Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis

Abstract

Promotion of good mental health in young people is important. Our aim was to evaluate the consistency and magnitude of the efficacy of universal/selective interventions to promote good mental health. A systematic PRISMA/RIGHT-compliant meta-analysis (PROSPERO: CRD42018088708) search of Web of Science until 04/31/2019 identified original studies comparing the efficacy of universal/selective interventions for good mental health vs a control group, in samples with a mean age < 35 years. Meta-analytical random-effects model, heterogeneity statistics, assessment of publication bias, study quality and sensitivity analyses investigated the efficacy (Hedges' g = effect size, ES) of universal/selective interventions to promote 14 good mental health outcomes defined a-priori. 276 studies were included (total participants: 159,508, 79,142 interventions and 80,366 controls), mean age = 15.0 (SD = 7.4); female = 56.0%. There was a significant overall improvement in 10/13 good mental health outcome categories that could be meta-analysed: compared to controls, interventions significantly improved (in descending order of magnitude) mental health literacy (ES = 0.685, p < 0.001), emotions (ES = 0.541, p < 0.001), self-perceptions and values (ES = 0.49, p < 0.001), quality of life (ES = 0.457, p = 0.001), cognitive skills (ES = 0.428, p < 0.001), social skills (ES = 0.371, p < 0.001), physical health (ES = 0.285, p < 0.001), sexual health (ES = 0.257, p = 0.017), academic/occupational performance (ES = 0.211, p < 0.001) and attitude towards mental disorders (ES = 0.177, p = 0.006). Psychoeducation was the most effective intervention for promoting mental health literacy (ES = 0.774, p < 0.001) and cognitive skills (ES = 1.153, p = 0.03). Physical therapy, exercise and relaxation were more effective than psychoeducation and psychotherapy for promoting physical health (ES= 0.498, p<0.001). In conclusion, several universal/selective interventions can be effective to promote good mental health in young people. Future research should consolidate and extend these findings.