Background
Study aims and objectives
Methods
Search strategy
Inclusion and exclusion criteria
Help-seeking Processes | |
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Inclusion criteria | Exclusion criteria |
[1] Studies reporting on adolescent help-seeking processes (barriers and facilitators, help-seeking attitudes, intentions, and behaviours) that focus on seeking, utilising and engaging with formal sources of care (i.e., school counsellor, school psychologist) | [1] Studies reporting on such processes concerning informal sources of help (i.e., family and peers) and self-help |
School-going Adolescents | |
Inclusion criteria | Exclusion criteria |
[1] Adolescents attending school-level education [2] identified as having mental health difficulties, or being at risk of such difficulties, by meeting screening criteria for and/or participating in TSMIs (i.e., depression, anxiety) | [1] Adolescents neither screened for nor participated in TSMIs [2] adolescents’ primary health condition is not mental health (i.e., autism spectrum disorder (ASD), substance use disorder) |
Adolescent Mental Health | |
Inclusion criteria | Exclusion criteria |
[1] Measures of mental health, including but not limited to mental health and well-being; pre-clinical psychological conditions or mental health conditions measured by a validated/commonly used rating scale, or by a structured psychiatric diagnostic interview [2] measures of other individual-level domains related to mental health (i.e., cognitive function, self-concept, emotional regulation, coping skills) [3] identified as at risk (i.e., by teacher/parent referral, self-referral) | [1] Mental health is not the primary outcome [2] mental health and another non-mental health-related co-occurring disorder/disability (i.e., anxiety and ASD) |
School-based Targeted Mental Health Interventions | |
Inclusion criteria | Exclusion criteria |
[1] Targeted approach delivered by Tier 2 (selected) or Tier 3 (indicated) programs, as defined in the Multi-Tiered System of Supports (MTSS*) framework [2] interventions with the primary aim of supporting adolescents’ mental health, (i.e., psychotherapeutic interventions, social and emotional learning interventions) [3] conducted in an individual or group setting [4] provided in a school-based setting (in-person or online) [5] provided in school-settings below university level | [1] Interventions with a universal approach (i.e., whole-school interventions, interventions without targeting a specific risk/symptom) [2] interventions with the primary objective to support adolescents’ non-mental health-related issues (i.e., learning difficulties, physical health conditions, alcohol/drug use) [3] Interventions outside the school setting (i.e., home-based, residential institutions, juvenile placements) [4] interventions targeting and/or involving both adolescents and caregivers (i.e., parents) [5] interventions that are both targeted and universal |
Methodology and Study Type | |
Inclusion criteria | Exclusion criteria |
[1] Studies utilising qualitative, quantitative, or mixed-method design [2] data-based/primary studies [3] studies published in peer-reviewed journals [4] published in English language [5] full-text studies available | [1] Qualitative, quantitative or mixed-methods studies not addressing this review’s research question [2] non-data-based/secondary studies; (i.e., reviews, meta-analyses or meta-syntheses, editorials, protocols, commentaries, letters) [3] non-peer-reviewed work (i.e., conference abstracts, theses, grey literature) [4] studies published in another language than English [5] studies for which full-text cannot be accessed |
Study selection
Data extraction
Quality assessment
Data synthesis
Results
Study Identification | Study Aims | Study Design | Country | School Setting | n adolescents (n total sample) | Gender | Age | Ethnicity |
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Dickinson et al. (2003) | To determine whether the TRAVELLERS programme was an appropriate, feasible, acceptable, and promising intervention for young people | Mixed-methods (only qualitative data used for this review) | Aotearoa, New Zealand | n = 2 secondary schools (one rural and one urban) | n = 34 | Females n = 24 Males n = 10 | 13–14 years (mean not reported) | Mainly Pakeha/European |
Evans et al. (2015) | To explore young people’s lived experiences of participating in a targeted SEL intervention; to generate new theoretical and empirical insights into the manifestation of iatrogenic effects within the educational domain | Qualitative | Wales (UK) | n = 4 secondary schools (n = 3 in post-industrial towns, n = 1 in a rural area) | n = 41 | Females 50% Males 50% | 12–14 years (mean not reported) | “White background” |
Fazel (2015) | To explore the role of schools in supporting the overall development of refugee and asylum-seeking children in the UK | Qualitative | Glasgow, Cardiff and Oxford (UK) | n = 3 schools located in Glasgow, Cardiff and Oxford (n = 1 per location) | n = 40 | Females n = 11 Males n = 29 | 15–24 years (mean age 17 years) | not reported |
