Academic Editor: Melinda S.
Butsch Kovacic
Received: 29 April 2025
Revised: 13 October 2025
Accepted: 15 October 2025
Published: 16 October 2025
Citation: Asplund, A.; Kummel, M.;
Laaksonen, C.; Erjavec, K.; Sakellari, E.;
Santala, E.; Korhonen, J. Promoting
Mental Health Literacy of
13–16-Year-Old Students: A
Systematic Review. Int. J. Environ. Res.
Public Health 2025, 22, 1578. https://
doi.org/10.3390/ijerph22101578
Copyright: © 2025 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license
(https://creativecommons.org/
licenses/by/4.0/).
Systematic Review
Promoting Mental Health Literacy of 13–16-Year-Old Students:
A Systematic Review
Aino Asplund 1, Maika Kummel 1,*, Camilla Laaksonen 1, Karmen Erjavec 2 , Evanthia Sakellari 3 , Elina Santala 1
and Joonas Korhonen 1,4
1 Emergency Care, Public Health Nursing, Midwifery and Diagnostic Services, Faculty of Health and
Well-Being, Turku University of Applied Science, 20520 Turku, Finland; joonas.korhonen@turkuamk.fi (J.K.)
2 Faculty of Health Sciences, University of Novo mesto, 8000 Novo Mesto, Slovenia; karmen.erjavec@uni-nm.si
3 Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public
Health, University of West Attica, 115-21 Athens, Greece; sakellari@uniwa.gr
4 Department of Nursing Science, Faculty of Medicine, University of Turku, 20014 Turku, Finland
* Correspondence: maika.kummel@turkuamk.fi; Tel.: +358-400-364370
Abstract
Purpose: The global rise in mental health challenges among adolescents has led to the de-
velopment of targeted interventions, including those designed to promote young people’s
understanding and awareness of mental health. This systematic review aims to identify
and evaluate interventions implemented among secondary school students with the goal of
enhancing mental health literacy, and to assess their effectiveness in achieving this outcome.
Methods: This review was partially aligned with the PRISMA 2020 guidelines. Studies were
retrieved from four electronic databases—CINAHL Complete, PubMed, Academic Search
Elite, and ERIC—and supplemented by a limited number of relevant studies identified out-
side the systematic search. The analysis focused on the content, delivery, design, evaluation
methods, and outcomes of mental health literacy (MHL) interventions conducted in sec-
ondary schools internationally. Results: A total of 16 articles met the inclusion criteria. The
articles described a variety of different MHL interventions (n = 12). The findings indicate
that school-based MHL interventions have a positive impact on students’ knowledge and
understanding of mental health, but stigma reduction demonstrated less consistent effects.
Study population, country, intervention content, delivery, methods, outcome measures,
sample sizes and participants’ age range varied notably across the studies. Conclusions:
Based on the evidence synthesized in this review, school-based MHL interventions appear
to be effective and may serve as a valuable component in broader efforts to promote mental
health in adolescence. These findings reinforce existing evidence and provide a foundation
for practical implications, but future research is highly recommended for a more solid base
of evidence.
Keywords: mental health literacy; mental health promotion interventions; secondary
school students
1. Introduction
Mental health problems pose a significant challenge to the well-being of young peo-
ple [1–5]. These challenges arise from various reasons, including adverse experiences, peer
pressure, and identity-related issues commonly encountered during adolescence [5].
According to a recent meta-analysis, a significant proportion, approximately one-third,
of mental health disorder symptoms appear before the age of 14 [6]. Young people’s mental
Int. J. Environ. Res. Public Health 2025, 22, 1578 https://doi.org/10.3390/ijerph22101578
Int. J. Environ. Res. Public Health 2025, 22, 1578 2 of 23
health encompasses their ability to engage in work or education, build and maintain healthy
relationships, experience emotions and hope, communicate effectively, and continue learn-
ing [5]. It also plays a vital role in shaping self-esteem and overall well-being [7].
If the mental health concerns of young people are not recognized or treated [3], both
their mental and physical health may be negatively affected later in life. This may reduce
their chances of leading a fulfilling life in adulthood [5].
However, stigma related to mental health issues may prevent adolescents from access-
ing appropriate support [8,9]. This stigma is often linked to a lack of knowledge regarding
mental health conditions [10]. Therefore, early interventions aimed at addressing the factors
contributing to mental distress [4] may significantly impact the future well-being of young
people [8]. They may also contribute to the sustainability of society, given the burden of
mental health conditions on public health [11].
Consequently, it is essential to consider evidence-based, proactive measures to promote
mental well-being at early stages. These early interventions may include providing young
people with awareness of mental health issues [8] and fostering resilience to help them
navigate challenges and life transitions [5].
These elements are central to the concept of mental health literacy (MHL) [12]. A
contemporary and evolving understanding of MHL includes knowledge of how to achieve
and maintain good mental health, the ability to recognize and understand mental disorders
and their treatments, and the capacity to distinguish between typical mood fluctuations
and clinical conditions [10,12]. It also encompasses knowing when and where to seek help,
as well as cultivating anti-stigma attitudes, including the reduction in both self-stigma and
stigma directed toward others [13].
