Lekamge Roshini Balasooriya, Jain Ria, Sheen Jenny, Solanki Pravik, Zhou Yida, Romero Lorena, Barry Margaret M, Chen Leo, Karim Md Nazmul, Ilic Dragan
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia.
J Youth Adolesc. 2025 Feb;54(2):271-289. doi: 10.1007/s10964-025-02135-6. Epub 2025 Jan 27.
Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Based on the Health-Promoting Schools Framework, whole-school interventions offer a promising strategy in this developmentally-sensitive cohort, through championing a systems-based approach to promotion and prevention that involves the key stakeholders in an adolescent's life. The evidence-base surrounding the effectiveness of whole-school interventions, however, remains inconclusive, partly due to the insufficient number of studies in previous meta-analyses. An updated systematic review and meta-analysis was thus conducted on the effectiveness of whole-school interventions promoting mental health and preventing risk behaviours in adolescence. From 12,897 search results, 28 studies reported in 58 publications were included. Study characteristics and implementation assessments were synthesized across studies, and quality appraisals and meta-analyses performed. Analyses identified a significant reduction in the odds of cyber-bullying by 25%, regular smoking by 31% and cyber-aggression by 37% in intervention participants compared to the control. Whole-school interventions thus offer substantial population health benefits through the reduction of these highly-prevalent issues affecting adolescents. The non-significant findings pertaining to the remaining eleven outcomes, including alcohol use, recreational drug use, anxiety, depression and positive mental health, are likely attributable to suboptimal translation of the Health-Promoting Schools Framework into practice and inadequate sensitivity to adolescents' local developmental needs. Given the ongoing challenges faced in the implementation and evaluation of these complex interventions, this study recommends that future evaluations assess the implementation of health-promoting activities in both intervention and control conditions and actively use this implementation data in the interpretation of evaluation findings.Preregistration: A pre-registered PROSPERO protocol (ID: CRD42023491619) informed this study.
青春期是精神障碍和危险行为发病的脆弱时期。基于健康促进学校框架，全校性干预措施为这个对发育敏感的群体提供了一个有前景的策略，它倡导一种基于系统的促进和预防方法，让青少年生活中的关键利益相关者参与进来。然而，围绕全校性干预措施有效性的证据仍然不确凿，部分原因是以往的荟萃分析中研究数量不足。因此，针对全校性干预措施在促进青少年心理健康和预防危险行为方面的有效性进行了一项更新的系统评价和荟萃分析。从12897条搜索结果中，纳入了58篇出版物中报道的28项研究。综合分析了各项研究的特征和实施评估情况，并进行了质量评估和荟萃分析。分析发现，与对照组相比，干预组参与者遭受网络欺凌的几率显著降低了25%，经常吸烟的几率降低了31%，网络攻击的几率降低了37%。因此，全校性干预措施通过减少这些影响青少年的高度普遍问题，为人群健康带来了实质性益处。与其余11项结果（包括饮酒、使用消遣性药物、焦虑、抑郁和积极心理健康）相关的不显著结果，可能归因于健康促进学校框架在实践中的转化不理想，以及对青少年当地发展需求的敏感度不足。鉴于在实施和评估这些复杂干预措施方面面临持续挑战，本研究建议未来的评估应在干预和对照条件下评估健康促进活动的实施情况，并在解释评估结果时积极使用这些实施数据。预注册：一项预注册的PROSPERO方案（编号：CRD42023491619）为本研究提供了指导。
