Schools are an important setting for the delivery of prevention and harm reduction interventions to adolescents. In April 2021, based on the findings of systematic reviews published in 2020, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) updated the evidence on its Best Practice Portal (BPP) concerning school-based programmes to improve young people’s mental health and wellbeing and reduce risks related to substance use. They relate to school-based multicomponent positive psychology interventions (MCPPIs), school anti-bullying interventions, and e-health school-based interventions.1,2
Multicomponent positive psychology interventions
Positive psychology interventions (PPIs) are scientifically based interventions that focus on strengthening positive emotions, thoughts, and behaviours through activities that can be easily implemented in daily routines.3 They focus on one component of wellbeing such as gratitude. In their simplest terms, MCPPIs differ in that they focus on two or more components that target both the eudaimonic (wellbeing as the realisation of one’s true inner potential and virtue as a pathway to experiencing a meaningful and fulfilling life) and hedonic (wellbeing as pleasure maximisation and pain avoidance) components of wellbeing.4 School-based MCPPIs aim to increase wellbeing indicators of mental health (i.e. subjective and psychological wellbeing) and reduce the most common psychological distress indicators (i.e. depression, anxiety, and stress) in adolescents.
While meta-analyses have shown the efficacy of MCPPIs in adult samples, the study of Tejada-Gallardo et al.3 is the first to investigate the effects in adolescents. Through meta-analysis they aimed to examine the immediate and long-lasting effects of school-based MCPPIs aimed at increasing wellbeing (subjective and psychological) and reducing psychological distress symptoms (depression, anxiety, and stress) of pupils from the general population aged between 10 and 18 years of age. While all of the nine studies (4898 participants) included wellbeing outcomes, only four looked at those related to psychological distress. Seven of the studies were randomised control trials and two were non-randomised control trials.
The authors found that MCPPIs can be effective in improving subjective (g=0.24, 95% CI: 0.11–0.38, p=0.000) and psychological (g=0.25, 95% CI: 0.01–0.51, p<0.05) wellbeing and reducing depression symptoms (g=0.28, 95% CI: 0.13–0.43, p=0.000) in adolescents. However, no effects were found for symptoms of anxiety, and effects on stress could not be analysed due to a lack of studies looking at this outcome. The positive effects on psychological wellbeing and depression symptoms were found to have remained significant in the long term. Based on these findings, the BPP rates these programmes as ‘beneficial’ and the authors conclude that:
Multicomponent positive psychology interventions offer an opportunity to ensure mental health during adolescents’ development in schools. Academic policies and education practitioners should consider the inclusion of these interventions within the school curriculum to promote adolescents’ mental health and optimal development.
(p. 1957)3
Anti-bullying interventions
Universal prevention activities target bullying as it has high prevalence rates and is associated with an increased lifetime prevalence of mental health disorders and therefore increase the risk of substance use. Two recent systematic reviews with meta-analysis have found small yet significant effects from these interventions on related outcomes. The findings have led the BPP to rate these kinds of interventions as ‘likely to be beneficial’.
The first review by Ng et al.4 covered 17 studies (n=35 694 participants) and found the interventions to have very small to small yet significant effects in:
- Reducing traditional bullying and cyberbullying perpetration (traditional: standardised mean differences [SMD] –0.30; cyber: SMD –0.16)
- Reducing traditional bullying and cyberbullying victimisation (traditional: SMD –0.18; cyber: SMD –0.13).
The authors found that programme effectiveness was not affected by type of intervention (i.e. whole school-based or classroom-based), programme duration, or presence of parental involvement. However, cyberbullying programmes were found to be more effective when delivered by technology-savvy content experts compared with teachers.
The second review by Fraguas et al.5 covered 69 randomised control trials (111 659 participants). They found school anti-bullying interventions to have small but significant effects in:
- Reducing bullying (effect size: −0.150; 95% CI: −0.191 to −0.109)
- Improving mental health problems (effect size: −0.205; 95% CI: −0.277 to −0.133) at study end point.