Since its early conceptualization, MHL has incorporated several elements, such as
awareness of self-help strategies [14] and coping mechanisms for managing stress [13],
which are closely linked to the concept of resilience [15]. Contemporary MHL interventions
targeting adolescents often include resilience-building components [16,17], such as problem-
solving [16] or the ability to adapt to challenging life events [15,18]. Crucially, adolescents’
resilience is a capacity that can be strengthened over time [15], and higher levels of MHL
are associated with greater resilience [19].
Schools are widely acknowledged as key environments for reaching large numbers
of students and play a pivotal role in shaping young people’s lives [20]. Adolescence is a
critical period for the implementation of these programs, given the emotional [5,21], social,
and cognitive [21] transitions that characterize this stage of development [9,16]. Within this
context, secondary school-based MHL programs are increasingly recognized as promising
approaches to address MHL-related issues, such as reducing stigma and encouraging
early help-seeking behaviors [11,22]. Research further suggests that such interventions can
significantly enhance students’ understanding of mental health-related issues and foster
more accepting attitudes [23–25].
Despite a growing body of research supporting the efficacy of MHL programs, several
important gaps remain. First, there is a lack of comprehensive reviews that systematically
evaluate the impact of MHL interventions specifically among adolescents aged 13–16—a
developmentally sensitive age group [9,21]. This age group corresponds to the target
population of the project on which this review is based. Second, the literature provides
limited insight into the relative effectiveness of different delivery formats, particularly
peer-led versus teacher- or professionally led approaches—an area that remains under-
explored [26]. Third, although the number of school-based MHL studies has increased,
variation in methodological approaches and evaluation tools limits the comparability and
generalizability of findings [9,23].
This systematic review aims to
Int. J. Environ. Res. Public Health 2025, 22, 1578 3 of 23
• Identify interventions implemented among secondary school students with the goal
of enhancing mental health literacy;
• Evaluate the aforementioned interventions;
• Assess interventions’ effectiveness among secondary school students with the goal of
improving mental health literacy.
Focusing on peer-reviewed studies published between 2013 and 2023, it captures
recent developments in the field and informs the evidence-based development of contextu-
ally appropriate MHL strategies within educational frameworks. The review addresses
three core research questions, emphasizing the focus areas and delivery of the MHL inter-
ventions; the study design and measurement tools; and the outcomes of the interventions.
The analysis is guided by an established conceptual definition of MHL, which includes
knowledge of mental health promotion, ability to recognize and understand mental disor-
ders and treatments, supporting help-seeking ability and reducing stigma [10,12,13] while
acknowledging that not all included studies explicitly adopt this framework.
2. Materials and Methods
2.1. Database Sources and Search Strategies
The literature search was conducted following the guidelines of the Preferred Re-
porting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 [27] conducted
on 20–21 June 2023. The databases CINAHL Complete, PubMed, Academic Search Elite,
and ERIC were used in the search. The following terms were used in the search: “mental
health literacy” OR “mental health education” OR “mental health knowledge” AND
intervention/“intervention” OR program/“program” OR education/“education” OR
method/“method” AND youth/“youth” OR adole/“adole*” OR “young people” OR
teen*/“teen*” OR pupil*/“pupil*” AND “secondary school” OR “high school” OR “sec-
ondary education” (Table 1). The following search modes were used (not all applicable to
all databases): Boolean/Phrase, 1 January 2013–31 December 2023, English language and
Text Word. The database search was supplemented with two additional articles via hand
search. The literature was reviewed between spring 2024 and spring 2025.
Table 1. Search terms used in different databases.
Database Search Terms Used
CINAHL Complete
“mental health literacy” OR “mental health education” OR “mental health
knowledge” AND intervention/”intervention” OR program/”program” OR
education/”education” OR method/”method” AND youth/”youth” OR
adole/”adole” OR “young people” OR teen/”teen” OR pupil/”pupil*” AND
“secondary school” OR “high school” OR “secondary education”
PubMed
“mental health literacy” OR “mental health education” OR “mental health
knowledge” AND intervention/”intervention” OR program/”program” OR
education/”education” OR method/”method” AND youth/”youth” OR
adole/”adole” OR “young people” OR teen/”teen” OR pupil/”pupil*” AND
“secondary school” OR “high school” OR “secondary education”
Academic Search Elite
“mental health literacy” OR “mental health education” OR “mental health
knowledge” AND intervention/”intervention” OR program/”program” OR
education/”education” OR method/”method” AND youth/”youth” OR
adole/”adole” OR “young people” OR teen/”teen” OR pupil/”pupil*” AND
“secondary school” OR “high school” OR “secondary education”
Int. J. Environ. Res. Public Health 2025, 22, 1578 4 of 23
Table 1. Cont.
