Whole-class mental health sessions in schools have a small but significant effect in reducing depression and anxiety symptoms, according to new analysis led by researchers at UCL (University College London) and Anna Freud.
The analysis, published in the journal Frontiers in Child and Adolescent Psychiatry, combined results from 71 existing studies involving 63,041 young people aged eight to 18.
The researchers found that sessions based on cognitive behavioural therapy (CBT), which helps people to recognise and challenge negative thoughts and behaviours, were more effective at reducing anxiety symptoms than mindfulness-based sessions or sessions drawing from other theories.
Lead author Dr Daniel Hayes, based in UCL's Department of Behavioural Science & Health and Anna Freud, a mental health charity for children and young people, said: "The value of whole-class mental health interventions has been contested. Past evidence has been mixed and some experts have argued that, given a lack of obvious benefit, schools should reconsider their use.
"Our findings, based on the most up-to-date evidence, show that whole-class sessions can work in reducing symptoms of depression and anxiety. Although the effect is small on average for individuals, such small effects can be impactful once scaled up at a population level.
"Not all interventions are equal. Our analysis found that CBT-informed sessions, where young people learn to understand their thoughts and behaviours, as well as how to manage them, were significantly more effective at reducing anxiety symptoms than mindfulness-based classes."
Senior author Professor Jessica Deighton, based in UCL's Division of Psychology & Language Sciences and Director of Applied Research and Evaluation at Anna Freud, said: "The mental health and wellbeing of children and young people has become a major public health concern, with increasing numbers in the UK and elsewhere in contact with specialist services.
"School-based mental health interventions can reach a large number of people, including those who may not otherwise seek help. As long as the approach is careful and evidence-based, tackling the issue with everyone in a class can avoid stigmatising those experiencing mental health problems and help build the wellbeing of all students.
"By increasing children's understanding of mental health and equipping them with techniques to help them cope with challenges, it is hoped that these interventions might help to prevent problems in later life.
"However, it's important to remember the impact of these interventions alone is often small, and should be part of a wider, whole-school approach to mental health and wellbeing. This involves building supportive relationships and a sense of belonging across the whole school community, and providing more targeted support for those that need it."
As part of their analysis, the researchers reviewed hundreds of existing studies.
The 71 studies they selected took place in 22 countries, with more than half occurring in Australia (27) and the United States (10). Most were conducted in secondary schools (51) rather than primary schools (19). The interventions were mostly delivered by teachers (36) and psychologists (22) and ranged from a single 30-minute session to more than two hours a week over four school years.
The research team divided interventions into three groups: sessions drawing on CBT; sessions based on mindfulness, in which people are encouraged to be aware of their thoughts, feelings and surroundings, as they occur; and those based on other theories or multiple theories, such as yoga, physical education and self-determination theory.
They found that interventions were linked to a later reduction in self-reported depression and anxiety symptoms but not to a later reduction in self-reported internalising symptoms – a broader category encompassing a range of emotional difficulties, such as feeling low, feeling anxious or having peer problems.
The outcomes for depression and anxiety did not vary according to the length of session or who delivered it. CBT-based sessions had more benefit for anxiety symptoms, but depression symptoms did not vary according to the underlying approach informing the intervention.
The study was funded by the UK's Department for Education and involved researchers from UCL and Anna Freud, as well as from the University of York, the University of Exeter, the University of Manchester, Liverpool John Moores University, Edge Hill University in Lancashire, Newcastle University, the University of Dundee and the University of Bath.
