Effectiveness of resilience-based interventions to promote mental well-being among secondary school children: a systematic review.

Background: Mental health conditions are becoming increasingly prevalent among school children. Well-being and resilience are vital for preventing and mitigating the severity of mental health issues. Equipping children with effective coping mechanisms and protective behaviours enhances their resilience to manage challenging life circumstances, leading to improved mental health. While evidence supports the effectiveness of resilience-based interventions in reducing mental health problems in adolescents, it is unclear which components enhance resilience most effectively and how follow-up duration influences outcomes. Furthermore, little is known about the facilitators and barriers impacting successful implementation of these interventions in school settings. The aim of this review was to identify effective resilience-based intervention components, facilitators and barriers, and outcome variation by follow-up period. Methods: A systematic review and narrative synthesis was carried out, with five electronic databases (EMBASE, MEDLINE, PsycINFO, CINAHL, and CENTRAL) searched to identify trials on resilience-based interventions that reported a measure of mental health problems or resilience in children or adolescents aged 11 to 19 attending secondary education. Results: A total of 34 trials were included from 3,419 records. Across trials, twelve resilience-based interventions were found to be effective compared to a control or alternative intervention for 5 of 9 outcomes: depressive symptoms, anxiety symptoms, resilience, emotional symptoms, and externalising problems. Interventions employing a multicomponent approach demonstrated significant effects in six of twelve trials showing positive results, particularly those combining social skills training, cognitive behavioural therapy (CBT) and positive psychology. Group-based interventions, especially those incorporating peer collaboration and social learning, appeared to be more effective. At short-term follow-up, ten studies reported significant effects across at least one outcome. These included small effects for anxiety, resilience, and externalising problems (k = 4), moderate effects for depressive symptoms and resilience (k = 3), and large effects for resilience and depressive symptoms (k = 2). Notably, one study yielded three significant outcomes, namely depressive symptoms, externalising problems, and resilience. At long-term follow-up, small but significant effects were reported in two studies (k = 2) for depressive and emotional symptoms. Conclusion: The findings provide evidence that resilience-based interventions can improve mental health outcomes for school children, including reducing depressive and anxiety symptoms, externalising problems, and increasing resilience. Future research should focus on addressing barriers like student engagement and implementation fidelity.