Database Search Terms Used
ERIC
“mental health literacy” OR “mental health education” OR “mental health
knowledge” AND intervention/”intervention” OR program/”program” OR
education/”education” OR method/”method” AND youth/”youth” OR
adole/”adole” OR “young people” OR teen/”teen” OR pupil/”pupil*” AND
“secondary school” OR “high school” OR “secondary education”
The database search was conducted by one author. Two authors were primarily in-
volved in data extraction after the database search, and these results were further discussed
with other authors in line with the inclusion and exclusion criteria to decide whether
the article should be included. There were no discrepancies between the authors about
data extraction.
2.2. Inclusion and Exclusion Criteria
This review focuses on adolescents aged 13 to 16 years, aligning with the target group
of the broader European Union co-funded Erasmus+ project wExchange (KA220-SCH-
A9C42879; https://wexchange.turkuamk.fi/ (accessed on 2 September 2024)), which seeks
to promote youth mental health through virtual mobility. The inclusion and exclusion
criteria outlined in Table 2 were applied to all identified articles.
Table 2. Inclusion and Exclusion Criteria (adapted from Gierisch et al. [28]).
Study Characteristic Inclusion Criteria Exclusion Criteria
Study design Intervention studies
Non-experimental studies, editorials and/or
commentaries, book reviews and/or letters,
dissertations, study protocols
Population Includes secondary school students aged 13 to16 years
Includes other than secondary school students
between age 13 to 16
Intervention Mental health literacy promotion
General mental health promotion, diagnostics,
care or rehabilitation of mental health
challenges/illnesses, therapeutic interventions
Comparators Any other ordinary intervention/nointervention No control group
Setting Secondary school Any other setting
Outcomes Mental health literacy, sub-areas ofmental-health literacy Any other outcomes
Other Articles published between 2013 and 2023,peer-reviewed, published in English language
Articles published before 2013 or after 2023,
not peer-reviewed, published in languages
other than English
2.3. Study Selection
According to Figure 1, 234 articles corresponding to the search terms were initially iden-
tified through the selected databases. After the removal of duplicates, a total of 149 articles
remained for further screening. The study selection was based on the review of the titles and
abstracts of the articles against the eligibility criteria presented in Table 2; 118 were excluded,
leaving 31 articles for full-text reading. Of these, 16 articles were excluded due to: irrelevant
study design (n = 3), irrelevant intervention (n = 1), and lack of a control group (n = 12). The
database search was supplemented with two additional articles via hand search, of which one
was excluded due to an irrelevant study design. The other met the inclusion criteria and was
added to the number of articles included.
Int. J. Environ. Res. Public Health 2025, 22, 1578 5 of 23
 
Records (n = 234) identified from: 
CINAHL Complete (n = 50) 
PubMed (n = 64) 
Academic Search Elite (n = 87) 
ERIC (n = 33) 
Records removed before screening: 
Duplicate records removed 
(n = 85) 
Records screened 
(n = 149) 
Records excluded (n = 118): 
  -Not relevant to the topic (n = 38) 
  -Irrelevant intervention (n = 2) 
  -Irrelevant study design (n = 57) 
  -Irrelevant study sample (n = 21) 
Reports sought for retrieval 
(n = 31) Reports not retrieved (n = 0) 
Reports assessed for eligibility 
(n = 31) 
Reports excluded (n = 16): 
 
- Irrelevant intervention (n = 1) 
- Irrelevant study design (n = 3) 
- No control group (n = 12) 
Records identified from: 
Manual screening (n = 2) 
Reports assessed for eligibility 
(n = 1) Reports excluded (n = 0) 
 
Studies included in review 
(n = 16) 
Identification of studies via databases and registers Identification of studies via other methods 
Id
en
tif
ic
at
io
n 
Sc
re
en
in
g 
 
In
cl
ud
ed
 
Reports sought for retrieval 
(n = 1) Reports not retrieved (n = 1) 
Figure 1. PRISMA flow diagram of the search process (adapted from Page et al. 2021 [27]).
Int. J. Environ. Res. Public Health 2025, 22, 1578 6 of 23
3. Results
3.1. Characteristics of the Included Articles
A summary of the 16 articles included in the review is presented in Table 3. The articles
described 12 different interventions. Mental Health and High School Curriculum Guide was
described in three of the included studies [11,17,29]. The Adolescent Depression Awareness
Program (ADAP) was discussed in two studies [30,31]. It’s Time to Start Talking (ITTST),
Finding Space for Mental Health, teen Mental Health First Aid, Innate Health Education and Re-
silience Training (iHEART), Rational Emotive Behaviour Therapy (REBT), Guide Cymru, Mental
Health Matters (MHM), and the Short MHL Programme (SMHLP) [9,32–37] each featured in
one study. Additionally, three studies described unnamed interventions [8,38,39].
