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Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis
Open accessAbstract
Promotion of good mental health in young people is important. Our aim was to evaluate the consistency and magnitude of the efficacy of universal/selective interventions to promote good mental health. A systematic PRISMA/RIGHT-compliant meta-analysis (PROSPERO: CRD42018088708) search of Web of Science until 04/31/2019 identified original studies comparing the efficacy of universal/selective interventions for good mental health vs a control group, in samples with a mean age <35 years. Meta-analytical random-effects model, heterogeneity statistics, assessment of publication bias, study quality and sensitivity analyses investigated the efficacy (Hedges' g=effect size, ES) of universal/selective interventions to promote 14 good mental health outcomes defined a-priori. 276 studies were included (total participants: 159,508, 79,142 interventions and 80,366 controls), mean age=15.0 (SD=7.4); female=56.0%. There was a significant overall improvement in 10/13 good mental health outcome categories that could be meta-analysed: compared to controls, interventions significantly improved (in descending order of magnitude) mental health literacy (ES=0.685, p<0.001), emotions (ES=0.541, p<0.001), self-perceptions and values (ES=0.49, p<0.001), quality of life (ES=0.457, p=0.001), cognitive skills (ES=0.428, p<0.001), social skills (ES=0.371, p<0.001), physical health (ES=0.285, p<0.001), sexual health (ES=0.257, p=0.017), academic/occupational performance (ES=0.211, p<0.001) and attitude towards mental disorders (ES=0.177, p=0.006). Psychoeducation was the most effective intervention for promoting mental health literacy (ES=0.774, p<0.001) and cognitive skills (ES=1.153, p=0.03). Physical therapy, exercise and relaxation were more effective than psychoeducation and psychotherapy for promoting physical health (ES=0.498, p<0.001). In conclusion, several universal/selective interventions can be effective to promote good mental health in young people. Future research should consolidate and extend these findings.
Overview
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Written from the paper’s full text.
TL;DR
This PRISMA/MOOSE systematic review and meta-analysis of 295 studies (447,206 individuals, mean age 15.4) found that universal and selective preventive interventions for young people improved several poor mental health outcomes, with small effect sizes. Psychoeducation and psychotherapy were particularly promising for specific outcomes, while eating-related problems, impaired functioning, internalising behaviours, and sleep-related problems did not show significant improvement.
Key findings
- Across 17 outcomes, interventions vs control improved interpersonal violence (ES=0.431, p=0.021), general psychological distress (ES=0.421, p<0.001), alcohol use (ES=0.401, p<0.001), anxiety features (ES=0.393, p<0.001), affective symptoms (ES=0.304, p<0.001), other emotional and behavioural problems (ES=0.304, p<0.001), consequences of alcohol use (ES=0.282, p=0.019), PTSD features (ES=0.279, p=0.017), conduct problems (ES=0.21, p<0.001), tobacco use (ES=0.208, p=0.002), externalising behaviours (ES=0.137, p=0.001), ADHD features (ES=0.132, p<0.001), and cannabis use (ES=0.07, p=0.013).
- No statistically significant differences were found for eating-related problems (ES=0.147, p=0.589), impaired functioning (ES=0.018, p=0.929), internalising behaviour (ES=0.001 after trim-and-fill, p=0.32), or sleep-related problems (ES=0.11, p=0.078).
- Psychoeducation had the highest effect size for ADHD features (ES=0.202, p=0.004), affective symptoms (ES=0.611, p<0.001), and interpersonal violence (ES=0.676, p=0.024); psychotherapy had the highest effect size for anxiety features (ES=0.453, p<0.001).
- NNT ranged from 18 (95% CI=12–91) for interpersonal violence to 85 (95% CI=49–384) for cannabis use at a 10% control event rate; PIN ranged from 59 (95% CI=41–305) for interpersonal violence to 284 (95% CI=164–1278) for cannabis use in the most conservative scenario. Heterogeneity was significant (I² 57.4%–98.7%), and publication bias was detected in two outcome categories.
