Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: A systematic review and meta-analysis

Abstract

BackgroundImplementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are.MethodsWe conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6–18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems.ResultsWe found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37–0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = −0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = −0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = −0.47 to 2.07). For CD the sample size was very small, so the results are imprecise.ConclusionA significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376].

Possible Mental Health Interventions for Family Members of a Close Relative Who Has Suicidal Thoughts or Committed Suicide: A Pilot Project at a Mental Health Center

“…Part of the program we described was a school-based intervention, i.e., psychoeducation. Some evidence suggests that school-based interventions to improve mental health are often effective [27]. The SEYLE study to reduce suicide is a good example.…”

“…Suicide rates decreased the most (by almost half) among children and adolescents (up to 19 years old) and middle-aged people (35-49 years old). The rate of suicide among young adults (ages [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] decreased by a similar amount, almost by half [8]. Even though the suicide rate for children and adolescents has decreased, it remains a critical health problem in Lithuanian society.…”

The Effects of a School-Based Mental Health Program on Students’ Knowledge, Behavior, and Depression: A Quasi-Experimental Study in Four Indonesian High Schools

“…A recent systematic review and metaanalysis on school-based mental health interventions for adolescents in Low-Middle Income Countries (LMIC) found no significant difference in standardized mean outcomes for depression between intervention and non-intervention. This review included 39 RCT and non-RCT studies published between 2007 and 2022 (Grande et al, 2023).…”

Meeting the Mental Health and Behavioral Needs of Children and Youth in Rural Foster Care: The Role of Schools

“…In fact, schools may be the only available source of mental health services in some rural areas (Enos, 2022; NASP, 2021). In addition, interventions promoting mental health within the school setting have effectively mitigated mental health issues among children and adolescents (Grande et al, 2023). With administrators, teachers, and support staff acting as positive agents of change for mental health (Moon et al, 2017), rural schools can offer foster families several effective measures to support children’s mental health, including psychoeducation, mental health screenings and referrals, telemental health opportunities, and the implementation of evidence-based therapies (EBTs).…”