Objectives: This study aims to provide a systematic review and meta-analysis of the literature on the long-term effects of interventions addressing children’s and adolescents’ mental health literacy and/or stigmatizing attitudes.Methods: Articles in English or German published between January 1997 and May 2020 were retrieved from five databases, leading to a total of 4,375 original articles identified.Results: 25 studies were included after applying exclusion criteria, 13 of which were eligible for meta-analysis. The overall average of the follow-up period was about 5 months. Long-term improvements were sustained for mental health literacy, d = 0.48, 95% CI = (0.34, 0.62), as well as for stigmatizing attitudes, d = 0.30, 95% CI = (0.24, 0.36), and social distance, d = 0.16, 95% CI = (0.03, 0.29). The combination of educational and contact components within interventions led to worse results for mental health literacy, but not stigmatizing attitudes or social distance.Conclusion: Interventions targeting children and adolescents generally have a brief follow-up period of an average of 5 months. They show a stable improvement in mental health literacy, but are to a lesser degree able to destigmatize mental illness or improve social distance.

Low health literacy is considered to lead to worse health-related outcomes and behaviors and has therefore been recognized as a social determinant of health. While health literacy and its potential determinants have been studied in adults, little research has been conducted with children. This study aims to address this research gap by investigating factors associated with children’s subjective health literacy. Cross-sectional data was collected from fourth graders at German schools with a self-report questionnaire. Sociodemographic characteristics, health-related attitudes, and motivation were analyzed. We used hierarchical multivariate linear regression to explain variance in the dependent variable “subjective health literacy”. A total of n = 907 fourth graders were surveyed. Regarding health literacy, eight out of ten participants (82.2%) reported that it was “rather easy” or “very easy” to deal with health-related information. Family affluence, but not language spoken at home, was significantly related to subjective health literacy, after controlling for confounding. Moreover, parental health orientation, self-efficacy, and motivation are factors significantly associated with health literacy. Based on the results of this study, it is hypothesized that a general motivation to learn new things about health, as well as an environment promoting health-positive behavior, might foster children’s health literacy.

Schools are relevant settings for supporting refugee adolescents' mental health. As education and migration are important social determinants of health, we aim to integrate the qualitative findings of our mixed-methods study into a broader discussion regarding the role of schools and the potential effects on refugee adolescents' lives and mental health, as well as the impact of the COVID-19 pandemic. In this article, we present the findings of school-based actors' (i.e., teachers and school psychologists) perception of refugee adolescents' access to mental health care. The interviews highlight the importance of schools and social activities as main stabilizers and sources of support for refugee adolescents’ mental health and the role trusting school-parent relationships play in mental health care help-seeking. Our data indicate that schools lack the resources to properly address these needs. However, these structural gaps are rooted into historical segregation and discrimination in the German educational system and left unaddressed, can increase stigma and intergenerational social inequalities, especially in connection to the COVID-19 pandemic. We conclude our article with a set of recommendations that could be relevant and implemented across different contexts to strengthen the role of the school setting in promoting the mental health and well-being of refugee adolescents.

Background: Most mental health problems develop during youth, with about three quarter emerging before age 25. In adolescence, stigmatizing attitudes related to mental illness become more nuanced and consolidate into one’s belief system. As the stigma of mental illness is still one of the leading barriers to help-seeking, intervention measures should explicitly address it before it becomes entrenched over time. Preventive measures, for example, based on promoting mental health literacy (MHL), can be used to address and tackle stigmatizing attitudes. The Canadian MHL-based intervention “the Guide” was translated and adapted for the use in German schools. The present study evaluates the effect of the German version of the Guide on attitudes towards mental illness among students in Germany. Methods: The first-time application of the Guide (German version) was evaluated with a pre-post-evaluation study with an intervention and a control group. The evaluation data of 188 students (intervention group n = 106, control group n = 82) were statistically analyzed focusing on the outcomes social stigma, social distance, and self-stigma. Results: The analysis showed that participants do not tend to hold stigmatizing attitudes even before the intervention. Nevertheless, the intervention was effective in reducing social stigma, but not in reducing social distance and self-stigma. Neither gender, pre-existing experience with mental illness, nor the delivery modality of the contact element within the intervention (speaker vs. video) seemed to influence the outcomes. Conclusions: The German version of the MHL-based intervention, the Guide, seems to be a suitable intervention to improve attitudes towards mental illness among students in Germany. More extensive research is necessary to confirm the findings and further explore factors that influence the program’s effects on attitudes short- and long-term.

Background: Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention’s effects on mental health knowledge and help-seeking efficacy among 10^thgrade students in Germany.Methods: 10^thgrade students (aged 14–17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention’s effects.Results: Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574,p < 0.001, partial η² = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311,p < 0.001, partial η² = 0.09).Conclusion: The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10^thgrade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.

Zusammenfassung: Hintergrund: Die Bedeutung von Mental Health Literacy (MHL) junger Menschen für den Umgang mit psychischen Belastungen und Erkrankungen wird vermehrt betont und deren Stärkung in präventiven Maßnahmen anvisiert. Da in Deutschland kaum MHL-Programme existieren, wurde ein kanadisches, MHL-basiertes Unterrichtsprogramm adaptiert, eingesetzt und evaluiert. Zum Programm liegen international Wirksamkeitsnachweise vor (z. B. bzgl. Wissenszuwachs, Stigmaverringerung), jedoch keine Berichte, wie das Programm von der Zielgruppe angenommen wird. Die vorliegende Studie widmet sich der Rezeption der Schüler:innen und prüft, ob sich das Programm für deutsche Schüler:innen eignet. Ziel der Arbeit: Es wird die Rezeption des Programms durch Schüler:innen dargestellt, um Akzeptanz, Eignung und Bedarfsangemessenheit zu erörtern. Material und Methoden: Die deutsche Programmversion wurde in Bielefelder Schulen pilotiert und evaluiert. Über programmspezifische Fragen schätzten teilnehmende Schüler:innen das Programm ein. Ergebnisse: Schüler:innen der 9 teilnehmenden Klassen bewerteten das Programm insgesamt, unterschiedliche Programmaspekte sowie die Relevanz für Schüler:innen gleichen Alters positiv. Auch die Auswertung offener Angaben bestätigt, dass das MHL-Programm an Bedarfe und Interessen zum Thema psychische Gesundheit anschließt und Schüler:innen der heterogenen Stichprobe erreicht hat. Schlussfolgerung: Die Ergebnisse legen nahe, dass sich das adaptierte Programm für Schüler:innen an deutschen Schulen eignet. Weitere Studien sind nötig, um dies zu bestätigen. Neben Wirksamkeitsprüfungen sollten Programmevaluationen die Einschätzung der Zielgruppe integrieren, da diese Hinweise bzgl. Akzeptanz und Entwicklungspotenzial liefert.