Methods
- PRISMA/MOOSE-compliant systematic review and meta-analysis (PROSPERO: CRD42018102143) searching Web of Science up to 04/31/2019, plus manual reference searches; inclusion required original interventional studies comparing universal or selective prevention vs a control group, meta-analysable data, English language, and samples with mean age <35 years.
- 295 articles were included: 447,206 individuals (234,330 intervention; 212,876 control), mean age 15.4 (SD 7.4), covering 17 poor mental health outcomes; 175 studies used selective approaches, 118 universal, and 2 both.
- Random-effects models estimated Hedges’ g; heterogeneity was assessed with I², publication bias with Egger’s test and trim-and-fill, and meta-regressions examined study quality. Sensitivity analyses stratified by intervention type, universal vs selective approach, and age group; NNT and PIN were also calculated.
Limitations
- Stated by the authors: limited evidence for some outcomes (sleep-related problems, impaired functioning, eating-related problems, interpersonal violence); inability to quantify differential efficacy of “other” and “combined” interventions or specific interventions within psychotherapy/psychoeducation; most studies were low quality (no blinding and/or randomisation) and the quality assessment may have been suboptimal; other potential modifiers could not be investigated due to heterogeneity; limited evidence on categorical mental disorders other than psychosis; only post-test efficacy, not long-term efficacy, was assessed; outcomes were pragmatically aligned with each study’s operationalisation.
- Evident from the text: heterogeneity was high (I² 57.4%–98.7%) and publication bias was detected in two outcome categories; effect sizes were generally small; some sensitivity analyses could not be performed because all interventions for consequences of alcohol use were universal and all PTSD interventions were selective.
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69 Own result · 26 Not checked yet · 20 Own method · 10 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“externalising behaviours (ES=0.137,p=0.001)”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“improved (in descending magnitude order) interpersonal violence (ES=0.431,p=0.021)”
plaindirectn = 447,206 ·- Asserted: passes — The authors put it forward as true.
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In the paper
“The NNT ranged from 18 (95% CI=12-91) for interpersonal violence to 85 (95% CI=49-384) for cannabis use when the CER was set to 10%”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Psychoeducation had the highest effect size for ADHD features (ES=0.202,p=0.004)”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our meta-analysis also found that universal and selective interventions are equally effective for the prevention of emotional and behavioural problems”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We showed that preventive universal and selective interventions for anxiety features were equally effective, with a particular high efficacy for psychotherapy, although effect sizes were small.”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no differences between preventive interventions conducted in children and adolescents and in adults for any of the outcomes evaluated (all p>0.05)”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there were no statistically significant differences between the intervention and the control condition for all the interventions (all p>0.05)”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also found that selective preventive interventions were more effective than universal interventions for general psychological distress.”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“internalising behaviours (ES=0.084;p=0.018 corrected with the trim and fill method to ES=0.001, p=0.32)”
plain- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 23
- The quote only partly states this claim. 1
- Probably not a substantial claim. 20
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Heterogeneity (I 2 ) across the included studies was statistically significant (p<0.001) and ranged from 57.4% (internalising behaviours) to 98.7% (alcohol use).”
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Publication bias was detected in two of the outcome categories with Egger's test (eTable VIII) and corrected with the trim and fill method.”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to our results, preventive interventions for PTSD features are effective, although effect sizes are small , both in the general population and in individuals with risk factors.”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but overall interventions were not statistically significant.”
plain- Asserted: passes — The authors put it forward as true.
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The quote only partly states this claim.
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In the paper
“Overall, the study demonstrated that primary universal and selective preventive interventions for poor mental health outcomes in young people are feasible and appear to be effective”
hedgedconditionaln = 447,206 ·- Asserted: passes — The authors put it forward as true.
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- Rests on an assumption: No prior systematic review and meta-analysis has comprehensively appraised the efficacy of primary universal and selective preventive interventions for poor mental health outcomes in young people.
- Rests on an assumption: It is not clear for which outcomes universal or selective approaches may be more effective.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared to control conditions, universal and selective interventions in young people can also improve externalising behaviours, ADHD features and cannabis use, but only with a marginal effect.”
