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  • Perspective
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Research recommendations for assessing potential harm from universal school-based mental health interventions

Nature Mental Health volume 2, pages 270–277 (2024)Cite this article

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Abstract

There is growing evidence that universal school-based mental health interventions can lead to negative outcomes in young people. This is a critical ethical issue, especially when young people cannot easily opt out of interventions run during school hours. So far, however, there is no guidance available about potential harms for researchers designing and running these interventions. In this Perspective, we set out five research recommendations: (1) acknowledge the possibility of potential harms; (2) identify types of potential harms; (3) measure and report potential harms in all outputs; (4) consider adverse events (for example, a suicide attempt); and (5) consider participant dropout and disengagement. Using simulated data, we demonstrate that even if trials show small negative effects, this could lead to considerable harm if interventions are scaled up across the population. Furthering research in this area will help ensure the field delivers interventions that are most effective and least harmful for everyone.

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Fig. 1: Recommendations for universal school-based mental health interventions.

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Data availability

The simulated data are available online (https://osf.io/pe53k/files/osfstorage).

Code availability

The simulation code is available online (https://osf.io/pe53k/files/osfstorage).

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Authors and Affiliations

  1. Department of Experimental Psychology, University of Oxford, Oxford, UK

    Lucy Foulkes, Jack L. Andrews & Tessa Reardon

  2. Department of Psychiatry, University of Oxford, Oxford, UK

    Tessa Reardon

  3. Division of Psychiatry, University College London, London, UK

    Argyris Stringaris

  4. Division of Psychology and Language Sciences, University College London, London, UK

    Argyris Stringaris

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L.F. conceptualized the manuscript and wrote the original draft. All authors reviewed and edited subsequent drafts, and read and agreed to the final version.

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Correspondence to Lucy Foulkes.

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Foulkes, L., Andrews, J.L., Reardon, T. et al. Research recommendations for assessing potential harm from universal school-based mental health interventions. Nat. Mental Health 2, 270–277 (2024). https://doi.org/10.1038/s44220-024-00208-2

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