NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health,Douglas House,18 Trumpington Road,Cambridge CB2 8AH,UK.
University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK.
Psychol Med. 2019 Jan;49(1):9-19. doi: 10.1017/S0033291718002490. Epub 2018 Sep 13.
Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake.
Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3-18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD.
We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes.
Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
虽然以学校为基础的方案有潜力改善一系列精神障碍的短期和长期结果，但针对儿童和年轻人（CYP）心理健康困难（MHD）的识别方案的证据基础还不够发达。在这项系统评价中，我们旨在确定和综合评估以学校为基础的方法识别经历 MHD 的学生的有效性和成本效益的证据，这些方法通过准确识别、转介率和服务利用率来衡量。
我们检索了电子文献数据库：MEDLINE、Embase、PsycINFO、ERIC、英国教育索引和 ASSIA。如果评估了识别 3-18 岁有 MHD、出现心理健康问题症状或面临增加患 MHD 可能性的心理社会风险的正规教育学生的策略的有效性或成本效益的比较研究，则将其纳入。
我们确定了 27 项研究，描述了 44 个独特的识别方案。只有一项研究是随机对照试验。大多数研究评估了普遍筛查方案的效用；在比较识别率的地方，比较测试在研究之间有所不同。研究的异质性、缺乏随机研究和不良结果报告使得证据基础较弱，只能对基于学校的识别方案的有效性得出初步结论。
需要设计良好的实用试验，包括评估成本效益和详细的过程评估，以确定不同识别模型的准确性，以及它们在现实环境中将学生与适当支持联系起来的有效性。
