Effectiveness of school-based interventions to improve mental health and wellbeing of students: an umbrella review

Half of all mental health conditions begin before 14 years of age, and students in this age group spend a substantial amount of time in school. This umbrella review synthesised evidence on contemporary, effective school-based interventions designed to improve the mental health and wellbeing of students in low- and middle-income countries (LMICs). Four databases (Web of Science, PubMed, CINAHL and Ovid PsycINFO) were searched from January 2013 to December 2023, identifying 12,126 records. After removing duplicates and screening titles, abstracts, and full texts, 85 systematic reviews (comprising 2932 primary studies) were included. Primary studies were predominantly conducted in North America (42.3%). Among reviews focusing on mental health symptoms (41 of 85), most targeted depression, anxiety and stress, with cognitive-behavioural therapy (CBT) and mindfulness emerging as the most effective interventions. Mental health literacy, socio-emotional competence and psychological wellbeing were the most frequently addressed domains within mental health promotion interventions (25 of 34 reviews). Seven reviews focused on suicide prevention, with Question Persuade Refer (QPR), Signs of Suicide (SOS) and Sources of Strength being the most frequently explored and effective interventions. No reviews included interventions based on the Health Promoting Schools (HPS) framework or a whole-school approach. Overall, evidence for school-based mental health interventions remains heterogeneous, with a concentration on depression, anxiety, CBT and mindfulness-based approaches, primarily in high-income countries (HICs). There is a critical need for further research and meaningful stakeholder engagement in LMICs to develop interventions responsive to local needs.