An estimated 10% to 20% of children and adolescents experience mental health issues such as anxiety and depression, making youth mental health a significant public health concern. Depression and anxiety are among the leading causes of poor health in teenagers, especially in high-income countries. Despite this, more than 60% of young people experiencing mental health problems do not receive appropriate support.
With increasing awareness of the importance of youth mental health, schools are increasingly seen as ideal settings for early intervention. Given the substantial amount of time students spend in school and the existing investments in infrastructure and human resources, including inclusive practices and school-based mental health or wellbeing programs, schools are well-positioned to roll out such initiatives. Importantly, schools offer a convenient and accessible environment that helps overcome barriers related to transportation, social stigma, family circumstances, geography, or socioeconomic status.
Typically, those school-based programs are generally classified into three basic categories. Promotion programs that support overall well-being, enabling students to develop essential life skills. Prevention programs to identify and address potential issues prior to them developing into more serious problems. Treatment programs are designed to provide targeted support to students already experiencing mental health challenges.
A 2013 UK study found that most schools tended to intervene only after students began showing symptoms. However, there is now increasing interest in universal prevention programs. These programs are delivered to all students, regardless of their risk level. These programs are considered a cost-effective way to promote resilience, reduce stigma, and identify emerging issues early, without relying on expensive screening procedures or highly specialized staff.
Experts suggest that these whole-school approaches could act like a mental health “vaccine,” helping protect all children from future emotional struggles.
A systematic review and meta-analysis were conducted using the MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials databases. This review covered the studies published before December 15, 2022. This analysis focused on universal interventions aimed at improving emotional outcomes, specifically anxiety, depression, and internalising symptoms in youth aged 8-18 years. This study was pre-registered with PROSPERO, and the risk of bias was assessed using custom-made tools based on the Cochrane guidelines.
A total of 71 unique studies involving 63,041 children and adolescents were included. Among these, 40 studies (n = 35,559) assessed anxiety outcomes, 50 studies (n = 49,418) examined depression outcomes, and 15 studies (n = 21,473) assessed internalizing outcomes. There was a statistically significant effect of universal school-based interventions on anxiety (effect size d = -0.0858, 95% confidence interval [CI] = −0.15 to −0.02, z = −2.46, p < 0.01), and depression (d = -0.109, 95% CI = −0.19 to −0.03, z = −2.60, p < 0.013). However, no significant effect was observed for internalizing outcomes overall. For anxiety outcomes, the theoretical foundation of the intervention played a significant role in its effectiveness (Q = 24.93, p < 0.001). Interventions based on cognitive behavioral therapy (CBT) principles demonstrated significantly greater effects compared to those based on mindfulness or other/multiple theoretical approaches.
In conclusion, this evidence shows that universal, school-based interventions for anxiety and depression yield only small effect sizes at the individual level. However, their implementation on a population scale can result in a substantial public health benefits. Researchers and intervention designers should critically consider the theoretical frameworks and delivery methods of such programs, particularly when targeting anxiety-related outcomes.
Reference: Hayes D, Deniz E, Nisbet K et al. Universal, school-based interventions to improve emotional outcomes in children and young people: A systematic review and meta-analysis. Front Child Adolesc Psychiatry. 2025;4:1526840. doi:10.3389/frcha.2025.1526840
