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Potential Harms Associated With Universal School-Based Mental Health Programs for Adolescents: A Scoping Review
Esther S Yao1, Terry Fleming2, Sarah E Hetrick3
1School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Summary
Universal school-based mental health programs for adolescents may cause harm. A review found 29% of studies reported potential harms, with some showing deterioration in well-being outcomes.
Area of Science:
- Public Health
- Adolescent Psychology
- Educational Psychology
Background:
- Universal school-based mental health programs aim to enhance adolescent well-being.
- Emerging evidence suggests these programs may inadvertently cause harm.
- A comprehensive understanding of potential adverse effects is crucial for program development and implementation.
Purpose of the Study:
- To systematically review and map the existing literature on potential harms associated with universal school-based mental health programs for adolescents.
- To identify and classify the types of harms reported in recent research.
- To synthesize current knowledge on adverse outcomes to inform practice and future research.
Main Methods:
- A scoping review was conducted following PRISMA-ScR guidelines.
- Searches were performed in four databases for peer-reviewed studies published between 2019 and 2024.
- Included studies evaluated universal school-based mental health programs for adolescents (13-18 years) and reported quantitative outcomes.
Main Results:
- Of 58 included studies, 29% (17 studies) reported at least one type of potential harm.
- 16% of studies showed statistically significant deterioration in at least one outcome in the overall sample.
- 29% of studies examining subgroup differences revealed deterioration in specific adolescent groups (e.g., by age, gender, baseline mental health).
Conclusions:
- Universal school-based mental health programs are associated with potential harms, including negative impacts on well-being outcomes.
- Harm can manifest as statistically significant deterioration, clinically meaningful decline, or adverse participant feedback.
- Findings underscore the need for careful program design, monitoring, and research to mitigate risks and optimize benefits for adolescent mental health.
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