A Comprehensive Review of School-Based Interventions and Their Implications for Youth Mental Health

Introduction

The global suicide and self-harm of youth has now turned into a serious public health issue, pushing a wide variety of personal, social, and environmental factors. The research on suicide, self-harm, and underlying reasons has been carried out in schools with a growing focus in recent years that echoes the seriousness of the situation within the school system. The primary aim of the proposed study is to conduct an in-depth analysis of classroom-based initiatives that prevent, treat, and address various suicide behaviours in young people attempting suicide-related behaviours. This group includes suicidal thoughts, suicide attempts, and self-harm with or without suicidal intent. The focus group is school-going children and adolescents, who form a vulnerable group where age-adjusted prevalence rates for self-harm range from 4.6% to 16.1% (Quarshie et al., 2020). Suicide attempts and self-harm can be a destructive factor to youth’s mental health and lead to the implementation of school-based programs by integrating and doing the critical assessment of the current theories, this study aims to identify evidence-based practices, highlight methodological limitations, and inform the development of tailored interventions that address the complex risk and protective factors associated with youth suicide and self-harm within educational contexts.

Literature Review

The literature review covers eight articles that focus on the aspects of youth mental health, self-harm, and suicide, but with a concentration on school-based interventions and their consequences. The studies varied in terms of population, age groups, and geographic regions. Researchers have conducted several studies that focused on college/university students, including an examination of stigma and suicidal ideation among U.S. college students (DeVylder et al., 2022) and the association between mobile phone addiction, depression, online social support and suicidal ideation among Chinese university students (Hu et al., 2022). The other studies focus on the adolescent age group, for example, a systematic review of self-harm in sub-Saharan African youth (Quarshie et al., 2020), a qualitative investigation into the needs and experiences of young people who self-harm (Hetrick et al., 2020), and analysis of moderators and mediators between bullying victimization and self As well, the other research team used trauma-focused therapy (Peters et al., 2022)and clinical/community samples examining childhood maltreatment, attachment, and suicidality (Stagaki et al., 2022).

The research employs a broad set of methods comprising both quantitative tools such as surveys and statistical techniques like regressions and moderation/mediation models, besides qualitative methods such as interviews and thematic analysis. Research synthesis is a systematic literature review aiming to summarize the existing evidence on a particular topic. The studies concentrated on various measures and measured parameters that included standardized models of mental health disorders, suicidal ideation, self-harm, stigma, mobile phone addiction, depression, online social support, childhood trauma, attachment, and mentalizing capabilities. Researchers assessed particular interventions, such as a school-based suicide prevention program (universal awareness/ screening and gatekeeper training). Also included were approaches specific for PTSD/interpersonal trauma as well as infant maltreatment, the effects of which were revealed. This multitude of populations, methods, measures, and interventions evince the multidimensional contextuality of youth mental health and the need to employ multidisciplinary, empirically dependable approaches.

The Impact of Stigma on Youth Mental Health

Researchers pointed out that stigma associated with mental health is one of the main impediments for adolescents with suicidal thoughts and suicidal behaviours to seek help and comply with treatment. DeVylder et al. (2022) investigated stigma and its association with mental health indicators in college students with suicidal thoughts by taking data from the 2020–2021 Healthy Study. The research results showed that students at college with suicidal thoughts are more likely to reflect adverse stereotypes; these stereotypes, in turn, aggravated their emotional issues, such as stress, sadness, and self-harm.

Conversely, Quarshie et al. (2020) did an extensive review focusing on self-harm in Sub-Saharan Africa among the youth; they identified complex issues of socio-environmental and individual factors that contribute to self-harm behaviors. The review article did not expressly aim to discuss stigma. Still, it acknowledged that cultural attitudes and social norms might influence the incidence and manifestation of self-harm as well in this region. These studies prove that this type of stigma exists almost everywhere, particularly in cases of suicide and self-harm among youth. Stigmatization aggravates the cycle of shame, isolated and resistant patterns to getting professional help, as it is complex enough already for the young who are experiencing mental health problems. The mental health stigma should be addressed through awareness campaigns, education programmes, and the promotion of conversations which are non-judgmental and inviting. This will help create a freedom-loving and supportive environment for the youth. By breaking down the stereotypes and creating a society that celebrates diversity and respects one another’s views and values, stigma can be eliminated, opening the door for young people to seek help without any fear of reprisal.