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, these findings indicate that selective and universal interventions for young people are feasible and generally consistent in their efficacy, being unaffected by publication bias (except for internalising behaviours) or study quality (except for impaired functioning).”
hedged- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, quality for most of the studies was low, with no blinding and/or randomisation.”
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the database was large and sufficiently powered to test the preventive efficacy for most outcomes.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Our meta-analysis also found that universal and selective interventions are equally effective for the prevention of emotional and behavioural problems, with a smaller ES compared to a previous meta-analysis focusing on preventive parenting programmes for emotional and behavioural problems on children in which this was medium 61 .”
What the sources say
- Not checked yetcites [61]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“a previous meta-analysis investigating the effect of psychosocial interventions on the prevention of disruptive behaviour problems that also had small effect sizes 63”
What the sources say
- Not checked yetcites [63]
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses stratified for (i) the type of intervention provided (psychoeducation vs psychotherapy vs combined vs others), (ii) the type of intervention (universal vs selective) and (iii) the age group of the population (children and adolescents -including studies in which all individuals are ≤18 years old, vs adults -including studies in which all individuals are ≥18 years old).”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, the quality assessment procedure employed in the current protocol may have been suboptimal compared to currently recommended methods.”
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Most of the available studies on selective or universal prevention have focused on the prevention of depression and related affective symptoms, but the findings are conflicting [15][16][17][18] .”
What the sources say
- Not checked yetcites [15] Fatori, 2018, The economic impact of subthreshold and clinical childhood mental disorders, J. Ment. Health source
- Not checked yetcites [16] Firth, 2019, The Lancet psychiatry commission: a blueprint for protecting physical health in people with mental illness, Lancet Psychiatry source
- Not checked yetcites [17] Fusar-Poli, 2019, Integrated mental health services for the developmental period (0 to 25 Years): a critical review of the evidence, Front. Psychiatry source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Consequently, the accuracy of these categorical outcomes relied on their definition provided by each individual study.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We also did not address systematically the financial and social benefits of preventive interventions.”
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 28 (eTable I) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) checklist 29 (eTable II)-compliant systematic review was registered on PROSPERO (CRD42018102143).”
What the sources say
- Not checked yetcites [28] Kolubinski, 2018, A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem, Psychiatry Res. source
- Not checked yetcites [29] Kumar, 2017, Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes, Cochrane Database Syst. Rev.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“A previous meta-analysis found significant reductions in anxiety symptoms after cognitive behavioural interventions, but effect sizes were small 59 .”
What the sources say
- Not checked yetcites [59]
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“We also rated blinding using the following scoring system: 0 for studies without a proper blinding or studies that did not clarify if blinding was carried out or not; 1 for studies with single blinding; 2 for studies with double or triple blinding.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Interestingly, NICE guidelines highlight the need for psychoeducation for individuals with ADHD, while they limit the indications of psychotherapy to particular ADHD cases 66 .”
What the sources say
- Not checked yetcites [66]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Finally, the outcomes analysed by the current review were pragmatically aligned with the operationalisation provided by each individual study.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“These interventions have been able to increase self-esteem and decrease stigma related behaviours 69 ,”
What the sources say
- Not checked yetcites [69]
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted meta-regressions to estimate the association between the efficacy of the interventions and study quality.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“However, this approach was decided a priori in the study protocol to fully meet the characteristics of the evidence reviewed and the expected large number of studies to be extracted and screened.”
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This was likely due to the fact that prevention of mental disorders is more established through indicated as opposed to universal or selective approaches.”
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“our results suggest that young people in the general population could benefit from preventive interventions regardless of their exposure to these risk factors, potentially by improving social competence and reducing antisocial behaviours 54”
What the sources say
- Not checked yetcites [54] Tay, 2018, Effectiveness of information and communication technologies interventions to increase mental health literacy: a systematic review, Early Interv. Psychiatry source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Other interventions may include parent training 22 , physical activity 23 or mindfulness-based interventions 24 , but their efficacy is again not fully consolidated.”
