{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:12:33Z","timestamp":1783444353435,"version":"3.54.6"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>One of the strategies to address the persistent youth mental health crisis is school-based educational programming. This paper reports on two distinct studies regarding Coming Up for AIR, a school-based mental health education program: (1) program effectiveness, measured as gains in student mental health literacy; and (2) trends in help-seeking behavior before, during, and after the pandemic. A survey on program content was administered to assess program effectiveness. Data collected between 2020 and 2023 from four schools yielded 473 responses. A comparison of pre- and post-scores demonstrated statistically significant gains in program content. Mental health literacy improved across gender and grade level (8th, 9th, and 10th), as well as for students with prior exposure to a mental health curriculum. In the second study, help-seeking behavior was evaluated before, during, and after the pandemic. While other programs measure intention, Coming Up for AIR measures actual behavior as students can ask for help for themselves or a friend. Data did not reflect individual student responses, but rather were aggregated and provided the number of students per presentation who requested help. Archived declaration card data from January 2019 through February 2024 was accessed, representing 28 different schools and 16,289 middle and high school student responses. School-level data were analyzed by grade level (middle school or high school) and date (pre-, intra-, or post-COVID-19). Significant differences in self-referral were found for both grade level and presentation date. Self-referrals were significantly higher post-COVID-19 compared to pre-COVID-19 with middle schoolers increasing 90% and high school students increasing 36%. Analysis of friend referrals showed a significant difference for grade level, but not presentation date. Again, middle school students were more likely to make a referral than high schoolers. The data suggest that the mental health crisis in middle school students persists at an alarming rate. Schools are at the forefront of addressing mental health issues for youth. External educational programming can bring awareness to mental health concerns and promote help-seeking in youth.<\/jats:p>","DOI":"10.3390\/ijerph22040523","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T05:21:04Z","timestamp":1743398464000},"page":"523","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["School-Based Mental Health Education: Program Effectiveness and Trends in Help-Seeking"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8858-2700","authenticated-orcid":false,"given":"Jean","family":"Kirnan","sequence":"first","affiliation":[{"name":"Psychology Department, School of Humanities & Social Sciences, The College of New Jersey, Ewing Township, NJ 08618, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna","family":"Fotinos","sequence":"additional","affiliation":[{"name":"Psychology Department, School of Humanities & Social Sciences, The College of New Jersey, Ewing Township, NJ 08618, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Pitt","sequence":"additional","affiliation":[{"name":"Psychology Department, School of Humanities & Social Sciences, The College of New Jersey, Ewing Township, NJ 08618, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Psychology Department, School of Humanities & Social Sciences, The College of New Jersey, Ewing Township, NJ 08618, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,29]]},"reference":[{"key":"ref_1","unstructured":"Office of the Surgeon General (OSG) (2024, December 29). Protecting Youth Mental Health: The U.S. Surgeon General\u2019s Advisory. Washington (DC): US Department of Health and Human Services; 2021. BACKGROUND, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK575985\/."},{"key":"ref_2","unstructured":"CDC (2024, December 31). Data and Statistics on Children\u2019s Mental Health, Available online: https:\/\/www.cdc.gov\/children-mental-health\/data-research\/index.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1001\/jamapediatrics.2023.0846","article-title":"Changes in depression and anxiety among children and adolescents from before to during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"177","author":"Madigan","year":"2023","journal-title":"JAMA Pediatr."},{"key":"ref_4","unstructured":"CDC (2024, December 30). Youth Risk Behavior Survey: Data Summary and Trends Report, 2013\u20132023, Available online: https:\/\/www.cdc.gov\/yrbs\/dstr\/pdf\/YRBS-2023-Data-Summary-Trend-Report.pdf."},{"key":"ref_5","unstructured":"National Alliance on Mental Illness, NAMI (2014, December 31). Mental Health by the Numbers. Available online: https:\/\/www.nami.org\/about-mental-illness\/mental-health-by-the-numbers\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S2215-0366(17)30002-0","article-title":"Reduction in adolescent depression after contact with mental health services: A longitudinal cohort study in the UK","volume":"4","author":"Neufeld","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.3368\/jhr.2023SI-intro-child-mental-health","article-title":"The Economics of Child Mental Health: Introducing the Causes and Consequences of Child Mental Health Special Issue","volume":"59","author":"Currie","year":"2024","journal-title":"J. Hum. Resour."