{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:03:05Z","timestamp":1792512185259,"version":"4.5.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Child Adolesc. Psychiatry"],"abstract":"\n Introduction<\/jats:title>\n There is debate into the impact of universal, school-based interventions to improve emotional outcomes. Previous reviews have only focused on anxiety and depression symptoms, omitting broader internalising symptoms, nor include the proliferation of newer studies which have focused on mindfulness in schools.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for studies focusing on universal interventions to improve emotional outcomes for young people aged 8\u201318 until 15\/12\/2022. The primary focus were post-intervention self-report anxiety, depression and internalising outcomes. We prospectively registered the study with PROSPERO, number (CRD42020189845). Risk of bias was assessed using specially devised tools adopted from Cochrane.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 71 unique studies with a total sample of 63,041 young people met the inclusion criteria. This included 40 studies with 35,559 participants for anxiety outcomes, 50 studies with 49,418 participants for depression outcomes, and 15 studies with 21,473 participants for internalising outcomes. Pupils who received universal school-based interventions had significantly improved anxiety (d\u2009=\u2009\u22120.0858, CI\u2009=\u2009\u22120.15, \u22120.02, z\u2009=\u2009\u22122.46,\n p<\/jats:italic>\n \u2009&lt;\u2009.01) and depression (d\u2009=\u2009\u22120.109, CI\u2009=\u2009\u22120.19, \u22120.03, z\u2009=\u2009\u22122.60,\n p<\/jats:italic>\n \u2009&lt;\u20090.013), but not internalising outcomes. For anxiety disorders, intervention theory moderated the intervention effectiveness (Q\u2009=\u200924.93,\n p<\/jats:italic>\n \u2009&lt;\u20090.001), with CBT principles being significantly more effective than those that applied mindfulness or other\/multiple theories.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Evidence suggests that universal, school-based approaches for anxiety and depression produce small effect sizes for pupils. We conclude that used as a population health approach, these can have an impactful change on preventing anxiety and depression. However, intervention developers and researchers should critically consider which theories\/approaches are being applied, particularly when trying to improve anxiety outcomes.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n PROSPERO CRD42020189845.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/frcha.2025.1526840","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T01:23:53Z","timestamp":1748827433000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":39,"title":["Universal, school-based, interventions to improve emotional outcomes in children and young people: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"4","author":[{"given":"Daniel","family":"Hayes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Deniz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Nisbet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"March","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Mason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Mansfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Ashworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Moltrect","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Liverpool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Merrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Boehnke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Humphrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Stallard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveetha","family":"Patalay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Deighton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1177\/0004867414533834","article-title":"Are child and adolescent mental health problems increasing in the 21st century? A systematic review","volume":"48","author":"Bor","year":"2014","journal-title":"Aust N Z J Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.1093\/ije\/dyz006","article-title":"Changes in millennial adolescent mental health and health-related behaviours over 10 years: a population cohort comparison study","volume":"48","author":"Patalay","year":"2019","journal-title":"Int J Epidemiol"},{"key":"B3","article-title":"Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation","year":"2017"},{"key":"B4","article-title":"The State of Mental Health in America","author":"Nguyen","year":"2018"},{"key":"B5","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.jadohealth.2012.12.016","article-title":"Social, demographic, and health outcomes in the 10 years following adolescent depression","volume":"52","author":"Naicker","year":"2013","journal-title":"J Adolesc Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.jad.2013.12.033","article-title":"Anxiety disorders in adolescents and psychosocial outcomes at age 30","volume":"163","author":"Essau","year":"2014","journal-title":"J Affect Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/S2215-0366(14)70357-8","article-title":"Mental health interventions in schools in low-income and middle-income countries","volume":"1","author":"Fazel","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/S2215-0366(14)70312-8","article-title":"Mental health interventions in schools in high-income countries","volume":"1","author":"Fazel","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.puhe.2014.10.006","article-title":"The value of using schools as community assets for health","volume":"129","author":"Caan","year":"2015","journal-title":"Public Health"},{"key":"B10","volume-title":"Transforming Children and Young People\u2019s Mental Health Provision: A Green Paper","year":"2017"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e012337","DOI":"10.1136\/bmjopen-2016-012337","article-title":"Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in southeast England","volume":"6","author":"Memon","year":"2016","journal-title":"BMJ Open"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s10964-005-1330-2","article-title":"Expanded school