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.
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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DOI：
10.1136/bmjopen-2018-022560
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发表时间：
2018-09-08
期刊：
影响因子：
2.9
通讯作者：
Williams C
中科院分区：
文献类型：
--
作者：
Mackenzie K;Williams C
本次审查旨在评估普遍提供的（所有5-16岁的学生），以学校为基础的心理健康干预措施的质量，内容和有效性的证据，旨在促进心理健康/福祉和复原力，使用经过验证的结果措施，并在联合王国提供，以告知联合王国学校为基础的福祉的实施。对英国主流学校环境中已发表的文献进行系统回顾。Embase、CINAHL、MEDLINE、PsycINFO、PsychArticles、ASSIA和Psychological and Behavioural Sciences发表于2000年至2016年4月。以英文出版;旨在改善主流学校环境中的心理健康/情感健康的普遍干预措施;在校学生是干预措施的直接接受者;采用了事前事后设计，允许使用经验证的成果衡量标准进行比较。确定了12项研究，包括随机对照试验和非对照的前-后设计（5项以小学为基础，7项以中学为基础）。采用叙述性综合与研究质量检查。以学校为基础的普遍干预措施的效果被认为是中性的或小的，对质量较差的研究和那些以小学为基础的研究（9-12岁的学生）产生了更积极的影响。研究在使用测量方法和研究设计方面差异很大。只有四项研究被评为“优秀”质量。方法学问题，如小样本量，不同的课程保真度和缺乏随机化降低了整体研究质量。如果有几个积极的结果，效果大小很小，方法问题使许多结果要谨慎解释。总体而言，结果表明了一种趋势，即高质量的研究报告较少的积极影响。唯一一项进行卫生经济学分析的研究表明，干预措施不具有成本效益。目前的证据表明，在英国，普遍的、以学校为基础的干预措施的效果是中性的，效果很小，这些干预措施旨在促进情绪或心理健康，或预防心理健康问题。需要采用强有力的长期方法，确保充分记录忠实性，使用对变化机制敏感的有效措施，报告因后续行动而失去的措施和任何不利影响。英国需要进一步的高质量和大规模的研究，以有力地测试对学生或更广泛的教育或卫生系统的任何长期利益。
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. A systematic review of published literature set within UK mainstream school settings. Embase, CINAHL, MEDLINE, PsycINFO, PsychArticles, ASSIA and Psychological and Behavioural Sciences published between 2000 and April 2016. 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. 12 studies were identified including RCTs and non-controlled pre-post designs (5 primary school based, 7 secondary school based). A narrative synthesis was applied with study quality check. 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. 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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