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1026\/0942-5403\/a000463","article-title":"Help-seeking behavior of adolescents and emerging adults with mental health problems during the COVID-19 pandemic: A scoping review","volume":"33","author":"Stelzmann","year":"2024","journal-title":"Kindh. Und Entwickl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1111\/eip.13109","article-title":"A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours","volume":"15","author":"Patafio","year":"2021","journal-title":"Early Interv. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/camh.12543","article-title":"School-based interventions to improve mental health literacy and reduce mental health stigma\u2013a systematic review","volume":"28","author":"Ma","year":"2023","journal-title":"Child Adolesc. Ment. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/josh.12461","article-title":"Effectiveness of universal school-based mental health awareness programs among youth in the United States: A systematic review","volume":"86","author":"Salerno","year":"2016","journal-title":"J. Sch. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"754.e1","DOI":"10.1016\/j.jadohealth.2005.08.011","article-title":"Stigma starts early: Gender differences in teen willingness to use mental health services","volume":"38","author":"Chandra","year":"2006","journal-title":"J. Adolesc. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/14623730.2004.9721941","article-title":"Educating young people about mental health and mental illness: Evaluating a school-based programme","volume":"6","author":"Rickwood","year":"2004","journal-title":"Int. J. Ment. Health Promot."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Campos, L., Dias, P., Duarte, A., Veiga, E., Dias, C.C., and Palha, F. (2018). Is it possible to \u201cfind space for mental health\u201d in young people? Effectiveness of a school-based mental health literacy promotion program. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15071426"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"44","DOI":"10.5463\/sra.v1i1.17","article-title":"Changing knowledge and attitudes with a middle school mental health education curriculum","volume":"1","author":"Wahl","year":"2011","journal-title":"Stigma Res. Action"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1037\/sah0000135","article-title":"Changing student attitudes about mental health conditions: NAMI ending the silence","volume":"4","author":"Wahl","year":"2019","journal-title":"Stigma Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/10973430208408430","article-title":"Children\u2019s views of mental illness: A review of the literature","volume":"6","author":"Wahl","year":"2002","journal-title":"Psychiatr. Rehabil. Ski."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102292","DOI":"10.1016\/j.janxdis.2020.102292","article-title":"Investigating the impact of masculinity on the relationship between anxiety specific mental health literacy and mental health help-seeking in adolescent males","volume":"76","author":"Clark","year":"2020","journal-title":"J. Anxiety Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/eip.12010","article-title":"The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth","volume":"7","author":"Wei","year":"2013","journal-title":"Early Interv. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1192\/pb.bp.112.041723","article-title":"School-based interventions targeting stigma of mental illness: Systematic review","volume":"38","author":"Mellor","year":"2014","journal-title":"Psychiatr. Bull."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1176\/appi.ps.201600052","article-title":"Evaluation of antistigma interventions with sixth-grade students: A school-based field experiment","volume":"68","author":"Painter","year":"2017","journal-title":"Psychiatr. Serv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S0140-6736(98)02381-2","article-title":"Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan","volume":"352","author":"Rahman","year":"1998","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e20190780","DOI":"10.1542\/peds.2019-0780","article-title":"A school-based intervention for mental illness stigma: A cluster randomized trial","volume":"145","author":"Link","year":"2020","journal-title":"Pediatrics"},{"key":"ref_24","unstructured":"Baker, T. (2025, January 18). Attitudes in Reverse, Princeton Junction, New Jersey, USA. Personal Communication. Available online: https:\/\/www.air.ngo\/."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/523\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:05:17Z","timestamp":1760029517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,29]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijerph22040523"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22040523","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,29]]}}}