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

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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

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

DOI 10.1136/bmjopen-2018-022560PMC PMC6129100

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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.

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Authors: Mackenzie, K., & Williams, C.
Affiliations: NHS Ayrshire and Arran (GB)
University of Glasgow (GB)
Corresponding author: Mackenzie, Karen
ORCID: Williams, Christopher
Venue: BMJ Open
Publisher: BMJ
Published: 2018-09
Volume: 8
Issue: 9
Pages: e022560
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2018-022560
PMC: PMC6129100
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: gold
doi.org
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 › Medicine › Public Health, Environmental and Occupational Health › 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

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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

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