The review also considered the population impact number (PIN). In its simplest terms, PIN is the number in the whole population among whom one case will be prevented by the intervention. The review found that an average anti-bullying intervention needs to include 147 (95% CI: 113–213) people to prevent one case of bullying; 107 (95% CI: 73–173) people to improve mental health problems; and 167 (95% CI: 100–360) people to prevent one case of cyberbullying perpetration or exposure.
e-health interventions
Champion et al.6 carried out a systematic review and meta-analysis on the effectiveness of eHealth school-based interventions targeting multiple lifestyle risk behaviours. They included 16 studies (n=18 873 participants), which involved randomised controlled trials of eHealth (internet, computers, tablets, mobile technology, or tele-health) interventions that targeted two or more of the following behaviours: alcohol use, smoking, diet, physical activity, sedentary behaviour, and sleep. The primary outcomes of interest for the meta-analysis were the prevention or reduction of unhealthy behaviours, or improvement in healthy behaviours of the six behaviours.
While they found some effectiveness in improving physical activity, screen time, and fruit and vegetable intake, the effects were small and only evident immediately after the intervention. There was no effect found for alcohol use or smoking. These findings led the BPP to rate eHealth interventions in school as having ‘unknown effectiveness’. The authors conclude that ‘further high quality, adolescent-informed research is needed to develop eHealth interventions that can modify multiple behaviours and sustain long-term effects’
(p. e206).
Concluding comment
The EMCDDA continues to draw on new evidence to provide stakeholders with an accessible and reliable evidence base through the BPP. The findings of the MCPPIs are of particular interest in the Irish context. The evidence suggests support for whole-school prevention programmes currently being delivered in Irish schools, for example, in Social, Personal and Health Education (SPHE) and the Wellbeing programme. Rigorous evaluation of these programmes would reflect international best practice, in line with European Union minimum quality standards for prevention, to which Ireland signed up:
Prevention interventions form part of a coherent long-term prevention plan, are appropriately monitored on an ongoing basis allowing for necessary adjustments, are evaluated and the results disseminated so as to learn from new experiences.7
Ireland’s school-based prevention programmes could make a valuable contribution to the evidence base for the effectiveness of such interventions.
Lucy Dillon
2 EMCDDA (2021) Best practice portal: School-based multicomponent positive psychology interventions on well-being and distress — evidence summary. Lisbon: EMCDDA. Available online at:
https://www.emcdda.europa.eu/best-practice/evidence-summaries/school-based-multicomponent-positive-psychology-interventions-well-being-and-distress_en
3 For a more detailed description, see p. 1944 of Tejada-Gallardo C, Blasco-Belled A, Torrelles-Nadal C and Alsinet C (2020) Effects of school-based multicomponent positive psychology interventions on well-being and distress in adolescents: a systematic review and meta-analysis. J Youth Adolesc, 49(10): 1943–1960.
https://www.drugsandalcohol.ie/34097/
4 Ng ED, Chua JYX and Shorey S (2020) The effectiveness of educational interventions on traditional bullying and cyberbullying among adolescents: a systematic review and meta-analysis. Trauma, Violence, & Abuse, Early online.
https://www.drugsandalcohol.ie/34096/
5 Fraguas D, Díaz-Caneja CM, Ayora M, et al. (2021) Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials. JAMA Pediatr, 175(1): 44–55. Available online at:
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2772453
6 Champion KE, Parmenter B, McGowan C, Spring B, Wafford QE, Gardner LA, et al. (2019) Effectiveness of school-based eHealth interventions to prevent multiple lifestyle risk behaviours among adolescents: a systematic review and meta-analysis. Lancet Digital Health, 1(5): e206–e221.
https://www.drugsandalcohol.ie/34095/
7 Council of the European Union (2015) Council conclusions on the implementation of the EU Action Plan on Drugs 2013–2016 regarding minimum quality standards in drug demand reduction in the European Union. 11985/15. Brussels: Council of the European Union.
https://www.drugsandalcohol.ie/24317/
