Guzman-Holst Carolina, Streckfuss Davis Rowan, Andrews Jack L, Foulkes Lucy
Department of Experimental Psychology, University of Oxford, Oxford, UK.
Child Adolesc Ment Health. 2025 Sep;30(3):208-222. doi: 10.1111/camh.12760. Epub 2025 Mar 18.
A growing body of evidence demonstrates that school-based mental health interventions may be potentially harmful. We define potential harm as any negative outcome or adverse event that could plausibly be linked to an intervention. In this scoping review, we examine three areas: the types of potential harms and adverse events reported in school-based mental health interventions; the subgroups of children and adolescents at heightened risk; and the proposed explanations for these potential harms.
We searched eight databases (1960-2023), performed an author search and hand-searched for published and unpublished studies that evaluated controlled trials of school-based group mental health interventions based on cognitive-behavioural therapy and/or mindfulness techniques, with the aim of reducing or preventing internalising symptoms or increasing wellbeing. Two independent raters screened studies for eligibility and assessed study quality using Cochrane tools. From eligible studies, we reviewed those that reported at least one negative outcome.
Ten out of 112 (8.93%) interventions (described in 120 studies) reported at least one negative outcome such as a decrease in wellbeing or an increase in depression or anxiety. Three out of 112 interventions (2.68%) reported the occurrence of specific adverse events, none of which were linked to the intervention. Of the 15/120 studies rated as high quality (i.e. those with low risk of bias), 5/15 (33.33%) reported at least one negative outcome. Negative outcomes were found for a number of subgroups including individuals deemed at high risk of mental health problems, male participants, younger children and children eligible for free school meals. About half (54.5%) of the studies acknowledged that the content of the intervention itself might have led to the negative outcome.
To design and implement effective school-based mental health interventions, the issues of potential harm and their related measurement and reporting challenges must be addressed.
越来越多的证据表明，基于学校的心理健康干预措施可能具有潜在危害。我们将潜在危害定义为任何可能合理地与干预措施相关联的负面结果或不良事件。在本范围综述中，我们考察三个方面：基于学校的心理健康干预措施中报告的潜在危害和不良事件的类型；风险增加的儿童和青少年亚组；以及对这些潜在危害的解释建议。
我们检索了八个数据库（1960 - 2023年），进行了作者检索，并手工检索已发表和未发表的研究，这些研究评估了基于认知行为疗法和/或正念技巧的学校团体心理健康干预的对照试验，目的是减少或预防内化症状或提高幸福感。两名独立评估员筛选研究的 eligibility 并使用Cochrane工具评估研究质量。从符合条件的研究中，我们回顾了那些报告至少一项负面结果的研究。
112项干预措施（在120项研究中描述）中有10项（8.93%）报告了至少一项负面结果，如幸福感下降或抑郁或焦虑增加。112项干预措施中有3项（2.68%）报告了特定不良事件的发生，其中没有一项与干预措施相关。在15/120项被评为高质量（即偏倚风险低）的研究中，5/15（33.33%）报告了至少一项负面结果。在包括被认为有心理健康问题高风险的个体、男性参与者、年幼儿童和符合免费学校餐条件的儿童等多个亚组中发现了负面结果。约一半（54.5%）的研究承认干预措施本身的内容可能导致了负面结果。
为了设计和实施有效的基于学校的心理健康干预措施，必须解决潜在危害及其相关测量和报告挑战的问题。
