More research needed in school-based mental health interventions

Research is lacking for studies of mental health promotion and care interventions implemented through school-based programs for children in low- and middle-income countries, according to a study published in The Lancet Psychiatry.

The article accompanied a similar review of school-based mental health interventions in high-income countries that also called for additional research.

High-income countries

Mental health intervention and prevention studies conducted in the high-income countries showed mostly positive but mixed results. Programs often were based on a tiered approach, but the researchers wrote that many strategies implemented in schools are not well-documented or analyzed. Universal approaches were shown to be less effective than selective approaches, but indicated approaches were shown to be most effective for depression outcomes. According to the researchers, one study showed that school-based interventions were effective, but 60% of eligible students did not participate in offered services.

“School-based services are unlikely to be a panacea for identification and treatment of all childhood mental illnesses,” the researchers wrote. “Some children do not attend school, might feel estranged from their school, or prefer to receive mental health services outside the school context.

“Some young people might fear labeling and medicalization if teachers have a prominent role in the detection of psychological distress. These issues need careful attention in training for teachers about mental health.”

Low- to middle-income countries

Most of the 22 school-based intervention studies (70%) in low- to middle-income countries reviewed were conducted in regions with ongoing armed conflicts or political violence, which the researchers wrote may confound the findings, particularly in treatment of PTSD. Seventeen of the studies included a control group. Sample sizes in the studies ranged from 18 to 888 participants and included 4,584 children who received an intervention and 3,241 in control conditions. Fifty-five percent of the studies showed positive effects, three showed positive results based on sex, and 32% showed no positive results.

Researchers wrote that health care can be provided through schools in low- and middle-income countries, which constitute more than 80% of the world’s children and adolescents, even though it is challenging to provide basic services in some areas, and many children in these countries don’t attend school.

They also wrote that evidence from studies in high-income countries shows that teachers can successfully provide mental health promotion interventions, but research to support the efficacy of treatment was “scarce” in low- and middle-income countries. Available research showed evidence for successful mental health promotion interventions, however, particularly if the intervention was structured and long-term.

The researchers concluded that more study is needed to determine which interventions are most appropriate for children in a school-based setting.

Disclosure: See the studies for full lists of relevant financial disclosures.

For more information:

Fazel M. Lancet Psychiatry. 2014;1:377-387.

Fazel M. Lancet Psychiatry. 2014;1:388-398.