Review: Universal mental health interventions for young students in adverse environments – a systematic review of evaluated interventions

Abstract

Background: Universal classroom-based interventions are a useful method to increase the mental health and resilience in children. Resilience describes the process that leads to a positive development despite adversities. It comprises the seven resources access to material resources, relationships, identity, power and control, cultural adherence, social justice and cohesion. Yet there is a paucity of studies evaluating interventions that enhance resilience in children exposed to adverse childhood experiences. Method: This systematic review investigates whether universal classroom-based interventions can increase the seven resilience-related resources in children that live in adverse environments. Search strings were formulated based on an adapted version of the PICO criteria. The risk of bias of the individual studies was assessed using the ROBINS-I tool. Results: Seventeen studies were included in the review, of which 15 found an increase in resilience. The resource power and control was targeted in every intervention. Not one intervention included all seven resources. Intervention outcomes related mostly to just two of the resources (power and control and identity) and were rarely linked to what was being trained in the intervention. Conclusion: The results of this review show that classroom-based interventions are suitable for promoting resilience in children living in adverse environments. Yet more high-quality studies are needed that evaluate the effectiveness of universal interventions on children living in adverse environments and specifically the effectiveness of training each of the seven resources. Future developments of school-based interventions should be careful to target and assess all resilience-related resources. Key Practitioner Message• Previous reviews show that classroom-based interventions can increase the well-being and mental health of children.• This systematic review reveals that universal classroom-based interventions are also suitable for enhancing the resilience of children exposed to adverse childhood experiences.• Considering the influence of resilience on well-being and mental health symptoms, interventions are needed that enhance all resources related to resilience.• This review provides methods for practitioners on how to strengthen resilience in children.

Review: Can digital mental health interventions bridge the ‘digital divide’ for socioeconomically and digitally marginalised youth? A systematic review

“…The scarcity and low quality of available research into DMHIs for socioeconomically and digitally marginalised youth limits the conclusions that may be drawn from this review. Previous research, however, has questioned the appropriateness and highlighted the challenges of applying stringent quality assessments beyond the context of the RCT (Higgen et al., 2021; Thomson, Craig, Hilton‐Boon, Campbell, & Katikireddi, 2018), cautioning that over‐reliance on quality assessments may potentially impede research progress in emerging research contexts.…”

“…The majority of interventions were based on behavioural or cognitive behavioural therapeutic models. There is an established evidence base for CBT‐based interventions among children and young people (Higgen, Mueller, & Mösko, 2021; Wright et al., 2019), with CBT widely adapted for digital delivery (Cervin & Lundgren, 2022; Ebert et al., 2015; Wickersham, Barack, Cross, & Downs, 2022) among children and young people (Christ et al., 2020; Ebert et al., 2015; Rooksby, Elouafkaoui, Humphris, Clarkson, & Freeman, 2015; Wickersham et al., 2022). There was huge variability between included studies, in terms of outcomes, technologies, participants and interventions.…”

A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries

“…Poor mental health during these developmental periods adversely affects positive development, social behaviours, educational outcomes and the health of future generations (Renwick et al, 2022 ). Mental health promotion and prevention interventions effectively implemented during childhood and adolescence, particularly in school settings, can positively impact mental health and well-being, and increase social and emotional skills and the academic performance of young people (Durlak et al, 2011 ; Barry et al, 2013 ; Taylor et al, 2017 ; Aldridge and McChesney, 2018 ), including those who have been exposed to adverse experiences (Higgen et al, 2022 ).…”

“…Additionally, since schools can be home to risk factors for poor mental health such as bullying and academic stress, school-based primary prevention programmes (universal, selective and indicated) can reduce the risk of mental ill-health (Harrison et al, 2022 ). Evidence points to the positive impact and cost-effectiveness of whole-school universal interventions that follow the World Health Organisation (WHO) Health Promoting Schools Framework (WHO, 2021b ) over curriculum-only programmes (Peterson et al, 2016 ; Singla et al, 2020 ; WHO/UNICEF, 2021 ; Higgen et al, 2022 ); however, high-quality implementation is crucial to the effectiveness and sustainability of programmes (Durlak and DuPre, 2008 ; Durlak et al, 2011 ).…”

Editorial: Going through the slippery landscape of conduct disorder, oppositional defiant disorder and help for children in humanitarian crises

“…Second, there is a need to evaluate resilience‐related interventions in children who live in adverse environments. Higgen, Mueller, and Mosko (2022) and others highlight in their systematic review of universal mental health interventions for young students that, while there is a need for future studies to evaluate the effectiveness of resilience‐related resources in schools, classroom‐based interventions that use enhanced collective agency as well as identity seem to be suitable. Yet in Ukraine, Calam, El‐Khani, and Maalouf (2022) explore how evidence‐based resources from United Nations Office on Drugs and Crime have helped to develop a pyramid of inter‐linked trauma‐informed interventions within the context of families and professional networks to assist child victims of military conflict, displacement and resettlement.…”