Review: School‐based interventions to improve mental health literacy and reduce mental health stigma – a systematic review

Abstract

Background: The steadily increasing prevalence of mental disorders in children and adolescents presents itself as a public health challenge, especially given the health, social and economic burden of mental disorders. School-based interventions aimed at improving mental health literacy and reducing mental health stigma have the potential to prevent mental disorders and promote mental well-being, thus reducing the burden of mental disorders. This review identified and synthesised evidence on the effectiveness of school-based interventions designed to improve mental health literacy and reduce mental health stigma. Methods: Electronic bibliographic databases including MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Child Development and Adolescent Studies, British Education Index and Applied Social Sciences Index and Abstracts (ASSIA) were searched. Randomised controlled trials (RCTs) were included if they assessed the effectiveness or cost-effectiveness of school-based intervention aimed at improving mental health literacy and reducing mental health stigma for children and young people aged 4-18 years. Quality of studies was appraised using the EPHPP tool. A numerical summary and a narrative description of the findings in relation to the research questions were synthesised. This systematic review was registered with PROSPERO (CRD42020191265). Results: We identified 21 studies describing 20 unique school-based mental health interventions. Overall, there is moderate evidence suggesting that school-based mental health interventions can be effective in improving mental health literacy and reducing mental health stigma defined as attitudes and beliefs regarding mental disorders. However, there is less evidence for their long-term effectiveness, as most studies did not include follow-ups. Conclusions: Despite exclusively including studies with randomised designs, intervention and methodological heterogeneity poses uncertainties to any conclusions made. Future research should focus on resolving methodological issues concerning how outcomes are assessed and include process evaluations to better inform the design of an intervention in term of its delivery and implementation. Key Practitioner Message• One in eight children and young people aged 5 to 19 years have at least one mental disorder. Research shows that low perceived need and attitudinal barriers are the main barriers to mental health treatment. Improving mental health literacy and reducing stigma may facilitate help-seeking and use of mental health services by young people. • School-based interventions can improve mental health literacy and reduce stigma in the short term; however, refresher interventions may be required to sustain the positive outcomes in the long term. • Interventions comprising mental health education followed by contact with a person with lived experience of mental disorders may be most effective. Live contact and filmed contact are equally effective.

A cluster randomised, 16-week, parallel-group multicentre trial to compare the effectiveness of a digital school-based cognitive behavioural resilience/wellbeing-building intervention targeting emotional and behavioural problems in vulnerable Year 4 primary school children in whole classes, to the usual school curriculum: a study protocol to the “CUES for Schools” trial

“…In the context of limited capacity in and access to child and adolescent mental health services (CAMHS), school-based mental wellbeing promotion initiatives have burgeoned, and, in England, become a mandatory part of curricula [7,8]. Research outcomes are mixed, with the best evidence for cognitive behavioural approaches, delivered to whole classes, which facilitates peer support and normalising without labelling vulnerable children [9][10][11]. In practice, outcomes continue to be poor, particularly for more vulnerable children: further development of interventions that are readily implementable longer-term is needed [12,13].…”

“…Scores range from 0 to 20, with lower scores indicating more positive outcomes (clinical cut-off > 9). • M&MF-B 6-item subscale (M&MF items [11][12][13][14][15][16] at 16 weeks. Scores range from 0 to 12, with lower scores indicating more positive outcomes (clinical cut-off > 5).…”

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers

“…Recent systematic reviews showed that intervention program designs which involved extended contact-time spread over days or weeks and with multiple components (such as survivors lived-experiences and film/ documentaries) had better impact on attitudinal change compared with ultra-short and abridged training programs [ 43 ]. Future depression-literacy programs must be mindful of this design consideration.…”

Towards school-based mental health programs in Nigeria: The immediate impact of a depression-literacy program among school-going adolescents and their teachers

“…Other training programmes, however, have observed sustained poor attitude despite intervention [31,32]. Recent systematic reviews showed that intervention program designs which involved extended contact-time spread over days or weeks and with multiple components (such as survivors lived-experiences and lm/ documentaries) had better impact on attitudinal change compared with ultrashort and abridged training programs [42]. Future depression-literacy programs must be mindful of this design consideration.…”