The included articles were published between 2014 and 2023. The studies were
conducted in a range of countries across the globe. Correspondingly, interventions were
organized in many countries (e.g., in Japan, Egypt, and Nigeria) and thus conducted not
only in English but also in other languages. The Mental Health and High School Curriculum
Guide intervention was examined in Canada, Iran, and Nicaragua [11,17,29]. All other
interventions were studied in a single country each, including Australia [32], Canada [29],
Egypt [8], Greece [39], Iran [11], Ireland [26], Japan [37], Nicaragua [17], Nigeria [38],
Norway [34], Portugal [9], the UK [33,35], and the USA [30,31,36].
The sample size across the included studies ranged from N = 59 [39] to N = 6679 [30]
and the study population between ages 10 and 25. The participants’ age range was relatively
narrow, two to three years, in some of the studies [9,11,30–32,37] while some studies
included participants across a very broad, eight to eleven, age spectrum [17,38].
Int. J. Environ. Res. Public Health 2025, 22, 1578 7 of 23
Table 3. Review of the final studies.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Abd El Salam et al.
(2023) Egypt
Evaluate impact of the
intervention on students’
knowledge and attitudes
towards mental illness
and perceptions on
help-seeking.
CRCT
Pre-test: n = 416
Post-test: n = 224
(allocated to intervention
and control groups)
Age of the participants
(years): 13–18
Unnamed intervention
Focus:
Stigma
Mental illness
Barriers to help-seeking
Methods: A didactic
component, group
discussions, homework
exercises, videos, lectures,
slide shows and panel
discussions.
Delivery: Teacher led
3 lessons/week under
1 month
20–30 min/lesson
Adapted version of MINI
international
neuropsychiatric interview
for children and
adolescent questionnaire
Pre–post test (6 month
follow up)
Positive effects on the
beliefs of mental illness
being like any other
illness, the incorrect
belief of mental illness
being an evil spirit.
Decreased stigma
(except for marrying a
person with mental
illness)
Positive effects on
willingness to seek
help from family
members or healthcare
workers
Bella-Awusah et al.
(2014) Nigeria
Evaluate impact of the
intervention on mental
health literacy and
reducing negative views
about persons with
mental illness
NRCT
Intervention group
n = 78
Control group n = 76
Age of the participants
(years): 10–18
Unnamed intervention
Focus:
Views on mental health
Behaviors indicating mh
challenges
Understand limitations
regarding responsibility
Ways to support peers
Strategies to promote mh
Methods: Group work,
discussions, presentations,
case vignettes
Delivery: two project staff
A 3 h mental health
awareness session.
Modified version of the
UK Pinfold questionnaire.
Statements were added to
the original questionnaire
based on myths and beliefs
surrounding mental illness
in the Nigerian context.
Small positive changes
in knowledge but not
in attitudes and social
distance.
Int. J. Environ. Res. Public Health 2025, 22, 1578 8 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Booth et al. (2023)
Ireland
Evaluate impact of the
intervention on mental
health literacy and
reducing negative views
about persons with
mental illness.
NRCT
Peer-led workshops
n = 245
Adult-led workshops
n = 291
Age of the participants
(years): 12–17
It’s Time to Start Talking
(ITTST)
Focus:
Attitudes to mental health,
Promote help-seeking
Identify trusted informal
sources of support
Information about how to
access formal support
Methods: Workshop
Delivery: Peer-led, adult-led
40 min workshop Author-designed
questionnaire
The General Help Seeking
Questionnaire
Mental health
knowledge and
help-seeking intentions
improved in both peer-
and adult-led groups
Campos et al.
(2018) Portugal
Evaluate impact of the
intervention on mental
health literacy
RCT
Intervention group
n = 259
Control group n = 284
Age of the participants
(years): 12–14
Finding Space for Mental
Health
Focus:
Mental health knowledge
Stigma
Help-seeking
First-aid skills
Self-help
Methods: Group dynamics,
music, videos
Delivery: Psychologist and a
psychology student
2 lessons (2 weeks)
90 min/lesson
Mental Health
Literacy questionnaire
(MHLq)
Pre–post test (1 week,
6 months
after intervention)
Intervention group
showed higher
improvement in MHL
when compared to the
control group
Gender differences:
Boys showed less
intention to seek help
and to help someone in
need compared to girls
Int. J. Environ. Res. Public Health 2025, 22, 1578 9 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Hart et al.
(2020) Australia
Evaluate impact of the
intervention on peer
support for adolescents
at risk of suicide and
examine whether
participation in a
program is distressing to
participants.
CRCT
Control group (physical
first aid) n = 790
Intervention group:
n = 807
Age of the participants
(years): 15–17
Teen Mental Health First
Aid aimed
Focus:
Peer support towards
adolescents at risk of suicide
Methods: presentation,
training, videos, role-plays,
group discussion, small
group and workbook
activities
Delivery: Trained extractor
3 × 75 min classroom
sessions (within 3 weeks)
A questionnaire including
items adapted from the
Australian National
Survey of Youth Mental
Health Literacy
Positive outcomes on
recognition of
suicidality and
appropriate first aid
intentions towards a
peer at risk of suicide
12 months after
training, most effects
were still significant.