Fazel et al. (2016) | To understand the experience of adolescents directly seen by school-based mental health services; concerning their experience of being seen within the school location, how they perceived therapy, whether it helped them, and finally, any worries that might be impacting their time at school | Qualitative | as above | as above | as above | as above | as above | Albania [5]; Somalia [4]; Sudan [3]; Iran/Iraq ‘Afghanistan [9]; other Asia [7]; South America [2] |
Gampetro et al. (2012) | To explore the perceptions of mental health needs of 18 inner-city teens diagnosed with behavioural or mental health issues | Qualitative | Chicago (US) | n = 1 school (low resource community) | n = 18 | Females n = 10 Males n = 8 | 12–18 years (mean not reported) | African American [12]; Hispanic [5]; Native American [1]; Caucasian [1] |
Garmy et al. (2015) | To explore adolescents’ experiences with a school-based cognitive-behavioural depression prevention program | Qualitative | Sweden | n = 6 schools (in four municipalities in rural and urban areas of southern Sweden) | n = 89 | Female 75% Male 25% | 13–15 years (mean not reported) | not reported |
Gibson et al. (2013) | To find out how young clients made sense of their experiences of counselling and whether this would be similar or different to the way that the professional literature constructs counselling | Qualitative | New Zealand | n = 2 high schools | n = 22 | Females n = 15 Males n = 7 | 16–18 years (mean not reported) | New Zealanders of European ancestry [11], Maori or Pasifika [5], ‘immigrants from other English-speaking countries’ [6] |
Gibson et al. (2014) | To explore how young clients who made use of a school counselling service understood their counselling experience | Qualitative | as above | as above | as above | as above | as above | as above |
Harrison (2019) | To investigate the processes by which Hong Kong Chinese secondary school students engage with school counselling services from the perspective of both clients and counsellors, and how the sociocultural context and the school setting influence these processes | Qualitative | Hong Kong, China | n = 3 secondary schools (private and coeducational) | n = 25 (total sample n = 33) | Females n = 16 Males n = 9 | 14 years+ (mean age 16.7 years) | Chinese (local Hong Kong) |
Harrison (2022) | To research the change processes experienced by adolescent Hong Kong Chinese clients, considering the voices of service users and providers | Qualitative | as above | as above | as above | as above | as above | as above |
Kendal et al. (2011) | To evaluate The Project’s feasibility and acceptability from the perspectives of staff and students in those schools | Qualitative | England (UK) | n = 3 high schools (located in socio-economically deprived urban areas of Northern England) | n = 9 (total sample n = 50) | Not specified for each informant group | 11–18 years | not reported |
Kit et al. (2019) | To explore Singapore Asian primary school children’s experiences of online live chat counselling, to gain insight into their motivations for engaging in help-seeking behaviours, and the utility of providing online counselling services to this population | Qualitative | Singapore | n = 1 primary school | n = 23 | Females n = 15 Males n = 18 | 9–12 years (mean not reported) | Ethnic mix of Chinese (n = 17), Malays (n = 9), Indians (n = 6) and another race (n = 1) |
Kvist Lindholm & Zetterqvist Nelson (2014) | To explore how the programme is constructed through the girls’ descriptions and arguments, which contradicts the official version of DISA | Qualitative | Sweden | n = 6 schools (located in a relatively small municipality in Sweden) | n = 32 | All female | 12–14 years (no mean reported) | not reported |
McKeague et al. (2018) | To investigate the feasibility of the DISCOVER workshop programme for students in UK sixth forms | Qualitative component of a cluster RCT | London, England (UK) | n = 10 schools (inner economically deprived and ethnically diverse city area) | n = 15 (total sample n = 34) | Females n = 12 Males n = 3 | 16–19 years (mean age 17.59 years) | Black British, African [6]; Black British, Caribbean [3]; White British [4]; other BME group [2] |
Nabors et al. (1999) | To investigate student perceptions about program strengths and weaknesses; barriers to participating in treatment; and treatment outcomes. In particular, the study aims to examine gender differences in response to focus group questions about mental health services for adolescents. | Qualitative | Baltimore City, Connecticut (US) | n = 3 high schools (inner city area) | n = 37 | Females n = 24 Males n = 13 | 14–19 years (mean age 16.4 years) | African American [30]; Caucasian [7] |
Nabors et al. (2000) | To explore stakeholder perceptions on the strengths, weaknesses, and outcomes of the ESMH program | Qualitative | as above | as above | n = 37 (total sample n = 108) | as above | as above | as above |
