A Systematic Review of School-Based Mental Health Programmes for Secondary School Students In Chinese Societies

Background and Purpose: School-based mental health programmes have grown increasingly popular as a means to address the mental health needs of adolescents, including in the Chinese societies of Hong Kong, mainland China, Macau, and Taiwan. However, much of the existing literature on school-based mental health has focused on programmes conducted in Western cultural contexts, and there remains a lack of synthesised evidence from existing programmes adopted in Chinese cultural contexts, particularly with regard to universal- and selective-level programmes implemented in secondary school settings. This review aims to identify and synthesise the specific components of school-based mental health programmes that are commonly used in Chinese cultural contexts.

Methods: This systematic review identified and summarised published literature that described mental health-related programmes that were implemented in school settings in Hong Kong, mainland China, Macau, and Taiwan. Specifically, programmes that were considered eligible for inclusion needed to (1) primarily target students and their outcomes; (2) target secondary school students (adolescents aged 12 to 19 years); (3) be implemented in school settings; (4) be universal or selective programmes; and (5) explicitly target mental health-related outcomes (e.g., literacy, attitudes, stigma, and symptoms). No limitations were placed on published literature in terms of their study phase (e.g., implementation, feasibility, applicability, or cost-effectiveness), study design, study duration, follow-up period, programme strategies, control condition, or who delivered the programme to ensure that as many interventions as possible could be captured.

Results: The study screened 651 published studies identified through searches of electronic databases, of which 30 met the systematic review inclusion criteria including 11 (36.67%) from Hong Kong, 17 (56.67%) from mainland China, 1 (3.33%) from Macau, and 1 (3.33%) from Taiwan. Twenty-one (70.00%) were universal-level programmes, while the remaining nine (30.00%) were selective-level programmes targeting specific at-risk populations. While traditional classroom-based psychoeducation remains popular, other delivery methods such as student-led projects and experiential learning activities (e.g., mindful meditation) have also begun to be incorporated. Half of the included studies were delivered by external mental health professionals, while the other half included the formal involvement of school stakeholders in implementation in conjunction with research team members, including students as peer leaders and co-creators (n = 6, only from Hong Kong), and/or teachers as trained implementers or supervisors (n = 13, from Hong Kong and Mainland China).

Conclusions and Implications: The findings highlight the diversity of school-based mental health programmes that exist within Chinese societies, including the increasing use of non-psychoeducation-based methods, and of students and teachers as active participants in the implementation of such programmes. Although conclusions cannot be drawn in the present review regarding the effectiveness of specific programme components in improving mental health-related outcomes, it nevertheless summarises the emerging trends within the field of school-based mental health programmes in Chinese societies, with implications for understanding ‘what works’ within this cultural context and in designing or adapting future programmes and interventions for this population.