Intervention
participants reported
feeling briefly
distressed after the
training, but not at
12 months follow up
Kelley et al.
(2021) UK
Evaluate impact of the
intervention on mental
well-being and
resilience.
NRCT
Intervention group
n = 205
Control group n = 64
Age of the participants
(years): 11–15
Innate Health Education and
Resilience training (iHEART)
Focus:
Information on resilience
and mental wellbeing
Methods: Animations,
video clips, exercises, games,
group activities
Delivery: trained facilitator
10 consecutive weeks
50 min/lesson
Warwick-Edinburgh
Mental Well-being Scale
(WEMWBS)
Inside-Out Resilience
Questionnaire (I-ORQ)
Pre–post test
3 questions on participants’
perceptions of the
intervention: resilience
and mental well-being
Post test only
Positive effects on
mental well-being,
resilience and impulse
control
Int. J. Environ. Res. Public Health 2025, 22, 1578 10 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Milin et al. (2016)
Canada
Evaluate impact of the
intervention on mental
health knowledge and
stigma.
RCT
Intervention group
n = 362
Control group n = 172
Age of the participants
(years): mean age 16.5
The Mental Health and High
School Curriculum
Focus:
Understanding of mental
health and illness
Reduce stigma
Promote help-seeking
behaviors
Methods: Curriculum Guide
of 6 modules. These
modules contain a lesson
plan embedded classroom
activities and resources
~6 h (mainly within 4
weeks)
Questionnaires on primary
outcome measures of
mental health knowledge,
attitudes and stigma
Pre–post test
Positive effects on
mental health
knowledge and
reduction in stigma
Miller et al. (2019)
USA
Evaluate impact of the
intervention on
depression literacy and
stigma of teachers and
their students.
RCT
Teachers n = 66
Students n = 6679
Intervention group
n = not reported
Control group n = not
reported
Age of the participating
students (years): 14–16
Adolescent Depression
Awareness Program (ADAP)
Focus:
Support treatment-seeking
behavior
Reduce stigma
Increasing depression
literacy
Methods: depression
education as part of the
standard high school health
education curriculum
Delivery: Teacher led
Teachers received 6 h
ADAP-manualized
training: included
program and medical
overview,
implementation
instructions, education
kit (teaching manual,
PP-lectures, group
activities, handouts and
DVDs.)
ADAP intervention was
administered to students
as part of 2–3 of the
standard health
curriculum classes.
The Adolescent
Depression Knowledge
Questionnaire (ADKQ)
The Reported and
Intended Behavior Scale
(RIBS)
Pre–post test
Teacher depression
literacy was associated
with student
depression literacy but
not with student
stigma.
Teacher stigma was not
related to student
depression literacy or
stigma
Int. J. Environ. Res. Public Health 2025, 22, 1578 11 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Ravindran et al.
(2018) Nicaragua
Evaluate impact of
intervention on
knowledge, stigma,
psychological distress,
substance use, stress,
resilience and quality of
life.
NRCT
Intervention group
n = 567
Control group n = 346
Age of the participants
(years): 14–25
Mental Health Curriculum
(MHC)
Focus:
Stigma
Knowledge on mental health
and illness
Experiences of mental illness
Help-seeking
Positive mental health
Methods: Education for
teachers and students,
guide for teachers, website
on MHC (articles,
presentations, videos,
stories), message board
forums
Delivery: Teacher led
12 consecutive weeks
60 min/lesson
Mental Health Knowledge
and
Attitudes Scale (MHKAS)
Attitudes subscale
The Brief COPE (coping
strategies)
The CRAFT (alcohol and
drugs)
The General Health
Questionnaire—12
(GHQ-12)
The Health-Promoting
Lifestyle Profile
II (HPLP II)
The Perceived Stress Scale
(PSS)
The Quality of Life Scale
(QOL)
The Resilience
Scale—Short Form (RS-14)
Pre–post test (12 weeks)
Positive effects on
mental health
knowledge, healthy
lifestyle choices,
adaptive coping,
reduction in stigma
and perceived stress
Int. J. Environ. Res. Public Health 2025, 22, 1578 12 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Sakellari et al.
(2014) Greece
Evaluate impact of
intervention on
perceptions of people
with mental illness
through drawings,
describe these
perceptions, and test the
possible changes in
perceptions after an
educational mental
health intervention
NRCT
Intervention group
n = 28
Control group n = 31
Age of the participants
(years): 13–16
Unnamed intervention
Focus:
Knowledge and
understanding of mental
health and illness
Prevention and treatment of
mental illness
Myths and truths about
mental health
Methods: Education,
discussion, messages to take
home.
Delivery: Teacher led
2 teaching hours
(approximately 60 min of
presentation and 30 min
of discussion)
Drawings on people with
mental illness
Pre–post test
Positive effects on
presenting people (in
the drawings) with
mental illness
Simkiss et al.