What the sources say
- Not checked yetcites [22] Fusar-Poli, 2020, What is good mental health? A scoping review, Eur. Neuropsychopharmacol. source
- Not checked yetcites [23] Gates, 2017, Efficacy of group social skills interventions for youth with autism spectrum disorder: a systematic review and meta-analysis, Clin. Psychol. Rev. source
- Not checked yetcites [24] Gore, 2011, Global burden of disease in young people aged 10–24 years: a systematic analysis, Lancet source
hedged- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Among the specific types of selective or universal interventions, psychopharmacological treatments are rarely used 19 , whereas psychotherapy 20 or psychoeducation 21 are more frequent.”
What the sources say
- Not checked yetcites [19] Fusar-Poli, 2013, The psychosis high-risk state a comprehensive state-of-the-art review, JAMA Psychiatry source
- Not checked yetcites [20] Fusar-Poli, 2016, Towards a standard psychometric diagnostic interview for subjects at ultra high risk of psychosis: CAARMS versus SIPS, Psychiatry J. source
- Not checked yetcites [21] Fusar-Poli, 2018, The science of prognosis in psychiatry: a review, JAMA Psychiatry source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Random-effects models were employed due to high heterogeneity in the included stdies 36 .”
What the sources say
- Not checked yetcites [36] Medalia, 2017, Cognitive skills training for homeless transition-age youth: feasibility and pilot efficacy of a community based randomized controlled trial, J. Nerv. Ment. Dis. source
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data was extracted independently from all the studies included by independent researchers.Both databases were then crosschecked by experienced clinical researchers, and discrepancies were resolved through consensus.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Psychoeducation for ADHD features, affective symptoms and interpersonal violence, and psychotherapy for anxiety features are particularly promising.”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The definitions of categorical outcomes provided by each individual study are accurate.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We rated randomisation, as we had planned and detailed in our protocol, according to the following scoring system: 0 for studies without a proper randomisation or studies that did not clarify if randomisation was carried out or not; 1 for studies that mentioned they carried out some randomisation but did not clearly specify the type; 2 for studies that detailed clearly their method of randomis”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A previous meta-analysis found that trauma-focused psychotherapy is effective to prevent PTSD in patients with acute stress symptoms 62 .”
What the sources say
- Not checked yetcites [62]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“by different mechanisms including the reduction of the use of avoidance coping skills and an increase in the levels of problem-solving coping skills 73 .”
What the sources say
- Not checked yetcites [73]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixthly, it was not possible to ascertain the long-term efficacy of the interventions, only the post-test efficacy and other implementation factors related to this.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The same researchers who carried out the literature search screened, first looking at the title and abstract, and then to the full text all the articles.Discrepancies were resolved through consensus”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
No prior systematic review and meta-analysis has comprehensively appraised the efficacy of primary universal and selective preventive interventions for poor mental health outcomes in young people.
“However, to our knowledge, no systematic review and metaanalysis has comprehensively appraised the efficacy of primary universal and selective preventive interventions for poor mental health outcomes in young people.”
The paper relies on this without support.
It is not clear for which outcomes universal or selective approaches may be more effective.
“It is also not clear for which outcomes universal or selective approaches may be more effective.”
The paper relies on this without support.
The 17 outcome categories represent the outcomes of universal and selective preventative approaches in young people that have been most widely and pragmatically investigated.
“Therefore, these categories represent the outcomes of universal and selective preventative approaches in young people that have been most widely and pragmatically investigated.”
The paper relies on this without support.
The definitions of categorical outcomes provided by each individual study are accurate.
