Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis

Gonzalo Salazar de Pablo; Andrea De Micheli; Dorien H Nieman; Christoph U Correll; Lars Vedel Kessing; Andrea Pfennig; Andreas Bechdolf; Stefan Borgwardt; Celso Arango; Therese van Amelsvoort; Eduard Vieta; Marco Solmi; Dominic Oliver; Ana Catalan; Valeria Verdino; Lucia Di Maggio; Ilaria Bonoldi; Julio Vaquerizo-Serrano; Ottone Baccaredda Boy; Umberto Provenzani; Francesca Ruzzi; Federica Calorio; Guido Nosari; Benedetto Di Marco; Irene Famularo; Silvia Molteni; Eleonora Filosi; Martina Mensi; Umberto Balottin; Pierluigi Politi; Jae Il Shin; Paolo Fusar-Poli

doi:10.1016/j.euroneuro.2020.10.007

Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis

Eur Neuropsychopharmacol. 2020 Dec:41:28-39. doi: 10.1016/j.euroneuro.2020.10.007. Epub 2020 Nov 6.

Authors

Gonzalo Salazar de Pablo¹, Andrea De Micheli², Dorien H Nieman³, Christoph U Correll⁴, Lars Vedel Kessing⁵, Andrea Pfennig⁶, Andreas Bechdolf⁷, Stefan Borgwardt⁸, Celso Arango⁹, Therese van Amelsvoort¹⁰, Eduard Vieta¹¹, Marco Solmi¹², Dominic Oliver¹³, Ana Catalan¹⁴, Valeria Verdino¹⁵, Lucia Di Maggio¹⁶, Ilaria Bonoldi¹⁷, Julio Vaquerizo-Serrano¹⁸, Ottone Baccaredda Boy¹⁷, Umberto Provenzani¹⁶, Francesca Ruzzi¹⁹, Federica Calorio¹⁹, Guido Nosari²⁰, Benedetto Di Marco¹⁹, Irene Famularo¹⁹, Silvia Molteni¹⁹, Eleonora Filosi¹⁹, Martina Mensi²¹, Umberto Balottin¹⁹, Pierluigi Politi¹⁹, Jae Il Shin²², Paolo Fusar-Poli²³

Affiliations

¹ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
² Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
³ Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands.
⁴ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience; The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
⁵ Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark.
⁶ Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Germany.
⁷ Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum im Friedrichshain, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
⁸ Department of Psychiatry (UPK), University of Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Germany.
⁹ Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
¹⁰ Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands.
¹¹ Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
¹² Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Neurosciences Department, University of Padova, Italy.
¹³ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁴ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Spain.
¹⁵ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Molecular and Developmental Medicine, Division on Psychiatry, University of Siena, Italy.
¹⁶ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
¹⁷ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁹ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁰ Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²¹ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Child and Adolescent Neuropsychiatric Unit.
²² Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
²³ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: paolo.fusar-poli@kcl.ac.uk.

PMID: 33162291
DOI: 10.1016/j.euroneuro.2020.10.007

Abstract

Promotion of good mental health in young people is important. Our aim was to evaluate the consistency and magnitude of the efficacy of universal/selective interventions to promote good mental health. A systematic PRISMA/RIGHT-compliant meta-analysis (PROSPERO: CRD42018088708) search of Web of Science until 04/31/2019 identified original studies comparing the efficacy of universal/selective interventions for good mental health vs a control group, in samples with a mean age <35 years. Meta-analytical random-effects model, heterogeneity statistics, assessment of publication bias, study quality and sensitivity analyses investigated the efficacy (Hedges' g=effect size, ES) of universal/selective interventions to promote 14 good mental health outcomes defined a-priori. 276 studies were included (total participants: 159,508, 79,142 interventions and 80,366 controls), mean age=15.0 (SD=7.4); female=56.0%. There was a significant overall improvement in 10/13 good mental health outcome categories that could be meta-analysed: compared to controls, interventions significantly improved (in descending order of magnitude) mental health literacy (ES=0.685, p<0.001), emotions (ES=0.541, p<0.001), self-perceptions and values (ES=0.49, p<0.001), quality of life (ES=0.457, p=0.001), cognitive skills (ES=0.428, p<0.001), social skills (ES=0.371, p<0.001), physical health (ES=0.285, p<0.001), sexual health (ES=0.257, p=0.017), academic/occupational performance (ES=0.211, p<0.001) and attitude towards mental disorders (ES=0.177, p=0.006). Psychoeducation was the most effective intervention for promoting mental health literacy (ES=0.774, p<0.001) and cognitive skills (ES=1.153, p=0.03). Physical therapy, exercise and relaxation were more effective than psychoeducation and psychotherapy for promoting physical health (ES=0.498, p<0.001). In conclusion, several universal/selective interventions can be effective to promote good mental health in young people. Future research should consolidate and extend these findings.

Keywords: Good mental health; Intervention; Outcomes; Promotion; Selective; Universal.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adolescent
Adult
Age Factors
Clinical Trials as Topic / methods
Cognitive Behavioral Therapy / methods
Female
Humans
Male
Mental Disorders / epidemiology
Mental Disorders / psychology*
Mental Disorders / therapy*
Mental Health*
Psychotherapy / methods
Young Adult