Understanding the Needs and Experiences of Self-Harming Youth

As described in the study by Hetrick et al. (2020), the authors implemented a qualitative research method in order to comprehend the issues that teenagers encounter when self-harming. Through the use of semi-structured interviews with seven people and the correlation of themes, the authors uncovered the link between negative feelings and the generation of self-harm behaviours. Such a study sheds light on the psychological dimensions of self-harming youth, stressing the fact that their emotions are ambiguous and often contribute to these self-destructive behaviours. Moreover, the study showed how different youths used coping mechanisms and that proper treatment should focus on what these young people like and dislike.

While the study by Khaki et al. (2022) followed a different procedure, including a systematic review, they aimed to identify mediators and moderators of the association between bullying victimization and self-harm/suicide in adolescents. Their findings suggested that depression and social support were important factors in whether they augmented or reduced the effect of bullying on mental health. The research indicated depression as a mediator with the potential to worsen the relationship between bullying, self-harm, or suicidal behavior. On the other hand, social support acted as a shield against the negative effects of bullying.

The two research findings highlight the complexity and heterogeneity of self-harm problems for young people. Despite the existence of commonalities, negative emotions and personality, bullying, some individual preferences, ways of coping and support systems can be highly varied. The effective interventions must be people-oriented, paying attention to the different circumstances and needs of each young individual who is involved in self-harming behaviors. Through the comprehension of the realities of the self-harming youth, the specific risk, and protective factors, intervention techniques can be adjusted to meet the different demands of the youth based on their situation, resulting in recovery and resilience.

The Role of Technology and Social Support in Youth Mental Health

Hu et al. (2022) conducted a study to explore the association between mobile phone addiction (MPA), depression, online social support (OSS), and suicidal ideation among university students in China. Their research showed that MPA and suicidal thoughts increased if they were mediated by depression. However, the moderated effect of OSS on the depression–suicide ideation relationship shows evidence of OSS as a safeguard for mental health against the negative impact of MPA.

Peters et al. (2022) studied how subjective distress, self-harm and suicidal ideation/behaviour changed among transitional-age youth receiving Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for PTSD and interpersonal trauma. Their pilot study identified the close relationship between emotional distress and self-harm, reflecting the necessity of including safety planning and coping skills in the TF-CBT protocols. These studies show how technology, social support, and the mental health of adolescents are inextricably intertwined. Although the excessive use of smartphones can also lead to negative outcomes such as depression and suicidal ideation, online social support can be regarded as a facilitator in such scenarios. Moreover, the mixture of coping strategies together with a safety plan in therapeutic interventions can help trauma-exposed people deal with self-harm and suicidality.

School-Based Interventions for Youth Mental Health

Robinson et al. (2013) systematically reviewed the interventions instituted in schools to deal with the occurrence, treatment, and response to suicidality among adolescents. The reviewers thus subclassified interventions into four categories: universal programs for awareness creation, selective interventions, target treatments, and postvention studies. As for the authors, they acknowledged those shortcomings and the evidence gaps, as well as indicated the potential of approaches such as screening programs and gatekeeper training.

Stagaki et al. (2022) focused on the way in which attachment and mentalization stand between childhood maltreatment, self-harming and suicidal behavior. In their study, through the finding of these two factors of insecure attachment and poor mentalizing abilities, a significant portion of the association between childhood trauma and self-harm or suicide in adulthood was explained.

Such evaluation underlines the need for school intervention programs and for applying a developmental approach during the process of youth mental health recovery. Though Robinson et al. (2015) concentrated on the appraisal of currently school-based programs, Stagaki et al. (2022) pinpointed the mechanisms that may be under the suicidal and self-harming behaviors later in life, which highlights the need for early interventions and trauma-informed practices in school settings. Effective school-based intervention should incorporate evidence-based strategies like the screening and training of gatekeepers. Additionally, the intervention should consider the trauma-exposed youth’s needs as well as promote safe attachment and mentalizing skills. Schools can facilitate the mental health of children and make them self-harm-free by adopting a complete and developmental-sensitive program.