mental health: challenges and opportunities in an emerging field","volume":"34","author":"Weist","year":"2005","journal-title":"J Youth Adolesc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1007\/s10902-013-9476-1","article-title":"Positive psychology at school: a school-based intervention to promote adolescents\u2019 mental health and well-being","volume":"15","author":"Shoshani","year":"2014","journal-title":"J Happiness Stud"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/S2215-0366(19)30403-1","article-title":"School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis","volume":"6","author":"Caldwell","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1475-3588.2012.00677.x","article-title":"How do schools promote emotional well-being among their pupils? Findings from a national scoping survey of mental health provision in English schools","volume":"18","author":"Vostanis","year":"2013","journal-title":"Child Adolesc Ment Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e029044","DOI":"10.1136\/bmjopen-2019-029044","article-title":"School-based intervention study examining approaches for well-being and mental health literacy of pupils in year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE)","volume":"9","author":"Hayes","year":"2019","journal-title":"BMJ Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s13063-023-07238-8","article-title":"Promoting mental health and well-being in schools: examining mindfulness, relaxation and strategies for safety and well-being in English primary and secondary schools\u2014study protocol for a multi-school, cluster randomised controlled trial (INSPIRE)","volume":"24","author":"Hayes","year":"2023","journal-title":"Trials"},{"key":"B18","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s11121-011-0231-8","article-title":"The public health impact of major depression: a call for interdisciplinary prevention efforts","volume":"12","author":"McLaughlin","year":"2011","journal-title":"Prev Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1017\/S0033291715001725","article-title":"Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention","volume":"46","author":"Stockings","year":"2016","journal-title":"Psychol Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1007\/s10567-018-0266-5","article-title":"A meta-analysis of universal school-based prevention programs for anxiety and depression in children","volume":"21","author":"Johnstone","year":"2018","journal-title":"Clin Child Fam Psychol Rev"},{"key":"B21","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.cpr.2016.10.005","article-title":"School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis","volume":"51","author":"Werner-Seidler","year":"2017","journal-title":"Clin Psychol Rev"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/phr09080","article-title":"School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis","volume":"9","author":"Caldwell","year":"2021","journal-title":"Public Health Research"},{"key":"B23","article-title":"Type I and Type II Errors and Statistical Power","author":"Shreffler","year":"2024"},{"key":"B24","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/S2215-0366(19)30440-7","article-title":"Prevention versus intervention in school mental health","volume":"6","author":"Fazel","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1111\/1467-9817.00200","article-title":"A systematic review and meta-analysis of randomised controlled trials evaluating interventions in adult literacy and numeracy","volume":"26","author":"Torgerson","year":"2003","journal-title":"J Res Read"},{"key":"B26","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Br Med J"},{"key":"B27","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Br Med J"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s40489-024-00463-0","article-title":"Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: a systematic review and meta-analysis","author":"Deniz","year":"2024","journal-title":"Rev J Autism Dev Disord"},{"key":"B29","doi-asserted-by":"publisher","first-page":"h5651","DOI":"10.1136\/bmj.h5651","article-title":"Three simple rules to ensure reasonably credible subgroup analyses","volume":"351","author":"Burke","year":"2015","journal-title":"Br Med J"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1037\/t10518-000","article-title":"Spence children\u2019s anxiety scale","author":"Spence","year":"1997","journal-title":"APA PsycTests"},{"key":"B31","volume-title":"The Children\u2019s Depression Inventory (CDI) Manual North Tanawanda","author":"Kovacs","year":"1992"},{"key":"B32","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/j.1469-7610.1997.tb01545.x","article-title":"The strengths and difficulties questionnaire: a research note","volume":"38","author":"Goodman","year":"1997","journal-title":"J Child Psychol Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1111\/jcpp.13817","article-title":"Editorial perspective: when is a \u2019small effect\u2019 actually large and impactful?","volume":"64","author":"Carey","year":"2023","journal-title":"J Child Psychol Psychiatry"},{"key":"B34","volume-title":"Mental Health of Children and Young People in England, 2023 - Wave 4 Follow up to the 2017 Survey","year":"2023"},{"key":"B35","volume-title":"Mental Health of Adolescents","year":"2021"},{"key":"B36","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s10464-008-9165-0","article-title":"Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation","volume":"41","author":"Durlak","year":"2008","journal-title":"Am J Community Psychol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"Br Med J"}],"container-title":["Frontiers in Child and Adolescent Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frcha.2025.1526840\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T01:23:55Z","timestamp":1748827435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frcha.2025.1526840\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":37,"alternative-id":["10.3389\/frcha.2025.1526840"],"URL":"https:\/\/doi.org\/10.3389\/frcha.2025.1526840","relation":{},"ISSN":["2813-4540"],"issn-type":[{"value":"2813-4540","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]},"article-number":"1526840"}}