Pella et al. (2018) | To examine anxious children’s perceptions of barriers to treatment attendance in a school-based setting and their association with demographic factors, child, and parent clinical characteristics, parenting style and parent service use history | Quantitative (RCT) | Baltimore City, Connecticut (US) | Not reported | n = 122 | Female 51.6% Male 48.4% | 6–18 years (mean age 11.03 years) | Non-white (50.9%); Asian (2.7%); African-American (35.7%); Hispanic (8%); more than one race (4.5%) |
Prior (2012a) | To analyse young people’s narratives of accessing a school counselling service | Qualitative | Central Scotland (UK) | n = 1 school (located in central Scotland) | n = 8 | Females n = 6 Males n = 2 | 13–17 years (mean not reported) | Not reported |
Prior (2012b) | To elucidate the key features and stages of the help-seeking process as defined by young people accessing school counselling | Qualitative | as above | as above | as above | as above | as above | as above |
Segrott et al. (2013) | To establish Bounceback’s aims, feasibility and acceptability, through: [1] exploring the view of young people who used the service in relation to acceptability and perceived outcomes; [2] examining Bounceback’s potential to prevent emotional/mental health issues in young people in becoming more severe; [3] examining the relationship between Bounceback and schools in which it operated; [4] identifying young people’s support needs during the transition from school to adulthood | Qualitative | Wales (UK) | n = 3 schools (located in south Wales, serving economically disadvantaged city populations and pupils from ethnic minority backgrounds) | n = 7 (total sample n = 16) | Females n = 3 Males n = 4 | 14–16 years (mean not reported) | not reported |
Van de Water et al. (2018a) | To compare the experiences and perceived efficacy of two PTSD interventions by treatment users (adolescents with PTSD) and treatment providers | Qualitative study nested within the main RCT study | Cape Town, South Africa | n = 4 high schools (lower income) | n = 10 (total sample n = 13) | Females n = 8 Males n = 2 | 13–18 years (mean not reported) | not reported |
Van de Water et al. (2018b) | To report on the experiences of stigma in adolescents participating in the RCT and use this knowledge to inform the wider implementation of these interventions for PTSD, especially in LMIS’s | as above | as above | as above | n = 10 | as above | as above | not reported |
Study Identification | Intervention | Delivery Method | Participants Mental Health | Key Themes Related to Help-seeking Processes |
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Dickinson et al. (2003) | TRAVELLERS: a school-based early intervention programme helping young people manage and process change, loss and transition | Group-based; in-person | Screening procedure (operates as a filter from the first to the last): answering no to self-report measure “do you feel good about yourself most of the time?“; or those who scored 40 and above on the Subjective Experience of Distress scale; or those who rated four of more life-events with major impact; or those who had attended 7 or more schools were also included | Anticipated stigma; navigating through stigma |
Evans et al. (2015) | The Student Assistance Programme (SAP): a targeted school-based SEL intervention | group-based; in-person | Students experiencing social and emotional problems, particularly within school and the family. The SAP stipulates four referral routes for the intervention: self-referral; teacher referral; parental referral; community services referral | Anticipated stigma; negative labelling; navigating through stigma |
Fazel (2015) | School-based mental health services for refugee children | individual, group or multimodal; in person | Refugees or asylum seekers identified as at risk and referred by teachers | Referral agent; confidentiality and trust; negative labelling; anticipated stigma |
Fazel et al. (2016) | as above | as above | as above | Available and accessible care; anticipated stigma; referral agent; confidentiality and trust; navigating through stigma |
Gampetro et al. (2012) | School-based health clinic | individual; in person | Adolescents with an Axis 1 diagnosis who were seen by the school-based health clinic’s licensed clinical social worker (LCSW). The adolescent also had to have received a DSM-IV-TR diagnosis during the one-year period data were being collected | Confidentiality and trust; available and accessible care |
Garmy et al. (2015) | DISA (‘depression in Swedish adolescents’): a school-based cognitive-behavioural depression prevention program. | Group-based; in-person | Adolescents deemed at risk due to their age between 13–15 years olds. This age group was chosen because adolescents at this age are considered sufficiently mature to grasp the theory of the program and because depression rates in this age group have been increasing | Anticipated stigma; negative labelling; navigating through stigma |
Gibson et al. (2013) | School counselling service | individual; in person | Students can self-refer or can be referred to counselling by a friend, teacher, or other professional. | Individual agency; referral agent |