Conclusions and Hypothesis

The literature summarizes the extensive influence of a range of factors on young people’s well-being, especially with regard to self-harm and suicide behaviours. It is indicated thereby that stigma encourages help-seeking behaviors to be hindered among youths, and it aggravates the challenges when dealing with mental health issues. Stigmatization, based on findings by researchers such as DeVylder et al. (2022), draws particular attention to the necessity of educational and awareness programs that are aimed at mitigating the influence of stigmatization on affected populations. Moreover, the study conducted by Hetrick and colleagues (2020) and by Khaki and colleagues (2022) stresses the fact that addressing both emotional distress and external adversities such as bullying requires a centered approach that is intended for each client.

Another common subject echoed in the literature is that social support, be it offline or online, serves a precise role in preventing negative mental health effects, particularly suicidal thoughts. This is of great importance in the context of technology intake in everyday life, manifested through Hu et al. (2022) study showing mobile phone addiction and online social support. Furthermore, the necessity of school-level interventions as a sample of prevention and reassume in suicide-related behaviors are stressed, implying grade-based plans and early, trauma-informed interventions within educational settings.

The most prominent strength of the review is the wide range of methods employed and the variety of populations studied so that one can get a broad view of all influential factors to youth mental health in different contexts. On the other hand, the literature gives rise to a number of limitations, such as the methodological weaknesses of the studies and the need for more research on the long-term effects on youth populations from a cohesive society.

In conclusion, research literature shows that the issue of youth mental health is considerably complex, and the effective implementation of supportive elements cannot be overlooked. By all means, progress is made in this matter, but there is also much room to improve the knowledge about the best strategies to support those students who are on the verge of self-harm and suicide, especially in schools. Thus, there is the proposal of holistic, multi-component school-based interventions that integrate screening, gatekeeper training, stigma-reduction, and tailored support so as to reduce suicide-related conduct of youth. It is essential to perform additional studies in this area to establish the effectiveness of the interventions provided and determine their suitability to various types of schools.

References

DeVylder, J., Yang, L. H., Goldstein, R., Ross, A. M., Oh, H., Zhou, S., Horowitz, L. M., & Bridge, J. A. (2022). Mental health correlates of stigma among college students with suicidal ideation: Data from the 2020–2021 Healthy Minds Study. Stigma and Health, 7(2), 247–250. https://doi.org/10.1037/sah0000376.

Emmanuel N-B Quarshie, Waterman, M. G., & House, A. O. (2020). Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review. BMC Psychiatry, 20(1).https://doi.org/10.1186/s12888-020-02587-z

Hetrick, S. E., Aruni Subasinghe, Anglin, K., Hart, L., Morgan, A., & Robinson, J. (2020). Understanding the Needs of Young People Who Engage in Self-Harm: A Qualitative Investigation. Frontiers in Psychology, 10.https://doi.org/10.3389/fpsyg.2019.02916

Hu, H., Yang, X., Phoenix, Zhao, C., Kuang, B., Zhang, G., & Lin, G. (2022). How mobile phone addiction is associated with suicidal ideation in university students in China: Roles of depression and online social support. Frontiers in Psychology, p. 13.https://doi.org/10.3389/fpsyg.2022.1001280

Khaki, Z., Shama el-Salahi, & Cooper, M. (2022). Moderators and mediators of the association between bullying victimization and self-harm and suicide in adolescents: A systematic review. Psychiatry Research Communications, 2(2), 100030–100030.https://doi.org/10.1016/j.psycom.2022.100030

Peters, W., Rice, S., Cohen, J., Smith, N. B., McDonnell, C. G., Winch, A., Nicasio, A. V., Zeifman, R. J., Álvarez‐Jiménez, M., & Bendall, S. (2022). Subjective distress, self-harm, and suicidal ideation or behavior throughout trauma-focused cognitive-behavioral therapy in transitional-age youth. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra000128

Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M. (2013). A Systematic Review of School-Based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis-the Journal of Crisis Intervention and Suicide Prevention, 34(3), 164–182. https://doi.org/10.1027/0227-5910/a000168

Stagaki, M., Nolte, T., Feigenbaum, J., King-Casas, B., Lohrenz, T., Fonagy, P., & P. Read Montague. (2022). The mediating role of attachment and mentalizing in the relationship between childhood maltreatment, self-harm, and suicidality. Child Abuse & Neglect, 128, 105576–105576.https://doi.org/10.1016/j.chiabu.2022.105576

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