general psychology Firouz meroei milan School Health Promomtion 2 1

Results of Searches 448 titles and abstracts 45 papers and reports scrutinised 15 reviews met inclusion criteria

Focus of Reviews

Results: Mental Health Universal approaches (17): – Whole school and HPS approaches better – Longer programmes better – Promotion of MH > prevention of MI – Medium to large effects Depression and self esteem (7 SRs + 5 studies) – Primary prevention better (medium to large effects) – Self esteem programmes modest effects – Knowledge based prgrammes not effective – Suicide prevention – potential for harm

Results: Mental Health Aggressive behaviour (221) – Range of different programmes effective – Better studies and well implemented programmes > effect – Effects > high risk groups Violence prevention (16) – Cognitive and behavioural strategies both effective – Primary prevention, multiple settings, qualified leaders, and longer time scales > effect Violence Prevention (44) – Non response and relationship programmes effective – Small to moderate effects overall

Results: Substance Use Smoking (76) – Most programmes (including information, social competence and multimodal) not effective – Some social influences programmes positive Drug prevention (207) – Universal programme focus – Impact small to very small Drugs psycho-education (62) – 18/62 some evidence of effect – Best programmes can achieve is short term delay

Green, Howes, Waters, Maher, Oberklaid 2005 Emotional and social health in primary school (8 reviews) Most studies of short class based programmes But more effect from: Sustained approaches (> I year) Whole school approaches with changes to school ethos Focus on promotion Involving parents Targeted programmes have a place

Problems with Evidence Process and implementation measures rarely not reported Quality of studies – Study size; implementation fidelity cf statistical power – Cluster design – Loss to follow up – Sensitivity of outcome measures

Issues Participation Autonomy Programme fidelity Randomisation Time scales

Conclusions School health promotion programmes can be effective but by no means always are Health Promoting Schools approach supported Long time scales Programmes more effective when focusing on positive health and wellbeing – Mental health – Health eating and physical activity Substance misuse programmes don’t work

Conclusions Poor mental health is the most important cause of disability throughout the life course There is no health without mental health Public mental health is going to become more and more of an issue More discussion needed on the nature of mental well-being, but enough consensus to get started

Conclusions Key places to start promoting mental health – Ourselves – Families – Schools