A new study found that a universal mental health intervention delivered in schools worsened kids’ mental health on one measure, and did not improve anxiety or depression. The intervention, Climate Schools, was delivered in 18 schools, while another 19 schools served as the “control” group that did not receive the intervention. Over 3000 Australian 9th and 10th graders were included in the study.
The primary outcome measured by the researchers was “internalizing problems.” Kids who received the intervention scored worse at the 6- and 12-month mark after the intervention, on average, than kids who did not receive the intervention. (By the 18-month mark, there was no difference between the groups.)
“Relative to baseline, and compared with controls, we found that students in the Climate Schools-mental health condition had higher internalizing scores at 6- and 12-months post-intervention,” the researchers write.
The kids who received the intervention reported higher “mental health knowledge” afterward—which the researchers note may indicate that increasing awareness of “mental health” actually worsens it.
On the secondary outcomes of depression and anxiety, there was no difference between the groups (meaning that the intervention had no effect). Depression and anxiety increased significantly over time for both groups of kids.
The researchers also assessed overall “psychological distress” and again found no difference between kids who received the intervention and those who did not.
In short, they write, “We found evidence that our standalone mental health intervention improved knowledge of mental health, however there was no evidence that the intervention improved other mental health outcomes, relative to a control.”
(Internalizing problems were measured using the emotional problems and peer problems subscales on the Strengths and Difficulties Questionnaire. Depression and anxiety were measured using the Patient Health Questionnaire-8 (PHQ-8) and the Generalized Anxiety Disorder scale (GAD-7), respectively. Psychological distress was measured using the six-item K6.)
The researchers also wondered if social connectedness could play a role—that is, might those kids who were more socially active have better mental health or possibly receive more benefit from the intervention? But the researchers found no effect of social connectedness on any of their measures. (To measure this, the researchers asked the kids to write down the names of three friends; kids who were listed more often were deemed more socially connected.)
The study was led by Jack L. Andrews at the University of New South Wales and published in Psychological Medicine.
The Climate Schools mental health intervention is billed as being based on cognitive-behavioral therapy and consists of six 40-minute class sessions. It is specifically intended to reduce anxiety and depression. It was delivered in addition to the schools’ regular health classes, which already include a mandatory mental health component.
The researchers acknowledge that previous studies have also found that this type of universal mental health curriculum for kids is ineffective at best. They write,
“Our results sit within a growing body of work indicating the limited efficacy of universal interventions for adolescents in reducing anxiety and depression. For example, two systematic reviews focusing on the effectiveness of cognitive behavioral therapy (CBT)-informed resilience interventions for young people found no benefits for depression or anxiety symptoms post-intervention.”
They add that mental health interventions that target kids who are specifically at-risk for poor mental health might be more effective, but that there is limited evidence to support that assumption. In fact, they cite evidence that targeted interventions might actually increase bullying and stigma toward the included at-risk kids.
These massive interventions may be rolled out with the best of intentions, but that doesn’t mean they are effective. For instance, the D.A.R.E. program, carried out in schools across the United States for decades in an attempt to reduce drug use in youth, has been reassessed as a complete failure—a waste of billions of taxpayer dollars.
Andrews, J. L., Birrell, L., Chapman, C., Teesson, M., Newton, N., Allsop, S., . . . & Slade, T. (2022). Evaluating the effectiveness of a universal eHealth school-based prevention programme for depression and anxiety, and the moderating role of friendship network characteristics. Psychological Medicine. Published online on July 15, 2022. https://doi.org/10.1017/S0033291722002033 (Link)