(2023) UK
Evaluate impact of
intervention on mental
health knowledge,
stigma and help-seeking
CRCT
Total N = 1926
Age of the participants
(years): 13–14
The Guide Cymru
Focus:
Knowledge of mental health
and illness
Stigma
Experiences of mental illness
Help-seeking and finding
support
Positive mental health
Methods: Not described in
the article
Delivery: teacher led
10–12 weeks The Knowledge and
Attitudes to Mental Health
Scales (KAMHS)
Pre–post test
Positive effects on
mental health
knowledge and
behavior, intentions to
seek help and avoidant
coping
Positive effects on
stigma to others and
self-stigma even
though result on
self-stigma was less
clear
Int. J. Environ. Res. Public Health 2025, 22, 1578 13 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Sælid and Nordahl
(2017) Norway
Evaluate and compare
impacts of interventions
on self-esteem and hope,
reducing symptoms of
anxiety, depression, and
dysfunctional thinking
RCT
REBT group n = 21
ATP group n = 21
Control group n = 20.
Age of the participants
(years): 16–19
Rational emotive behavior
therapy REBT
Focus:
Recognize distressing
thinking, behavior and
beliefs
Methods: Therapeutical
sessions
Delivery: Therapist
REBT: 3 sessions,
ATP: 3 sessions
Hospital Anxiety and
Depression Scale (HADS)
The Rosenberg Self-Esteem
Scale (RSES)
Herth Hope Index (HHI)
Dysfunctional Attitude
Scale (DAS-A)
Satisfaction evaluation.
Pre–post test (6 month)
Both interventions
reduced symptoms of
anxiety and
depression, increased
self-esteem and hope.
Only REBT reduced
dysfunctional thinking
Swartz et al.
(2017) USA
Evaluate effects of
intervention on
depression literacy,
sustainability of change
and receipt of mental
health treatment
RCT
Intervention group
n = 3681
Control group n = 2998
Age of the participants
(years): 14–15
Adolescent Depression
Awareness Program (ADAP)
Focus:
Information about
depression symptoms and
treatment
Understanding depression
as a medical illness similar
to other illnesses
Understanding connection
between depression and
suicide
Decreasing stigma
Methods: interactive
lectures as part of health
education, videos, film
assignments, homework,
group activities and teaching
kit (e.g., instructor’s manual)
Delivery: Teacher led
2–3 lessons (3 h in total)
45–90 min/lesson
Adolescent Depression
Knowledge Questionnaire
(ADKQ)
Reported and Intended
Behavior Scale (RIBS)
Pre–post test (6 week, 4
month)
Child and Adolescent
Services Assessment
4-month post test only
Positive effects on
depression literacy.
No effects on stigma
Int. J. Environ. Res. Public Health 2025, 22, 1578 14 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Weisman et al.
(2016) USA
Evaluate effects of
intervention on mental
health knowledge and
stigma
NRCT
Study 1.
Teachers n = 7
Students, intervention
group n = 142
Age of the students
(years): 11–13
Study 2.
Students n =120
Intervention group n =
unclear
Control group n =
unclear
Age of the students
(years): 12–14
The Mental Health Matters
(MHM)
Focus:
Knowledge of mental health
and illness
Decrease stigma
Methods: curricula included
interactive language arts
activities, theater play,
handouts, home- and
groupwork, planning a
poster on a mental health
disorder, note-taking and a
game.
Delivery: community
volunteers
5-day sessions Knowledge (19- item test)
Revised Attribution
Questionnaire (rAQ),
Attitudes Toward Serious
Mental Illness Scale
Adolescent Version
ATSMI-AV
Open ended questions
Pre–post test
Evaluation form on
acceptability of the
intervention
Post test only
MHM was perceived
acceptable
Positive effects on
knowledge.
Controversial results
on reduction in stigma
Yamaguchi et al.
(2020) Japan
Evaluate effects of the
intervention on
knowledge of mental
health and illness,
help-seeking and peer
support
CRCT
Intervention group
n = 364
Control group n = 611
Age of the participants
(years): 15–16
Short MHL Program
Focus:
Knowledge on common
mental disorders and
symptoms
Mental health problems
closely associated with
lifestyle
Seeking help from reliable
adults
Peer-support skills
Methods: 2 animated films,
class discussions
Delivery: a health care
teacher and class teacher
Two 50 min sessions Questions regarding
general knowledge about
mental health and illnesses
2 vignettes describing
cases regarding depression
and schizophrenia. The
vignettes were adapted
from those in Jorm et al.
(1997). After reading the 2
vignettes, students were
asked questions related to
the topics.
Pre–post test
Positive effects on
knowledge,
recognition of the
necessity of seeking
help, intentions of
seeking help and
helping peers
Int. J. Environ. Res. Public Health 2025, 22, 1578 15 of 23
Table 3. Cont.
Author/Year/Country Study Focus Study Design andPopulation
Name, focus and delivery
of Intervention
Duration of
Intervention Evaluation Tools
Intervention
Outcomes
Zare et al.