Gibson et al. (2014) | as above | as above | as above | A direct solution to a problem; misconceptions of the service |
Harrison (2019) | School counselling service | individual; in person | Not specified | Available and accessible care; misconceptions of the service; confidentiality and trust; negative labelling |
Harrison (2022) | as above | as above | Not specified | Available and accessible care; confidentiality and trust |
Kendal et al. (2011) | “The Change Project” (The Project): an intervention to promote EWB in high schools | individual; in person | Students self-referred for emotional difficulties including anxiety, low mood, self-esteem, and relationship problems | Individual agency; referral agent; available and accessible care; competing academic schedules |
Kit et al. (2019) | Online counselling portal, part of the iZ Hero Challenge | individual; online (within scheduled after school hours) | Students experiencing socio-emotional distress were identified by teachers through the school’s participation in the iZ Hero Challenge. They identified 228 nine- to 12-year-old children in need of help. Through teachers referrals a total of 33 children (18 males, 15 females) aged between 9 to 12 years old agreed to participate | Direct solution to a problem; confidentiality and trust; available and accessible care |
Kvist Lindholm & Zetterqvist Nelson (2014) | DISA (‘depression in Swedish adolescents’): a school-based cognitive-behavioural depression prevention program. | Group-based; in-person | Girls at risk of developing depression. Offered to girls specifically; to address concerns about teenage girls’ mental health and is based on the view that this group is ‘at risk’ for developing depression | Anticipated stigma; negative labelling |
McKeague et al. (2018) | DISCOVER: “How to handle stress” workshop programme. This is a self-referral school-based group intervention designed for stressed students in sixth form | group-based; in person | Students self-referred owing to self-perceived need for psychological support in managing common adolescent stressors | Available and accessible care; competing academic schedules; confidentiality and trust; navigating through stigma |
Nabors et al. (1999) | Expanded School Mental Health Program | individual; in person | Not specified | Competing academic schedules; negative labelling; confidentiality and trust; available and accessible care |
Nabors et al. (2000) | as above | as above | Not specified | Anticipated stigma; competing academic schedules; referral agent |
Pella et al. (2018) | STARS: School-based treatment for anxiety research study | individual; in person | DSM-IV primary diagnosis of an anxiety disorder based on the Anxiety Disorders Interview Schedule for DSM-IV | Competing academic schedules; confidentiality and trust; anticipated stigma |
Prior (2012a) | School counselling service | individual; in person | Not specified | Anticipated stigma; negative labelling |
Prior (2012b) | as above | as above | as above | Anticipated stigma; referral agent; confidentiality and trust; individual agency; direct solution to a problem |
Segrott et al. (2013) | Bounceback: a school-based support service for young people experiencing difficulties detrimental to their mental and emotional well-being | Individual; in-person | Teachers referred young people with emotional difficulties/mental health issues, which had the potential to cause a crisis or have a negative effect on emotional well-being | Anticipated stigma; confidentiality and trust |
Van de Water et al. (2018a) | Task shifted psychotherapeutic PTSD intervention composed of two treatments: Supportive counselling (SC) and prolonged exposure therapy for adolescents (PE-A) | individual; in person | Trauma-exposed adolescents with chronic (at least 3 months) full PTSD or subthreshold PTSD who were entered into the RCT in the first year (2014) were asked to participate | Anticipated stigma; negative labelling; confidentiality and trust; misconceptions of the service; referral agent; direct solution to a problem |
Van de Water et al. (2018b) | as above | as above | as above | Confidentiality and trust; misconceptions of the service |
1. Qualitative design | 2. Quantitative (randomised) design | 3. Quantitative (non-randomised) design | 4. Mixed-methods design | MMAT total Score | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Study Identification | 1.1 | 1.2 | 1.3 | 1.4 | 1.5 | 2.1 | 2.2 | 2.3 | 2.4 | 2.5 | 3.1 | 3.2 | 3.3 | 3.4 | 3.5 | 4.1 | 4.2 | 4.3 | 4.4 | 4.5 | % (points) |
Evans et al. (2015) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Fazel (2015) | Y | P | Y | Y | Y | 90% (4.5/5) | |||||||||||||||
Fazel et al. (2016) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Gampetro et al. (2012) | Y | Y | P | Y | Y | 90% (4.5/5) | |||||||||||||||
Garmy et al. (2015) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Gibson & Cartwright (2013) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Gibson & Cartwright (2014) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Harrison (2019) | Y | P | Y | Y | Y | 90% (4.5/5) | |||||||||||||||
