Provincial Centre of Excellence for Child and Youth Mental Health at CHEO, Ottawa, Ontario, Canada.
Child Adolesc Psychiatry Ment Health. 2008 Jul 21;2(1):18. doi: 10.1186/1753-2000-2-18.
Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others.
即使是在最年幼的学童中，也存在针对心理健康状况对个体进行污名化或歧视性的观点和行为。我们对已发表和未发表的科学文献进行了系统性综述，这些文献涉及针对 18 岁及以下学生的以学校为基础的干预措施，以预防或消除这种污名化。确定了 40 项相关研究，但仅认为适合进行定性综合。证据基础存在五个局限性，这些局限性妨碍了对学校为基础的干预措施的有效性和危害做出明确推断：报告质量差、缺乏随机对照试验证据、所有研究设计的方法质量差、临床异质性大以及结果不一致或为零。然而，我们的证据基础内外都提供了一些有启发性的证据，使我们能够建议制定、实施和评估一项课程，该课程促进同理心的发展，从而促进社会包容和包容。这些效果可能主要通过让特别但不仅是最年幼的儿童与婴儿直接、有组织地接触来实现，而只有年龄较大的儿童和青少年才能与经历心理健康问题的个人直接接触。使用教育活动、材料和内容来增强直接接触带来的假设益处的价值也需要进一步研究。总体而言，该课程可能对一些学生起到一级预防作用，对另一些学生起到二级预防作用。
