School-based programmes to improve mental health and well-being and reduce risks
Adolescents spend a significant part of their lifetime in school and, therefore, this environment plays an important role in their social, emotional and psychological development. Psychological distress can appear during adolescence in the form of mental health problems, such as anxiety and depression. It is also manifested in external symptoms including impulsiveness and aggression, which are the later predictors of stress levels and risk behaviours, such as substance use. Schools could serve as a vehicle for the promotion of positive youth development and effective learning.
In our latest Best Practice Portal update, we highlight the results of recent systematic reviews on school interventions addressing the mental health and well-being of young people.
School-based multi-component positive psychology interventions aim to improve well-being and mental health and reduce the most common psychological distress indicators (i.e., depression, anxiety and stress) in adolescents. Positive psychology interventions focus on strengthening positive emotions, thoughts and behaviours through activities that can be easily implemented in daily routines. These interventions were found to be effective in improving psychological well-being and reducing depression symptoms.
Bullying is a major target for universal prevention given the high prevalence rates, association with increased lifetime prevalence of mental health disorders, and the fact that evidence is emerging which suggests that school anti-bullying interventions have valuable population impact. A recent meta-analysis documented that anti-bulling interventions can be more effective than very established interventions for specific health conditions. Authors were able to calculate the Population Impact Number (PIN), which is the number of people who should be exposed to an intervention in order to prevent one case. They found that, on average, an anti-bullying intervention needs to include 140 pupils to prevent one case of bullying exposure and 107 to improve mental health problems. To put these results into context, 35 450 people need to take aspirin for six months after a first non-haemorrhagic stroke to avoid one death or 324 girls needs to be vaccinated for human papillomavirus to prevent one case of cervical cancer.
In the EMCDDA Best Practice Portal, we host a specific registry of evaluated prevention programmes – the Xchange Registry. The following list highlights the Xchange entries rated as beneficial, or likely to be beneficial, school-based programmes aimed at tackling risk behaviours and focusing on life-skills training:
- Eigenstandig Werden (Becoming independent): life-skills training with a focus on substance use and bullying
- Unplugged - a Comprehensive Social Influence programme for schools: life-skills training with correction of normative beliefs
- KiVa (Anti-bullying programme): Combined universal and indicated type of an anti-bullying programme for school children
- Olweus Bullying Prevention Programme: a school-wide programme designed to prevent bullying amongst children
- IPSY: life skills training with discussions on school context and learning climate
E-health in schools
Results are still not clear on whether e-health school-based interventions addressing multiple lifestyle risk behaviours have an effect on alcohol and smoking.
Multiple health behaviour change interventions target risk factors in combination and are a promising method to improve lifelong health. This approach capitalises on evidence that changing one lifestyle behaviour could increase self-efficacy to improve others. Given that teaching time is often restricted, interventions that simultaneously address multiple risk behaviours are particularly advantageous in school settings. E-health interventions (delivered via the internet, computers, tablets, mobile technology or tele-health) offer increased student engagement, fidelity and scalability. Internet technology is becoming increasingly embedded in school education.
The conclusions of the review, included in the BPP, highlight that e-health school-based interventions addressing multiple lifestyle risk behaviours can be effective in improving physical activity, screen time, and fruit and vegetable intake, however, effects are small and only evident immediately after the intervention. No effect was seen for alcohol or smoking.
Brief interventions for substance use in teens
A new BPP update highlights the positive effects of brief behavioural interventions on alcohol use but not on cannabis.
A recent review investigated the effects of brief interventions, including motivational interviewing (MI), psycho-education, and treatment as usual, in adolescents for substance use in adolescents. The results of the meta-analysis confirm the evidence, which was already coming together for adults, that MI reduces heavy alcohol use and alcohol use days also in adolescents. However, it does not reduce cannabis use days.
The EMCDDA will host a new webinar on the 28 April and it will address the application of science-based strategies in policy- and decision-making at local level.
The European Prevention Curriculum (EUPC) includes training for Decision-, Opinion-, and Policy-makers (DOPs) on how to prioritise evidence-based interventions and policies and on how to advocate for them. This represents a paradigm shift from offering guidance (‘let things happen’) to actively promoting change in decision-making (‘make things happen’). Speakers and stakeholders from Belgium, Germany, Estonia and Croatia will gather in conversation around this topic.
Webinar registration form: https://us02web.zoom.us/webinar/register/WN_FN8RBcZDTfqy7z9M56fQ6w
This content was published in the Best pratice portal update briefing on 15.4.2021