“the accuracy of these categorical outcomes relied on their definition provided by each individual study.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Compared to controls, available interventions significantly improved mental health literacy (Hedges' g=0.685), emotions (g=0.541), selfperceptions and values (g=0.49), quality of life (g=0.457), cognitive skills (g=0.428), social skills (g=0.371), physical health (g=0.285), sexual health (g=0.257), academic/occupational performance (g=0.211) and attitude towards mental disorders (g=0.177)”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [185]
Experimental — accuracy not yet measuredIn the citing paper
“This is especially important given that one in every seven adolescents aged 10-19 years experiences a mental health condition, 85”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [85]
In the citing paper
“In a meta-analysis, Salazar de Pablo and colleagues 85 found a small effect for changes in attitudes towards people with mental health conditions across 16 studies involving youth of various ages (effect size Hedges g=0•18).”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [85]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Abstract
“other emotional and behavioural problems (ES=0.304,p<0.001)”
§ CONCLUSIONS
“other emotional and behavioural problems (ES=0.304;p=0.004)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Abstract
“conduct problems (ES=0.21,p<0.001)”
§ CONCLUSIONS
“conduct problems (ES=0.210;p=0.021)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ CONCLUSIONS
“Selective interventions outperformed universal interventions for externalising behaviours as well (ES=0.217p=0.040), but overall interventions were not statistically significant.”
§ CONCLUSIONS
“externalising behaviours (ES=0.137;p=0.001)”
Citations
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Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies
Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., et al. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01161-7 · Cited by 3,835
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Thornicroft, G., Sunkel, C., Alikhon Aliev, A., Baker, S., Brohan, E., el Chammay, R., Davies, K., Demissie, M., Duncan, J., Fekadu, W., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01470-2 · Cited by 748
Preventive psychiatry: a blueprint for improving the mental health of young people
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Self-citationRisk and protective factors for mental disorders beyond genetics: an evidence‐based atlas
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Self-citationThe Lancet Psychiatry Commission: transforming mental health implementation research
McGinty, E. E., Alegria, M. M., Beidas, R. S., Braithwaite, J., Kola, L., LESLIE, D. L., Moise, N., Mueller, B., Pincus, H. A., Shidhaye, R. R., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00040-3 · Cited by 137
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Self-citationde Pablo, G. S., Besana, F., Arienti, V., Catalán, A., Vaquerizo‐Serrano, J., Cabras, A., Pereira, J. F., Soardo, L., Coronelli, F., Kaur, S., et al. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.100909 · Cited by 57
Self-citationCarucci, S., & Abbracciavento, G. (2021) · Medico e Bambino · doi:10.53126/meb40s709 · Cited by 55
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Kessing, L. V., Ziersen, S. C., Caspi, A., Moffitt, T. E., & Andersen, P. K. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.2206 · Cited by 52
Self-citationAutism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis
Vaquerizo‐Serrano, J., de Pablo, G. S., Singh, J., & Santosh, P. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05046-0 · Cited by 59
Self-citationSalazar de Pablo, G., De Micheli, A., Solmi, M., Oliver, D., Catalan, A., Verdino, V., Di Maggio, L., Bonoldi, I., Radua, J., Baccaredda Boy, O., et al. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000294 · Cited by 51
Self-citationHelland, S. S., Mellblom, A. V., Kjøbli, J., Wentzel‐Larsen, T., Espenes, K., Engell, T., & Kirkøen, B. (2022) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-022-01213-2 · Cited by 50
“Previous research has found unspecified psychoeducation to be effective for mental health literacy and cognitive skills in mental health interventions, but not for emotion regulation (de Pablo et al., 2020).”
BackgroundSantini, Z. I., Ekholm, O., Koyanagi, A., Stewart-Brown, S., Meilstrup, C., Nielsen, L., Fusar-Poli, P., Koushede, V., & Thygesen, L. C. (2022) · Mental Health & Prevention · doi:10.1016/j.mhp.2022.200233 · Cited by 40
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Public health primary prevention implemented by clinical high-risk services for psychosis
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“285), with physical therapy, relaxation, and exercise being the most effective interventions [85].”
BackgroundSelf-citationHayes, D., Mansfield, R., Mason, C., Santos, J., Moore, A., Boehnke, J. R., Ashworth, E., Moltrecht, B., Humphrey, N., Stallard, P. N., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02135-y · Cited by 32
“When it comes to effect sizes for constructs related to help seeking, including mental health literacy ([MHL; 24], universal interventions appear to fare equally well as targeted interventions [25].”
