Universal school-based e-health interventions for wellbeing, anxiety and depression: A systematic review and meta-analysis.

Background: Given that 'digitally native' children and young people spend much time at school, universal e-mental health interventions (ueMHIs) may have a role in supporting their wellbeing and reducing common mental health problems like anxiety and depression. However, the efficacy of school-based ueMHIs has never formally been evaluated.

Methods: During this systematic review and meta-analysis, we searched online databases MEDLINE, ERIC and ACM and the grey literature for trials of school-based ueMHIs targeted at improving wellbeing or reducing anxiety or depression in students aged 5-18. Primary outcomes were changes in symptoms of wellbeing, anxiety and depression at <3 months. Secondary outcomes were changes in these symptoms at 3-12 months and >12 months. Meta-analysis was conducted using a random effects model. Quality of included studies was appraised using the Cochrane risk of bias (RoB) tool. This study was registered with PROSPERO, CRD42023421872.

Findings: From 11,026 screened records, 15 papers were found and included in a systematic review. Of these, 14 papers including 8844 students were analysed in the meta-analysis. School-based ueMHIs did not significantly reduce anxiety (SMD = -0.55, 95% CI -1.68, 0.59) or depression (SMD = -0.29, 95% CI = -0.89, 0.32) at <3 months. School-based ueMHIs also did not significantly reduce anxiety (SMD = -1.03, 95% CI -3.20, 1.14) or depression (SMD = -0.47, 95% CI -1.40, 0.46) at 3-12 months. School-based ueMHIs did not significantly improve wellbeing at <3 months (SMD = 0.01, 95% CI -0.12, 0.14) and favoured control condition at 3-12 months (SMD = -0.14, 95% CI -0.23, -0.05). RoB was high across most studies and the overall quality of evidence was very low.

Interpretation: Although existing school-based ueMHIs show promise for addressing pupil mental health concerns, further higher-quality evidence is needed. There is room for the development of new school-based ueMHIs for reducing pupil anxiety and depression and improving wellbeing in a scalable, clinically and cost-effective manner, whilst not causing harm.