(2021) Iran
Evaluate effects of the
intervention on mental
health promotive
behaviors
RCT
Intervention group
n = 110
Control group n = 110
Age of the participants
(years): 13–15
Mental Health and High
School Curriculum Guide
Focus:
Information on mental
health and illness
Stigma
Help-seeking/support
Positive mental health
Self-help
Methods: lectures based on
interaction, group activities,
role-play, independent
learning
Delivery: Teacher led
6 lessons (6 weeks)
60–90 min/lesson
MHL questionnaire Positive effects on
overall MHL,
knowledge, reducing
stereotypes and
self-help strategies
Abbreviations: MHL mental health literacy, RCT Randomized Controlled Trial, CRCT Cluster Randomized Controlled Trial, NRCT Non-randomized controlled trial.
Int. J. Environ. Res. Public Health 2025, 22, 1578 16 of 23
3.2. Focus Areas and Delivery of the Mental Health Literacy Interventions
As outlined in Table 3, the included studies aimed to evaluate the outcomes of several
(n = 12) different MHL interventions implemented in secondary school settings.
The interventions Finding Space for Mental Health [9], The Mental Health and High School
Curriculum Guide [11,17,29], the Short MHL Programme (SMHLP) [37], Guide Cymru [35],
It’s Time to Start Talking (ITTST) [32], The Mental Health Matters [36], the intervention
described by Abd El Salam et al. [8] and Bella-Awusah et al. [38] focused on multiple
MHL subdomains, including mental health knowledge, stigma reduction, help-seeking,
and self-help strategies.
The Innate Health Education and Resilience Training (iHEART) program focused on re-
silience and wellbeing among young people [33], while Sakellari et al. [39] presented an
intervention specifically designed to promote adolescents’ positive perceptions of individu-
als experiencing mental health challenges.
Some of the interventions included did not target general subareas of MHL but
focused on specific mental health challenges. The Adolescent Depression Awareness Program
(ADAP) focused on increasing depression literacy [30,31] and Rational Emotive Behavior
Therapy (REBT) [34] on increasing self-esteem, hope and reducing anxiety, depression, and
dysfunctional behavior. The Teen Mental Health First Aid [32] focused on peer support for
adolescents at risk of suicide.
The interventions varied in how they were delivered. Several studies (n = 7) de-
scribed interventions delivered by schoolteachers who had received specific training be-
forehand [11,17,29–31,35,37]. Two studies described peer-led interventions [26,32]. Some
interventions were delivered by therapists [34] and psychologists [9], while others by re-
searchers, project staff, trained facilitators [8,33,38,39] or trained community members [36].
The duration of the interventions varied considerably, ranging from a single 40 min
workshop [26] to weekly 60 min lessons implemented over 10–12 weeks [17]. The Mental
Health and High School Curriculum Guide varied in duration across studies [11,17,29]. Most
commonly, interventions consisted of two to three lessons or sessions, each lasting between
20 and 90 min [8,9,30,32,34,37–39]. The studies highlighted a diverse range of methods,
including a website featuring articles and stories [17], lectures [8,11,30], slide shows and
panel discussions [8], role-play, self-directed learning [11], animations, exercises, games [33],
videos [9,30,33], music [9], question-and-answer activities [11], and collaborative group
work [9,11,30,33].
3.3. Study Design and Measurement Tools
The study designs were cluster-randomized controlled trials [8,11,32,35,37], random-
ized controlled trials (RCTs) without a cluster component [9,29–31,34] and non-randomized
controlled trials [17,26,33,36,38,39].
Most studies (n = 13) adopted a quantitative approach [9,11,17,26,29–32,34–38], while
the remaining (n = 3) employed a mixed-methods approach [8,33,39].
A variety of quantitative and qualitative measurement tools were employed to assess
the outcomes of the respective interventions. In addition to demographic questionnaires
and study-specific, author-developed tools [11], several (n = 13) previously developed and
validated questionnaires were identified across the studies [8,9,17,26,30–36,38].
As summary, most studies employed different measurement tools to assess similar
outcomes. Only a few instruments, the Mental Health Literacy Questionnaire (MHLq) [9,32],
the Adolescent Depression Knowledge Questionnaire, and the Reported and Intended
Behavior Scale [30,31] were used in more than one study. Only a few studies reported
follow-up testing (n = 5). Time of follow-up varied between three [17], four [30] and
six [8,9,34] months.
Int. J. Environ. Res. Public Health 2025, 22, 1578 17 of 23
3.4. Outcomes of the Interventions
According to this systematic review, MHL interventions achieved several positive
outcomes; however, some results were modest or limited in their effectiveness (Table 3).
The reported interventions increased secondary school students’ knowledge of mental
health [9,11,17,26,29,35–38], help-seeking and [8,9,26,35,37] self-help abilities [9,11], re-
duced stigma [8,11,35,36,39], and supported impulse control and resilience [33].
