress and/or mental difference. Interviews with secondary school teachers carried out by one of the authors (ZT) show how awareness of mental health and mental disorder has increased in UK secondary schools over the last decade and how this has led to an expansion in the numbers of students thought to have mental health problems that required professional intervention. As a result, teachers now identify many behaviours and experiences they previously deemed ordinary and/or understandable as likely mental health problems that required professional expertise they lacked. Rather than preventing mental health problems, it is likely that this ideology, and the resulting practices it encourages, are creating them.

Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents

BackgroundThere is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health.MethodsSchools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools.DiscussionThis is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India.Trial registrationClinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).

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.

Qualitative experiences of Australian mental health staff with students exposed to domestic violence

The prevalence of domestic violence is concerning due to its debilitating impact on the psychological, social and academic functioning of children. This study explored the experiences, strengths and challenges of school mental health staff in relation to students exposed to domestic violence. Interviews with 10 school wellbeing staff working in Victoria, Australia, showed that these staff felt confronted and distressed, and were unsure of their role in managing the complexities associated with students’ exposure to domestic violence. Staff reported the need for educators, students and parents to be educated on domestic violence, and for improved school structures and policies that encourage staff consultation and self-care following students’ disclosures of domestic violence. The results of this study are discussed within the context of trauma-informed practice and multi-tiered mental health promotion in schools.

Randomized Control Study of the Implementation and Effects of a New Mental Health Promotion Program to Improve Coping Skills in 9 to 11 Year Old Children: Passport: Skills for Life.

Passport: Skills for Life is a universal, primary school mental health promotion program to increase children’s coping skills. A stratified randomized control study with pretest, post-test and 1-year follow-up included 1,492 3rd to 6th grade children, from higher and lower socio-economic levels, randomly assigned by school to receive the program or a control group. Implementation and effects were evaluated by questionnaires and focus groups with children, parents and teachers as well as classroom observations. Program activities were well implemented and greatly appreciated, with perceived improvements in resolving conflicts, communicating feelings and coping. Compared to the controls, participants had increased emotional awareness, sustained 1 year later; conceived of more ways to cope in fictitious situations and reported using more, and more useful strategies, sustained 1 year later. Positive Academic Behaviors increased, but were not sustained the following year. This is a promising program to improve coping and emotional awareness that merits further research on its effects.

Teacher Mental Health Literacy: Results from a State-wide Survey in Schools

Abstract Background Teachers have an important role to play in context of mental health literacy (MHL) promotion of school-aged children. Their MHL is seen as the counterpart of student`s health literacy. Especially vulnerable schoolchildren such as those affected by adverse life events (e.g. parental mental health problems) can benefit from programs. In addition, the whole school environment has impact on school mental health promotion. Yet, only little evidence is available on teachers MHL in Europe. The aim is to provide evidence from a state-wide survey on the state of MHL of teachers in Germany. Methods Based on semi-structured interviews with school teachers from all school types in one federal state, including primary and secondary schools, a MHL online questionnaire was developed. The survey was conducted in in 2017 in N = 2500 teachers in Germany. Descriptive and regression analyse have been performed. Results Teachers feel considerable uncertainties when working with children affected by adversities related to parental mental health problems. Dealing with the social family background seems hard. Teachers state that they don`t feel comfortable when aiming at mental health promotion of affected children or children in general. Data also show that they may tend to make misjudgements, and that they are not sufficiently trained to address mental health issues in the classrooms. Regression models show that the degree and quality of teaching mental health is affected by differences across school forms, satisfaction with and engagement of school principals in mental health action, learned strategies to respond to parents, and experienced stress, burden and exposure during their work. Conclusions Increasing teacher MHL and the environmental capacities and responsiveness towards school mental health promotion should be an important capacity building strategy. Policy support for school mental health promotion is a critical means to sustain effective whole-school approaches.

School Mental Health Promotion: Supporting Children Impacted by Family and Parent Mental Health Conditions

Given the high prevalence of children living with a parent who has a mental health condition, prevention and early intervention strategies have attracted much attention over the past decade. Given the role teachers and educators play in children’s academic and social development, the school context has gained much attention in mental health promotion research. There is a growing evidence of the effectiveness of school-based mental health programs to facilitate strategies that address some of the challenges associated with stigma and prejudice.

Monitoring Social Media and Technology Use to Prevent Youth Suicide and School Violence

With suicide as the second leading cause of death for individuals between the ages of 10 and 34 and with mass school shootings averaging once per year, schools are exploring ways to prevent this seemingly increase in youth suicide and other forms of youth violence. School-based prevention initiatives such as social/emotional learning curricula, school-based mental health services, and internal threat assessment protocols are becoming more prevalent. Along with these prevention efforts, increases in youth use of technology and social media have created a market for social media monitoring companies that use algorithms to analyze youth social media posts for threats of harm toward themselves or others. School districts contract with these social media monitoring companies for assistance in identifying youth who may be at risk for violence. The purpose of this article is to describe one school district’s experience using social media monitoring programs as part of their comprehensive school violence prevention and mental health promotion effort. The school district was alerted to many students who made suicidal and homicidal threats on social media and after identifying those students, the students were able to receive referrals for mental health support.

