A cluster randomized trial of the impact of school-based, universal, mental health screening and feedback on students' mental health and help-seeking

Objective: Most children and adolescents with mental disorders do not access appropriate help, facilitating a lifetime of entrenched difficulties. School-based, universal, mental health screening has been used as one method to increase pediatric service use and subsequently reduce mental health problems. Despite its popularity, there are no randomized trials that demonstrate the efficacy of this method to improve pediatric mental health. Method: The current trial randomly allocated 84 schools, of which 53 provided data (10,660 students; aged 7.4-19.0 years) across the state of New South Wales, Australia, to receive either immediate screening with caregiver feedback or no screening. Approximately 12 months later, students in all schools were assessed for mental health, service use, and school attendance. Results: At 12 months, students enrolled in schools that received screening with feedback 12 months earlier self-reported lower total mental health difficulties (primary outcome) than students enrolled in schools that did not engage in screening (mean difference= 0.09, SE = 0.02, t(6713) = 3.78, p < .001, 95% CI difference = 0.04 to 0.13). Interestingly, the groups did not differ significantly on use of mental health services over the previous year (primary outcome) (mean difference = 0.00, SE = 0.02, t(6707) = 0.19, p = .851, 95% CI difference = −0.04 to 0.03). Schools that engaged in screening reported fewer days’ absence for students than did control schools. Conclusion: This is the first randomized trial indicating that school-based screening with feedback to caregivers may reduce mental health difficulties, although the mechanism through which this occurs remains unclear. Study preregistration information: Development and validation of a universal mental health screening tool and follow-up referral system to identify at-risk students in Australian schools; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380905