Scoping review: potential harm from school-based group mental health interventions

Area of Science:

• Child and Adolescent Psychology
• Educational Psychology
• Mental Health Interventions

Background:

• Growing evidence suggests school-based mental health interventions may pose potential harm.
• Potential harm is defined as negative outcomes or adverse events linked to interventions.
• This review examines types of harm, at-risk subgroups, and explanations for potential harm in school mental health programs.

Purpose of the Study:

• To review potential harms and adverse events in school-based mental health interventions.
• To identify subgroups of children and adolescents at heightened risk for negative outcomes.
• To explore proposed explanations for these potential harms.

Main Methods:

• Scoping review of controlled trials of school-based group mental health interventions (1960-2023).
• Interventions focused on cognitive-behavioural therapy and/or mindfulness for internalizing symptoms or wellbeing.
• Screening of 112 interventions across 120 studies, with a focus on those reporting negative outcomes.

Main Results:

• 8.93% of interventions reported negative outcomes (e.g., decreased wellbeing, increased depression/anxiety).
• High-quality studies showed a 33.33% rate of negative outcomes.
• Negative outcomes disproportionately affected at-risk individuals, males, younger children, and those eligible for free school meals.

Conclusions:

• Potential harms in school mental health interventions require careful consideration.
• Challenges in measuring and reporting negative outcomes must be addressed.
• Effective design and implementation necessitate addressing potential harm issues.