Cited by 131School Health and Nursing EducationChild and Adolescent Psychosocial and Emotional DevelopmentEarly Childhood Education and Development

Universal, school-based interventions to promote mental and emotional well-being: What is being done in the UK and does it work? A systematic review

Open access
Mackenzie, Karen, Williams, Christopher·2018·BMJ Open

Abstract

OBJECTIVES: The present review aimed to assess the quality, content and evidence of efficacy of universally delivered (to all pupils aged 5-16 years), school-based, mental health interventions designed to promote mental health/well-being and resilience, using a validated outcome measure and provided within the UK in order to inform UK schools-based well-being implementation. DESIGN: A systematic review of published literature set within UK mainstream school settings. DATA SOURCES: Embase, CINAHL, MEDLINE, PsycINFO, PsychArticles, ASSIA and Psychological and Behavioural Sciences published between 2000 and April 2016. ELIGIBILITY CRITERIA: Published in English; universal interventions that aimed to improve mental health/emotional well-being in a mainstream school environment; school pupils were the direct recipients of the intervention; pre-post design utilised allowing comparison using a validated outcome measure. DATA EXTRACTION AND SYNTHESIS: RESULTS: Effectiveness of school-based universal interventions was found to be neutral or small with more positive effects found for poorer quality studies and those based in primary schools (pupils aged 9-12 years). Studies varied widely in their use of measures and study design. Only four studies were rated 'excellent' quality. Methodological issues such as small sample size, varying course fidelity and lack of randomisation reduced overall study quality. Where there were several positive outcomes, effect sizes were small, and methodological issues rendered many results to be interpreted with caution. Overall, results suggested a trend whereby higher quality studies reported less positive effects. The only study that conducted a health economic analysis suggested the intervention was not cost-effective. CONCLUSIONS: The current evidence suggests there are neutral to small effects of universal, school-based interventions in the UK that aim to promote emotional or mental well-being or the prevention of mental health difficulties. Robust, long-term methodologies need to be pursued ensuring adequate recording of fidelity, the use of validated measures sensitive to mechanisms of change, reporting of those lost to follow-up and any adverse effects. Further high-quality and large-scale research is required across the UK in order to robustly test any long-term benefits for pupils or on the wider educational or health system.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2018-022560

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

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?

  • Reviews exploring the effectiveness of universal interventions have generally found small effects of the interventions on outcomes including anxiety, depression and externalising problems, suggesting limited effectiveness.

    “Reviews exploring the effectiveness of universal interventions have generally found small effects of the interventions on outcomes including anxiety, depression and externalising problems, suggesting limited effectiveness (Caldwell et al., 2019; Dray et al., 2017; Mackenzie & Williams, 2018).”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [22]Reavley N, Bassilos B, Ryan S, et al Interventions to build resilience in Young People: a literature review. Melbourne: Victorian Health Promotion Foundation, 2015.

Cited by

Sorted by citations

Authors
Mackenzie, K., & Williams, C.
Affiliations
  • NHS Ayrshire and Arran (GB)
  • University of Glasgow (GB)
Corresponding author
Mackenzie, Karen
Venue
BMJ Open
Publisher
BMJ
Published
2018-09
Volume
8
Issue
9
Pages
e022560
ISSN
2044-6055 (ISSN-L)
OpenAlex
W2890066719
Cited by
131
References
41
Citations by year
2026: 19 · 2025: 33 · 2024: 24 · 2023: 18 · 2022: 15 · 2021: 12 · 2020: 7 · 2019: 2 · 2018: 1
FWCI
1.29
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Education › Early Childhood Education and Development
Keywords
universal interventions, school-based intervention, mental health promotion, emotional well-being, resilience, mental health prevention, elementary school students, intervention efficacy, study quality, cost-effectiveness, UK schools
MeSH terms
Child, Child Welfare, United Kingdom, Humans, Mental Health, Mental Health Services, School Health Services, Outcome Assessment, Health Care, Quality Improvement

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review