Cited by 104School Health and Nursing EducationChild and Adolescent Psychosocial and Emotional DevelopmentMental Health Treatment and Access

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Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis

Open access
Salazar de Pablo, Gonzalo, De Micheli, Andrea, Nieman, Dorien H., Correll, Christoph U., Kessing, Lars Vedel, Pfennig, Andrea, Bechdolf, Andreas, Borgwardt, Stefan, Arango, Celso, van Amelsvoort, Therese, Vieta, Eduard, Solmi, Marco, Oliver, Dominic, Catalan, Ana, Verdino, Valeria, Di Maggio, Lucia, Bonoldi, Ilaria, Vaquerizo-Serrano, Julio, Baccaredda Boy, Ottone, Provenzani, Umberto, Ruzzi, Francesca, Calorio, Federica, Nosari, Guido, Di Marco, Benedetto, Famularo, Irene, Molteni, Silvia, Filosi, Eleonora, Mensi, Martina, Balottin, Umberto, Politi, Pierluigi, Shin, Jae Il, Fusar-Poli, Paolo·2020·European Neuropsychopharmacology

Abstract

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

AI snapshot

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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Integrity signals

Registry

Crossref · 10.1016/j.euroneuro.2020.10.007

Cites

58 of 58 references verified0 citation errors · 0 not checkable

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69 Own result · 26 Not checked yet · 20 Own method · 10 Own interpretation · 1 No basis given

Verify all 36 references — free account
  • It may state two separate claims as one. 23
  • The quote only partly states this claim. 1
  • Probably not a substantial claim. 20
36 of 36
  • 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.”
4 of 4

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Research works printed but not linked: 1

  1. Sharp, 2016, The effects of a pedometer-based intervention on first-year university students: a randomized control trial, J. Am. Coll. Health, 64, 630, 10.1080/07448481.2016.1217538 · DOI

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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)
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
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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