‘Push on through’: Children’s perspectives on the narratives of resilience in schools identified for intensive mental health promotion

Child mental health is a growing concern for policymakers across the global north. Schools have become a key site for mental health interventions, with new programmes aimed at promoting ‘resilience’, through which children may maintain or regain mental health during adversity. As one of the first studies to explore the early impact of intensive mental health promotion in schools from children’s perspectives, we adopt a governmentality approach to consider the logic and techniques of such programmes with a specific focus on England. An innovative visual methodology was used to focus on student perspectives of mental health interventions in school. Young peoples’ photo representations of mental health were collected and used to stimulate focus group discussions with 65 students aged 12–14, across seven schools. ‘Resilience’ was seen to be the key organising concept for mental health interventions in schools. The concept was viewed as narrowly focused on attitude towards—and performance in—school work, with individuals being encouraged to ‘push on through’ difficulties to achieve success. Young people were critical of this approach, suggesting several alternatives. These included increased access to independent mental health professionals, safe spaces within schools and mental health education that addressed the social and affective dimensions of mental health difficulties.

Depressive symptoms in adolescents in Kuching, Malaysia: Prevalence and associated factors.

The trend of depression is rising worldwide. There are limited studies on depression in adolescents. The aim of this study was to estimate the prevalence of and identify the factors associated with depressive symptoms in adolescents in Kuching, Malaysia, and to analyze the relationship between depressive symptoms and suicidal ideation. A cross-sectional study was conducted in 320 students from urban and rural secondary schools. The participants were randomly selected via multi-stage sampling. They completed the Malay versions of the Children's Depression Inventory (CDI) and Beck Scale for Suicide Ideation (BSS). The prevalence of depressive symptoms was 26.2%. On binary logistic regression analysis, variables with significant association with depressive symptoms were race (P = 0.028), type of class (P < 0.001), mother's education level (P = 0.036), type of housing (P = 0.036), parents' marital status (P = 0.012), alcohol intake (P = 0.005), stealing (P < 0.001) and history of disciplinary record (P = 0.005). Variables that remained significant on multivariable logistic regression were type of class (P = 0.004), parents' marital status (P = 0.017) and stealing (P < 0.001). Students from the Arts stream (OR, 2.43) with parents who were separated, divorced or widowed (OR, 3.13) and who had experience of stealing (OR, 3.27) were predicted to be at risk of developing depressive symptoms. There was a significant correlation between total CDI score and total BSS score (P < 0.001). The prevalence of depressive symptoms in adolescents was high. Depressive symptoms are significantly correlated with suicidal ideation. Greater collaboration between the education and health agencies is essential for mental health promotion in schools and early detection of depression, especially in at-risk adolescents.

Repetitive Negative Thoughts and the Vulnerability for Emotional Problems among Adolescents

Repetitive negative thoughts are generally viewed as a specific cognitive vulnerability factor that seems to be involved in the etiology and maintenance of emotional problems. The existing study aimed to investigate the role of repetitive negative thoughts in the vulnerability for emotional problems and determine the prevalence rates of this problems among secondary schools' adolescents, hence, a descriptive cross sectional study design was used. A self- administered questionnaire sheet was used to collect data from 480secondary schools' student. Study results revealed that there were significant positive correlation between neuroticism as an indicator of general vulnerability, repetitive negative thoughts and emotional problems. Whereas, behavioral inhibition had a significant negative correlation with repetitive negative thoughts and emotional problems. Further, more than three quarter (77.6%) of the studied students have symptoms of depression and majority (87.3%) of the studied students have symptoms of anxiety. Conclusion, depression and anxiety had high prevalence rates among adolescents. also, repetitive negative thoughts contribute to adolescents' vulnerability for depression and anxiety. Consequently it is recommended to Conduct school and community-based mental health promotion and prevention programmes directed toward adolescents, their families, educational staff and others who have direct contact with adolescents. And consider repetitive negative thoughts clinically can be effective in treatment of depression and anxiety.

Mindfulness Training in UK Secondary Schools: a Multiple Case Study Approach to Identification of Cornerstones of Implementation

This paper examined the facilitators and barriers to implementation of mindfulness training (MT) across seven secondary/high schools using a qualitative case study design. Schools varied in level of implementation. Within schools, head teachers, members of school senior leadership teams, and staff members involved in the implementation of MT were interviewed individually. In addition, focus groups were conducted with other members of school staff to capture a broad range of views and perspectives. Across the case studies, several key themes emerged, which suggested four cornerstones to successful implementation of MT in schools. These were: people, specifically the need for committed individuals to champion the approach within their schools, with the support of members of the senior leadership teams; resources, both time and financial resources required for training and delivery of MT; journey, reflecting the fact that implementation takes time, and may be a non-linear process with stops and starts; and finally perceptions, highlighting the importance of members of the school community sharing an understanding what MT is and why it is being introduced in each school context. Similarities and differences between the current findings and those of research on implementation of other forms of school mental health promotion programs, and implementation of MT in healthcare settings, are discussed.

Exploring Students’ Participation in Universal, Depression and Anxiety, Prevention Programmes at School: A Meta-aggregation

Mental health promotion in schools is a key priority for national governments. The aim of this meta-aggregation is to synthesise the findings from universal, depression and/or anxiety, cognitive behavioural therapy and/or interpersonal therapy-based, programmes implemented in schools, which are focused on reducing depression and anxiety in student populations aged 8–17 years. Electronic databases were searched for published original qualitative studies which assess students’ perceptions and experiences from participating in universal, school-based, depression and/or anxiety, prevention programmes. Extraction and synthesis of findings were assisted by NVivo qualitative data analysis software. The Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI QARI) Critical Appraisal Checklist for Interpretative and Critical Research was used for assessing methodological quality of the included studies. The confidence of synthesised qualitative findings (ConQual) approach was followed for assessing the confidence in the estimates of syntheses output. Five studies from Australia, Sweden, and UK met the inclusion criteria. Modification in the structure and mode of implementation of universal prevention programmes is required in order to enhance programmes’ applicability and impact. The study provides key practical recommendations to stakeholders and policy makers about the content, delivery, and implementation of school-based, universal, prevention programmes.