Harrison (2022) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Kendal et al. (2011) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Kit et al. (2019) | Y | P | Y | Y | Y | 90% (4.5/5) | |||||||||||||||
Kvist Lindholm & Zetterqvist Nelson (2014) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
McKeague et al. (2018) | Y | P | Y | Y | Y | 90% (4.5/5) | |||||||||||||||
Nabors et al. (1999) | Y | P | P | P | Y | 70% (3.5/5) | |||||||||||||||
Nabors et al. (2000) | Y | P | P | P | Y | 70% (3.5/5) | |||||||||||||||
Prior (2012a) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Prior (2012b) | Y | Y | Y | Y | Y | 100% (5/5) | |||||||||||||||
Segrott et al. (2013) | Y | P | N | P | Y | 60% (3/5) | |||||||||||||||
Van de Water et al. (2018a) | Y | P | Y | Y | Y | 90% (4.5/5) | |||||||||||||||
Van de Water et al. (2018b) | Y | P | P | Y | Y | 80% (4/5) | |||||||||||||||
Pella et al. (2018) | P | N | N | N | Y | 30%(1.5/5) | |||||||||||||||
Dickinson et al. (2003) | Y | P | N | Y | P | Y | Y | Y | N | Y | N | N | P | N | Y | 57% (8.5/15) |
Key theme and subtheme | Illustrative quotes |
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a. Access-related Factors | |
a.1 Individual agency | “I certainly want to work out what’s best for me without someone else telling me” [participant] (Gibson & Cartwright, 2013) “If I think I need help I’ll go get help” [participant] (Prior, 2012a) |
a.2 Referral agent | “It was actually from Mrs Smith, one of the guidance teachers [that I first heard about counselling]” [participant] (Prior, 2012b) “when I joined the high school yeah. I tell my the teacher… I have this problem which can make me not concentrate… and she advised me to see X” [participant] (Fazel et al., 2016) |
a.3 Confidentiality and trust | “[the counsellor is] someone you can trust” [participant] (van de Water, et al., 2018) “yes I feel safe because instead of sharing with my friends who might spread it around, I can just talk to online counsellors” [participant] (Kit et al., 2019) “I just feel really trusted with him [counsellor]” [participant] (Segrott et al., 2013) |
a.4 Direct solution to a problem | “I don’t talk to somebody about my past. But I knew I needed help” [participant] (Prior, 2012a) “if I didn’t go to the iZ Hero counselling, I would probably still not know how to handle my problems” [participant] (Kit et al., 2019) “I thought Jan could maybe help me with my problem. just help like she’d gie me options on what to dae[do]” [participant] (Prior, 2012a) |
a.5 Misconceptions of the service | “I thought I knew something about what to expect but it turned out to be quite different” [participant] (Harrison, 2019) “the clinic is only for people who are physically ill (e.g., bleeding, coughing, etc.), which implies that both participants and clinic employees did not believe PTSD to be an illness that could be effectively treated by medical professionals ” [author] (van de Water et al., 2018) |
b. Concerns Related to Stigma | |
b.1 Anticipated stigma | “If people found out you were there then some people can be a bit spiteful” [participant] (Prior, 2012a) “yes, there is [a need for a course like DISA], but it is strange that it takes for granted that girls will feel bad” [participant] (Garmy et al., 2015) |
b.2 Negative labelling | “Yes, they bring up negative thoughts all the time and everything and then it feels like as if, then apparently I have low self-esteem or something like that” [participant] (Kvist Lindholm & Zetterqvist Nelson, 2015) “People would “[not] talk to them. They make fun of them,” “say, ‘you are crazy’ and ignore them”, or “judge them” [participant] (van de Water et al., 2018) “they would laugh at me; think I am stupid” [participant] (van de Water et al., 2018) |
b.3 Navigating through stigma | “I could relate to TRAVELLERS… I hadn’t thought about life’s a journey before the group. I talked to my friends and told them that we talked about things going on in our lives and my friends thought I was lucky. There was no shame and no teasing” [participant] (Dickinson et al., 2003) “… since it was a small group, we wouldn’t feel intimidated to just tell people stuff. It was more confidential in a sense” [participant] (McKeague et al., 2018) |
c. The School Setting | |
c.1 Available and accessible care | “You know usually like whenever I’m sick, I could come down here and… they help me get better, and I then could go back to class. So that’s convenient you know” [participant] (Gampetro et al., 2012) “well all the other services I did… you know the NHS, and… it was all very clinical and it wasn’t comfortable. I mean [bounceback] made the effort sort of thing; it was little things like, you know, you could sit and you could eat with them… it’s like you go in and they know how to make you feel warm and welcome” [participant] (Segrott et al., 2013) “I think in the school is better” [participant] (Fazel et al., 2016) |
c.2 Competing academic schedules | “I think it just took a lot of time. It took a whole school day and for me that’s really a lot of information that I missed and had to catch up on” [participant] (McKeague et al., 2018) |