Songco Annabel, Francis Deanna A, McDermott Emma A, Lim Chloe Y S, Allsop Abigail, Croguennec Joseph, Sicouri Gemma, Mackinnon Andrew, Hudson Jennifer L
Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
Child Adolesc Psychiatry Ment Health. 2025 Jan 29;19(1):5. doi: 10.1186/s13034-024-00854-5.
Primary school students struggling with mental health are less likely than high school students to access mental health care, due to barriers such as mental health stigma and low mental health literacy among children and parents. The near universal reach of schools offers a potential avenue to increase access to mental health care through early identification. The potential risks of this approach also need to be understood. This study monitored the impact of universal screening for mental health symptoms on stigma and mental health outcomes for primary school students.
Across 6 primary schools, a cluster randomised controlled trial allocated schools to one of two conditions. Conditions varied based on the order and frequency of symptom and stigma questionnaires. A sample of 798 children (8 to 13 years; Mage = 10.29) completed assessments at baseline, 6-week, and 12-week follow-ups.
Significant time-by-group interaction effects were present, indicating differing changes in mental health stigma between groups. Follow-up analyses of subscales showed significant time-by-group interaction effects for concerns around self-stigma and secrecy, but not for public stigma. The frequency and presentation order of the questionnaires impacted on mental health stigma. Initially, children reporting on mental health symptoms before stigma, reported heightened stigma, but over time, those receiving more frequent presentations of the symptom check experienced an overall stigma reduction, contrasting with an increase in the comparison group.
The frequency and presentation order of mental health symptom assessments impact children's reports of mental health stigma, underscoring the importance of screening context. Potential screening harms, such as exacerbating self-stigma and secrecy, warrant consideration. Addressing stigma-related barriers is crucial for enhancing mental health care access for children in schools. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12622001114730) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384472 Date of trial registration: 12th August 2022.
由于诸如心理健康污名化以及儿童和家长心理健康素养较低等障碍，与高中生相比，有心理健康问题的小学生获得心理健康护理的可能性更小。学校几乎覆盖全体学生，这为通过早期识别来增加获得心理健康护理的机会提供了一条潜在途径。这种方法的潜在风险也需要了解。本研究监测了对小学生心理健康症状进行普遍筛查对污名化及心理健康结果的影响。
在6所小学中，一项整群随机对照试验将学校分配到两种情况之一。情况根据症状和污名调查问卷的顺序和频率而有所不同。798名儿童（8至13岁；平均年龄=10.29岁）的样本在基线、6周和12周随访时完成了评估。
存在显著的时间×组交互效应，表明两组之间心理健康污名化的变化不同。分量表的随访分析显示，在围绕自我污名化和保密问题上存在显著的时间×组交互效应，但在公众污名化方面不存在。调查问卷的频率和呈现顺序影响心理健康污名化。最初，在报告污名化之前先报告心理健康症状的儿童，报告的污名化程度有所增加，但随着时间的推移，那些更频繁接受症状检查呈现的儿童总体污名化程度有所降低，这与对照组的增加形成对比。
心理健康症状评估的频率和呈现顺序会影响儿童对心理健康污名化的报告，凸显了筛查背景的重要性。潜在的筛查危害，如加剧自我污名化和保密问题，值得考虑。解决与污名化相关的障碍对于改善学校儿童获得心理健康护理至关重要。试验注册澳大利亚和新西兰临床试验注册中心（ACTRN12622001114730）https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384472 试验注册日期：2022年8月12日。
