Systematic review of outcome measures used in evaluation of school-based mental health interventions

Abstract

Aims

The past decade has seen an increase in policy initiatives and school-based interventions aimed at improving children's mental health. However, to know if an intervention or policy is making an impact, to support data comparisons across interventions, and to enable schools to track student mental health, we need to identify instrument(s) that can detect change. This study seeks to identify instruments that have been shown to detect change in child mental health when implemented universally in schools.

Methods

We conducted a systematic review of instruments measuring mental health symptoms or skills in randomised controlled trials of schools-based universal mental health interventions in primary (elementary) schools published between 2012 and 2023 in English. The aim was to synthesise evidence on instruments’ ability to detect change. Risk of bias assessment was conducted using the RoB-2 tool.

Results

Forty-two instruments were identified across the 39 included studies and captured a range of dimensions of mental health. Only one study was found to be at low risk of bias, 27 studies were at some risk of bias, and 11 studies were at high risk of bias. Nine instruments were used in more than one study. The teacher-reported Strengths and Difficulties Questionnaire (SDQ) was the most commonly used instrument and showed statistical evidence of its ability to detect change arising from interventions addressing children's mental health.

Conclusions

The teacher-reported SDQ shows promise as an instrument that could be used universally in primary schools to evaluate interventions and monitor changes in child mental health.