BackgroundPriority actions for promoting population mental health and wellbeing
Barry, M. M., Kuosmanen, T., Keppler, T., Dowling, K., & Harte, P. (2023) · Mental Health & Prevention · doi:10.1016/j.mhp.2023.200312 · Cited by 32
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“05).(14) It was also consistent with a result of another metal analysis of a digital interventions, social media included to improve positive mental health outcomes among young people involving supervision (Cohen’s d=0.”
BackgroundResultMental Health and Positive Development Prevention Interventions: Overview of Systematic Reviews
Harrison, L., Sharma, N., Irfan, O., Zaman, M., Vaivada, T., & Bhutta, Z. A. (2022) · PEDIATRICS · doi:10.1542/peds.2021-053852g · Cited by 25
Cognitive reserve in mental disorders
Amoretti, S., & Ramos‐Quiroga, J. A. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.04.011 · Cited by 23
Supporting Mental Health in Youth Sport: Introducing a Toolkit for Coaches, Clubs, and Organisations
Walton, C. C., Carberry, S., Wilson, M., Purcell, R., OLIVE, L. S., Vella, S. A., & Rice, S. (2021) · International Sport Coaching Journal · doi:10.1123/iscj.2021-0042 · Cited by 25
Arango, C., Buitelaar, J. K., Correll, C. U., Díaz‐Caneja, C. M., Figueira, M. L., Fleischhacker, W. W., Marcotulli, D., Parellada, M., & Vitiello, B. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.04.005 · Cited by 25
“Early interventions are associated with better outcomes than delayed treatment ( Arango et al., 2021 ; Pablo et al., 2020 ; Catalan et al., 2021 ) and can therefore be considered central to the efforts of changing the trajectory of the disease.”
Self-citationKvamme, L. S., Keleş, S., Nes, R. B., Vaskinn, L., Waaler, P. M., Wentzel‐Larsen, T., & Kjøbli, J. (2022) · Residential Treatment for Children & Youth · doi:10.1080/0886571x.2022.2111397 · Cited by 19
“A recent systematic review and meta-analysis of 276 mental health promotion studies presented psychoedu-cative interventions as the most effective for improving cognitive skills and mental health literacy among young people (Salazar de Pablo et al., 2020).”
BackgroundArmaou, M., Pears, M., Konstantinidis, S. T., & Blake, H. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21030375 · Cited by 18
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“Universal interventions targeting the general public effectively promote positive mental health outcomes [41], regardless of the vulnerability of the population to mental disorders.”
BackgroundAn agenda for future research regarding the mental health of young people with care experience
Devaney, J., Power, L., Jacobs, P., Davidson, G., Hiller, R. M., Martin, J., McCartan, C. J., McCusker, P., McGuire, R., Phillips, A., et al. (2023) · Child & Family Social Work · doi:10.1111/cfs.13015 · Cited by 14
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Promoting good mental health in the whole population: The new frontier
Fusar‐Poli, P., & Santini, Z. I. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.09.010 · Cited by 15
Self-citationResilience, prevention and positive psychiatry
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Self-citationSantini, Z. I., Thygesen, L. C., Koyanagi, A., Stewart-Brown, S. L., Meilstrup, C., Nielsen, L., Olsen, K. R., Birkjær, M., McDaid, D., Koushede, V., et al. (2022) · Mental Health & Prevention · doi:10.1016/j.mhp.2022.200247 · Cited by 24
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The impact of podcast-based interventions on mental health: A systematic scoping review
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“…psicoeducación es una modalidad de intervención que permite trabajar sobre la prevención, la promoción y la inter-vención en relación a la salud mental (Makama et al., 2019; Morgado et al., 2021), cuya eficacia ha sido demostrada en numerosas ocasiones (de Pablo et al., 2020; Fonseca et al., 2021).”
