School-based mental health services for primary children

School-based services delivered by teachers and other school-based professionals can help reduce mental health problems in primary-age children, reports a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

The findings are based on a meta-analysis of 43 controlled trials involving almost 50,000 primary school children. The study examined the overall effectiveness of school-based mental health services, as well as the relative effectiveness of various school-based intervention models that differed according to treatment target, format and intensity.

Overall, school-based services had a small to medium effect (effect size = +0.39) in reducing mental health problems. Interventions that targeted child behaviour problems demonstrated the largest effect sizes (+0.76). Interventions that were implemented multiple times per week were found to be more than twice as effective as those that were only implemented on a weekly (or less) basis.

Source: The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis (March 2018), Journal of the American Academy of Child & Adolescent Psychiatry, Volume 57, Issue 3

One in five pupils in the UK experience emotional and behavioural problems

Around one in five children and young people in the UK experience emotional and behavioural problems according to the first findings from a survey of over 30,000 young people (aged 11 to 14), which were collected as part the National Lottery-funded HeadStart programme.

Pupils in the 114 participating HeadStart schools were asked to complete the online Wellbeing Measurement Framework. This report, by Jessica Deighton and colleagues, explores the data related to the prevalence of mental health problems in young people and how this varies by gender, ethnicity, special educational needs status, free school meal eligibility, and child-in-need status. The findings reveal that:

  • Pupils in Year 9 are more likely to report mental health problems than those in Year 7.
  • Girls are more likely to say they had experienced emotional problems (with 25% of girls saying they had a problem compared to 11% of boys) but in contrast, boys are more likely to say they have experienced behavioural problems (with 23% of boys saying they had experienced them compared with 15% of girls).
  • Pupils from Asian, Black, Mixed, and other ethnic groups were less likely to indicate they were experiencing emotional problems than young people in the White ethnic group.
  • Pupils with special educational needs, those eligible for free school meals, and those classified as children in need were also more likely to say they were experiencing both emotional and behavioural problems.

The report concludes that there is a consistent association between deprivation and mental health problems, however, the schools involved in HeadStart are typically located in less socially and economically advantaged areas of the UK and differ from the national average in terms of proportions with special educational needs and proportions of white pupils, so all results must be understood in this context.

Source: Mental health problems in young people, aged 11 to 14: Results from the first HeadStart annual survey of 30,000 children (January 2018), Evidence Based Practice Unit (EBPU) Evidence Briefing #1:11

Later school start time may produce benefits but more evidence is needed

Many studies have been conducted to examine the impact for pupils of later school start times, some of which can be found in previous issues of Best Evidence in Brief. This Campbell systematic review summarises the findings from 17 studies to examine the evidence on the impact of later school start times on pupils’ mental health and academic performance.

The studies included in the review were randomised controlled trials, controlled before-and-after studies and interrupted time series studies with data for pupils aged 13 to 19 and that compared different school start times. The studies reported on 11 interventions in six countries, with a total of almost 300,000 pupils.

The main results of the review suggest that later school starts may be associated with positive academic benefits and psychosocial outcomes. Later school start times also appear to be associated with an increase in the amount of sleep children get. Effect sizes ranged from +0.38 to +2.39, equivalent to an extra 30 minutes to 2 hours of sleep each night. However, the researchers point out that, overall, the quality of the body of evidence is very low, and so the effects of later school start times cannot be determined with any confidence.

Source: Later school start times for supporting the education, health, and well-being of high school students: a systematic review (December 2017), A Campbell Systematic Review 2017:15

Can friendships as a teenager predict later mental health?

Research by Rachel Narr and colleagues at the University of Virginia looked at whether the quality of friendships during adolescence can predict aspects of long-term mental and emotional health.

The study looked at a sample of 169 teenagers over 10 years, from age 15 to 25. They were surveyed annually and asked about who their closest friends were along with questions about those friendships. They were also assessed on anxiety, social acceptance, self-worth and symptoms of depression.

The researchers found that teens who prioritised close friendships at age 15 had lower social anxiety, an increased sense of self-worth and fewer symptoms of depression at age 25 than their peers. However, teens who had lots of friends, rather than a few close friendships, had higher levels of anxiety as young adults.

The study also determined that there was a low relation between teens having high-quality friendships and being more sought after by their peers, suggesting that although some teens manage both popularity and close friendship well, and attract both due to similar characteristics, for the most part, these two types of social success are due to different personal attributes.

Source: Close friendship strength and broader peer group desirability as differential predictors of adult mental health (August 2017), Child Development doi:10.1111/cdev.12905

The world’s largest school-based mental health programmes

School-based mental health programmes are now delivered to millions of children, particularly in high-income countries.

J Michael Murphy and colleagues have published a review of those programmes that reach the largest populations. In an article for the Harvard Review of Psychiatry, they profile eight programmes that have shown their effectiveness using randomised controlled trials or quasi-experimental studies. Most of the programmes focus on primary prevention or target specific vulnerable populations, rather than being aimed at supporting children with diagnosed disorders.

For each of the programmes, there is a description of its approach and a review of the supporting evidence. The eight programmes are:

  • Positive Behavioral Interventions & Supports
  • FRIENDS
  • Positive Action
  • Promoting Alternative Thinking Strategies (PATHS)
  • Skills for Life
  • MindMatters
  • Good Behavior Game
  • Cognitive-Behavioral Intervention for Trauma in Schools

Between them, the programmes have reached more than 25 million children, although the authors point out that these have mainly been in high-income countries. There is limited evidence that these programmes could be implemented at scale in low- and middle-income countries.

The authors suggest that, with the growing availability and diversity of programmes, greater attention can now be paid to assessing the processes and practices of implementation that are associated with successful, widely disseminated and sustainable programmes.

Source: Scope, scale, and dose of the world’s largest school-based mental health programs (August 2017), Harvard Review of Psychiatry

Social media and children’s mental health

In a new report from the Education Policy Institute, Emily Firth has examined the evidence of the impact of using social media on young people’s mental health and emotional well-being.

One of the key findings from the report is evidence of a beneficial impact. This is because young people can connect with others to improve their social skills online, develop their character and resilience and collaborate on school projects. In the recent PISA well-being survey of 15-year-olds, 90.5% of boys and 92.3% of girls in the UK agreed or strongly agreed with the statement “It is very useful to have social networks on the internet”. Also, importantly, those with mental health problems are able to use the internet to seek support, either through social media networks or through the online provision of advice and counseling support. For example, 78% of young people contacting the organisation Childline now do so online.

However, the report also highlights several negative effects on the well-being of young people linked with social media, including cyber-bullying, concerns about excessive use and sharing of private information and harmful content. It also finds that attempts to restrict children’s internet access are likely to be counterproductive as they hinder the development of vital skills needed to counter such risks. Rather than seeking to protect young people from all online risks­, the report calls on policy makers to promote proactive measures that build resilience in children, in order to help them lead safe digital lives.

Source: Social media and children’s mental health: a review of the evidence (June 2017) Education Policy Institute