School-based Mental Health Interventions Targeting Depression or Anxiety: A Meta-analysis of Rigorous Randomized Controlled Trials for School-aged Children and Adolescents

Abstract

Past meta-analyses in mental health interventions failed to use stringent inclusion criteria and diverse moderators, therefore, there is a need to employ more rigorous methods to provide evidence-based and updated results on this topic. This study presents an updated meta-analysis of interventions targeting anxiety or depression using more stringent inclusion criteria (e.g., baseline equivalence, no significant differential attrition) and additional moderators (e.g., sample size and program duration) than previous reviews. This meta-analysis includes 29 studies of 32 programs and 22,420 students (52% female, 79% White). Among these studies, 22 include anxiety outcomes and 24 include depression outcomes. Overall, school-based mental health interventions in grades K-12 are effective at reducing depression and anxiety (ES = 0.24, p = 0.002). Moderator analysis shows that improved outcomes for studies with anxiety outcomes, cognitive behavioral therapy, interventions delivered by clinicians, and secondary school populations. Selection modeling reveals significant publication and outcome selection bias. This meta-analysis suggests school-based mental health programs should strive to adopt cognitive behavioral therapy and deliver through clinicians at the secondary school level where possible.

Improving mental health through fostering healthy lifestyles in young people: one of the targets in the WPA Action Plan 2023‐2026

“…Universally delivered psychosocial interventions, especially those based on interpersonal skills training, emotional regulation, alcohol, drug and lifestyle education, can improve youth mental health and reduce risky behaviors. Randomized controlled tri als showed that, compared to control groups, school-based interventions have a significant positive effect on symptoms of depression and anxiety, suicide attempts, and suicidal ideation 10,11 .…”

Editorial: The need for more effective school‐based youth mental health interventions

“…In contrast to the results by Caldwell and colleagues, an update of the meta‐analysis on school‐based anxiety and depression interventions for primary and secondary education using more stringent inclusion criteria (e.g. only including randomized controlled trials, quantitative outcomes) did show effectiveness on children's levels of anxiety with small effects (Zhang, Wang, & Neitzel, 2023). Also for children with externalizing problems, there are interventions with an evidence base, including behavioral teacher training for primary school children (also see Staff, 2022) and interventions focused on planning and organizational skills for children in secondary education.…”

“…A good example of how to investigate which elements of school-based interventions work for whom is a randomized controlled microtrial into different techniques of a brief teacher training for primary school-aged children with impairing levels of inattention, hyperactivity and/ or impulsivity (Staff et al, 2021) are effective in reducing the child's behavioural problems, and also showed that specific moderators, such as class size, age of the child and the child's cognitive performances influenced intervention outcomes. Another example is the abovementioned meta-analysis by Zhang et al (2023) which showed that to decrease anxiety and depression, targeted interventions are more effective than universal programs, interventions were more effective in secondary compared to primary education and cognitive behavioural interventions were more effective than other interventions, while the length of the intervention did not matter. More studies like this are needed to be able to take decisions on how to allocate the limited resources and personalize interventions to the school setting and the child.…”

Visits to Alberta Emergency Departments for Child Mental Health Concerns During the COVID-19 Pandemic

“…However, inaccessibility to school-based mental health services is a plausible mediating factor for the changes in ED mental health visits that we observed. Results from recent meta-analyses suggest that school-based services are effective in reducing depression and anxiety symptoms 26 and that programs for at-risk children can reduce psychological stress symptoms 27 . Children seeking emergency mental health care may be the children these programs are most effective and tailored for.…”