Yani, D. I., Chua, J. Y. X., Wong, J. C. M., Pikkarainen, M. A., & Shorey, S. (2024) · International Journal of Mental Health Nursing · doi:10.1111/inm.13494 · Cited by 14
Mental Health Literacy about Personality Disorders: A Multicultural Study
Altuncu, K. A., Lomoriello, A. S., Buglio, G. L., Martino, L., Yenihayat, A., Belfiore, M. T., & Boldrini, T. (2023) · Behavioral Sciences · doi:10.3390/bs13070605 · Cited by 9
“Indeed, good mental health can be defined by different core domains—including MHL [2]—which can be targeted and potentially improved through universal and selective interventions [46].”
BackgroundITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people
Fusar‐Poli, P., Minichino, A., Brambilla, P., Raballo, A., Bertolino, A., Borgatti, R., Mensi, M. M., Ferro, A., & Galderisi, S. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.2232 · Cited by 11
“This level of activity includes implementation studies [32], local cohort studies encompassing psychopathology, neurocognition, neuroimaging to improve prediction of outcomes [33], evidence-based medicine analyses of the CHR-P literature [15], [34][35][36], and prospective studies validating the prognostic accuracy of…”
BackgroundSelf-citationVettor, M. D., Buglio, G. L., Barsanti, A., Ciocca, G., Gennaro, A., Göksal, R., Lingiardi, V., Giovanardi, G., & Boldrini, T. (2025) · Societies · doi:10.3390/soc15020044 · Cited by 8
van Amelsvoort, T., & Leijdesdorff, S. M. J. (2022) · World Psychiatry · doi:10.1002/wps.20930 · Cited by 8
Lee, J., Correll, C. U., Lee, T. Y., Oh, S., Kim, J., Rhee, S. J., Kim, M., Kim, S. H., Ahn, Y. M., Ha, K., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.115 · Cited by 8
Self-citationYang, Y., Fu, L., Cheng, S., & Fowler, P. J. (2025) · Adolescent Research Review · doi:10.1007/s40894-024-00254-y · Cited by 8
“Likewise, another study (Salazar de Pablo et al., 2020) examined universal and selective prevention and promotion programs involving 159508 participants with a mean age of 15 years across 276 studies, demonstrating a wide range of positive mental health outcomes, including but not limited to the…”
Mental health literacy interventions for female adolescents: a systematic review and meta-analysis
Arnold, E. R., Liddelow, C., Lim, A. S. X., & Vella, S. A. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02648-2 · Cited by 13
“…interventions due to their clinical and therapeutic approach (e.g., Cognitive Behavioural Therapy; [53]); (b) were reviews or secondary in nature (e.g., systematic reviews; [54]); (c) included male and female participants, wherein female data could not be independently extracted (e.g., [55]).”
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Mental illness, mental health, and mental well-being
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“Thesecouldsupplementtraditional and effective community-based efforts at promoting mental health literacy 44 .”
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Universal online self-help ACT interventions for youth: A systematic review
Morey, A., Samuel, V. M., & Williams, M. O. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104576 · Cited by 9
“A systematic review by Salazar de Pablo et al. (2020) evaluated the effectiveness of universal and selective interventions for improving mental health and well-being outcomes in CYP.”
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Anttila, M., Lantta, T., Ylitalo, M., Kurki, M., Kuuskorpi, M., & Valimaki, M. A. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s311788 · Cited by 11
Jordans, M. J. D., Koppenol‐Gonzalez, G. V., Bleile, A. C. E., Orech, B., Brian, A. J., & Verreault, K. (2024) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2024.2344157 · Cited by 6
Effect Evaluation of Mental Nursing in Nursing of Young Cancer Patients Based on Big Data
Ren, Y. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.888183 · Cited by 5
Digital Strategies to Accelerate Help-Seeking in Youth With Psychiatric Concerns in New York State
Birnbaum, M. L., Garrett, C., Baumel, A., Germano, N., Lee, C. S. Y., Sosa, D., Ngo, H., Fox, K. H., Dixon, L. B., & Kane, J. M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.889602 · Cited by 8
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“As schizophrenia is increasingly recognized as a neurodevelopmental disorder, early intervention leads to better outcomes than delayed treatment (Salazar de Pablo et al., 2020; Arango et al., 2021; Catalan et al., 2021).”
