School-based depression and anxiety prevention programs: An updated systematic review and meta-analysis

Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.

Étude sur la transférabilité d’une intervention d’éducation en santé dans le parc HLM : une méthode de recherche à l’épreuve du transfert pour décrire autrement les fonctions-clés

La transférabilité des interventions en santé est un enjeu essentiel à la réduction des inégalités sociales de santé. Mais ces interventions sont complexes et leur efficacité n’est pas garantie lors d’un transfert d’un contexte à l’autre. La description des fonctions-clés des interventions concourt à une meilleure transférabilité. Toutefois, celle-ci repose rarement sur une méthode permettant de concevoir l’intervention en situation de transfert.

Cet article explicite le processus méthodologique permettant l’identification des fonctions-clés de l’intervention en situation de transfert, et leurs déclinaisons nommées : « éléments de passation » (EP).

Nous nous sommes appuyés sur une recherche collaborative orientée par la conception (RoC) visant à concevoir une intervention d’éducation pour les locataires âgés du parc social, leur permettant de décider et d’agir pour adapter leur logement à leurs besoins.

Deux cycles de recherche sont menés au sein d’entreprises sociales pour l’habitat (ESH) avec des comités de recherche réunissant chercheurs, locataires et professionnels. Plusieurs étapes collaboratives ont été nécessaires : l’étude du contexte de l’ESH1 et la création d’une culture commune ; la formation des professionnels impliqués dans l’intervention d’éducation ; la déclinaison du modèle selon les critères de transférabilité d’ASTAIRE (outil pour l’analyse de la transferabilité des interventions en promotion de la santé) ; l’identification des variations et des éléments stables du modèle au moment du transfert vers deux autres ESH ; l’identification des fonctions-clés du modèle et de ses « éléments de passation ».

À l’épreuve du transfert, l’intervention est décrite en quatre catégories de fonctions-clés, déclinées en EP. Les EP sont des résultats issus de la RoC jugés signifiants par les acteurs de la recherche. Ce sont des phénomènes explicatifs révélant des situations à prévoir pour réussir le transfert et rendre l’intervention efficace. Ils permettent de donner sens aux fonctions-clés pour que les acteurs souhaitant transférer l’intervention dans leur contexte puissent mieux s’y préparer.

What is the evidence base for integrating health and environmental approaches in the school context to nurture healthier and more environmentally aware young people? A systematic scoping review of global evidence

This scoping review collates empirical and gray literature that examines how schools are acting to nurture healthier and more environmentally aware young people through integrated approaches. Over the last twenty years, integration has been increasing within school contexts. Approaches include teaching and learning, physical environmental adaptations, developing ecologically focused policy, and reorienting wider school culture. We noted a developing discourse around what constitutes evidence in this emerging interdisciplinary field. Developing a better understanding of integrated approaches and an evidence base of what works and how could inform interdisciplinary collaboration and enable a clearer message to be communicated to stakeholders about how the school context can nurture healthier and more environmentally aware young people.

Addressing social determinants of health inequities through settings: a rapid review

Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base.

Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.

School health promotion providers' roles in practice and theory: results from a case study

BACKGROUND

Implementation is critical to the success of health promotion (HP) in schools, but little is known about how schools can best be assisted during this process. This article focuses on Austrian HP providers and aspects their roles incorporate.

OBJECTIVE

To investigate the providers' role in the practice of HP implementation and how it differs from its official description. On the basis of these findings, implications are suggested.

METHODS

The data were gathered within the framework of an explorative case study of complex HP interventions. We draw on four interviews with HP organisation staff, five documents from the providers' organisations and seven interviews with school staff from three schools.

RESULTS

In practice, providers took up different responsibilities, e.g., acting as emotional support to school staff and supporting the documentation of projects, guided more by the schools' needs than by the programmes they are helping to implement. Providers focused mostly on the implementation of single activities and did little to emphasize the necessity of organisational change.

POLICY IMPLICATIONS

Our findings suggest that providers' background in health should be complemented by a deeper understanding of the importance of organisational change to further support HP implementation.