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Self-citationEmotional impact on children during home confinement in Spain
Sánchez-Ferrer, F., Cervantes-García, E., Gavilán-Martín, C., Quesada, J. A., Cortés‐Castell, E., & Nso‐Roca, A. P. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.969922 · Cited by 4
“By contrast, the existence of a garden at home was linked to a better emotional state in children in that they can “leave” the house to take a walk or to be in the sun, both elements traditionally associated with happiness, as well as increased access to physical exercise (18).”
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“To date, prophylactic interventions aimed at adolescents have yielded encouraging results in terms of reducing symptoms (e.g., [69, 134, 186, 204, 208]) and increasing wellbeing (e.g., [134, 162, 181]).”
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“Currently, school ‐ based intervention programs are categorized as universal, selective, and targeted (Salazar de Pablo et al. 2020).”
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“…pandemic has had a significant impact on the mental health of the general population, particularly for certain at-risk groups, including patients with pre-existing cardiometabolic disorders, women, adolescents, and young adults (Penninx et al, 2022; Chi et al., 2021; Salazar de Pablo et al., 2020).”
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Emotional impact on children during home confinement in SpainPreprint
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“16 24 Young people in higher education settings present a particular set of opportunities for preventive and promotive interventions given the social connected-ness of student populations.”
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“…typically incorporate psychoeducation and practical coping strategies and are aimed at preventing mental health problems from emerging or reoccurring, reducing symptoms for those already experiencing problems, and/or promoting wellbeing (Salazar de Pablo et al., 2020; Vostanis et al., 2013).”
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Impact of Mental Health Literacy on Improving Quality of Life Among Adolescents in Barcelona
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Metadata
- Authors
- Salazar de Pablo, G., De Micheli, A., Nieman, D. H., Correll, C. U., Kessing, L. V., Pfennig, A., Bechdolf, A., Borgwardt, S., Arango, C., van Amelsvoort, T., Vieta, E., Solmi, M., Oliver, D., Catalan, A., Verdino, V., Di Maggio, L., Bonoldi, I., Vaquerizo-Serrano, J., Baccaredda Boy, O., Provenzani, U., Ruzzi, F., Calorio, F., Nosari, G., Di Marco, B., Famularo, I., Molteni, S., Filosi, E., Mensi, M., Balottin, U., Politi, P., Shin, J. I., & Fusar-Poli, P.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Northwell Health (US)
- Rigshospitalet (DK)
- University Hospital Carl Gustav Carus (DE)
- University of Cologne (DE)
- University of Basel (CH)
- Hospital General Universitario Gregorio Marañón (ES)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- University of Padua (IT)
- King's College London (GB)
- University of Siena (IT)
- University of Pavia (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Yonsei University (KR)
- ORCID
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 41
- Pages
- 28-39
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W3095238552
- Cited by
- 104
- References
- 58
- Citations by year
- 2026: 5 · 2025: 17 · 2024: 20 · 2023: 15 · 2022: 28 · 2021: 19
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Communities in ADDI (University of the Basque Country) (submittedVersion, other-oa)
- Communities in ADDI (Universidad del Pais Vasco) (submittedVersion, cc-by-nc-nd)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
- Hispana (submittedVersion, cc-by-nc-nd)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc-nd)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- universal interventions, selective intervention, youth, mental health literacy, psychoeducation, social skills, quality of life, physical health, sexual health, academic performance, intervention efficacy, school-based intervention, physiotherapy, psychotherapy, cognitive skills, emotions
- MeSH terms
- Adolescent, Adult, Age Factors, Mental Disorders, Clinical Trials as Topic, Female, Humans, Male, Mental Health, Psychotherapy, Cognitive Behavioral Therapy, Young Adult
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