Studies focusing on interventions targeting specific mental health challenges also
reported positive outcomes. Students reported being more likely to recognize suicidality
in a peer and provide appropriate help [32], reported reduced symptoms of depression
and anxiety, and increased self-esteem and hope [34], as well as improved depression
literacy [30]. Some studies reported no or modest effects on attitudes, social distance [38],
and stigma [17,30,35].
When examining specific aspects of MHL more closely, six studies [8,9,11,17,30,35]
addressed issues related to mental health knowledge, with Swartz et al. [30] focusing on
depression literacy. All the referenced studies indicated positive findings in increasing
mental health knowledge, covering information on mental health, causes of mental illness,
and specific mental health conditions [11] as well as their symptoms [30]. Additionally, Abd
El Salam et al. [8] reported positive results in altering potentially culture-related perceptions
of mental health issues as being due to supernatural powers, with students showing a
significant decrease in their belief that mental illness is caused by evil spirits (p < 0.001).
The importance of different interventions in contributing to help-seeking preferences
was also evident [8,9,11,35]. Despite positive findings regarding the increase in help-
seeking, Abd El Salam et al. [8] found an adverse outcome when students sought help from
their peers rather than professionals, thereby risking the spread of misleading information
about mental health. However, Ravindran et al. [17] did not find a significant difference
between the intervention and control groups in help-seeking tendencies. Campos et al. [9]
suggested that girls are more willing to seek help for mental health conditions than boys,
even though gender did not significantly affect the intervention’s effectiveness.
Regarding resilience, the effectiveness of the interventions remains inconclusive. The
Mental Health Curriculum study by Ravindran et al. [17] found no significant differences
between the intervention and control groups in terms of improving resilience. Similarly,
the study by Kelley et al. [33] indicated that the “iHEART” intervention did not lead to
significant improvements in resilience when assessed using quantitative methods (r = 0.14).
However, qualitative data yielded more promising results.
The interventions varied in their effectiveness in addressing mental health-related
stigma. Several studies [8,9,11,17,35] reported positive effects of MHL interventions in
reducing stigma. Swartz et al. [30] did not report any significant impact on stigma while
Simkiss et al. [35] observed improvements in stigma towards others (p < 0.001) but found no
clear evidence on effectiveness in addressing self-stigma (p = 0.59). Nevertheless, the study
highlighted the importance of MHL interventions in increasing young people’s willingness
to talk about mental health. Abd El Salam et al. [8] also found that, despite overall positive
changes in attitudes through education, students remained unwilling to marry a person
with a mental illness. Campos et al. [9] reported greater intervention effectiveness in
reducing stereotypes among individuals who knew someone with a mental illness.
4. Discussion
4.1. Summary of Findings and Comparison with Previous Studies
This systematic review aimed to identify and evaluate interventions implemented
among secondary school students with the goal of enhancing mental health literacy, and to
assess their effectiveness.
Int. J. Environ. Res. Public Health 2025, 22, 1578 18 of 23
In summary, it can be concluded that a total of 16 articles met the inclusion criteria. The
articles described a variety of different MHL interventions (n = 12) and took place in various
countries worldwide. Several interventions focused on multiple MHL subdomains, but
some of them focused on specific mental health challenges. The interventions differed both
in how they were delivered and, in their duration, which varied considerably. The studies
included cluster-randomized controlled trials, standard randomized controlled trials, and
non-randomized controlled trials. A variety of quantitative and qualitative measurement
tools were employed to assess the outcomes of the respective interventions. School-based
MHL interventions generally increased secondary school students’ knowledge of mental
health [9,11,17,26,29,35–38], help-seeking and self-help abilities [8,9,11,26,35,37], reduced
stigma [8,11,35,36,39], and supported impulse control and resilience [33]. These findings
are in line with previous research [11,22–25].
Improved mental health knowledge enhanced understanding of mental health is-
sues [9,11,17,35], including more specific acceptance of mental health concerns within
oneself and others [35]. Interventions also helped conceptualize mental illness similarly to
other medical conditions and challenged non-evidence-based assumptions about mental
health [8].
Not all outcomes were consistently positive, particularly in relation to stigma. Some
interventions showed positive results in reducing stigma [8,17,29,35] whereas some showed
no effect [30,36]. This finding is consistent with a broader societal reluctance to discuss
mental health issues openly, despite efforts by professionals to frame mental illnesses
as equivalent to physical health conditions [7]. The mixed results found in this review
reflect previous studies reporting both effective stigma reduction [24,25] and inconsistent
outcomes [40]. Self-stigma was identified as more resistant to change than stigma towards
others [35].
Stigma is a major barrier for help-seeking [13,41] and stigmatizing attitudes were
found to stem from various factors, including religious beliefs, supernatural interpretations,
and limited access to evidence-based information [13]. Increased mental health knowledge
and familiarity with mental health conditions play key roles in stigma reduction [13,41].
Additional cultural and societal barriers—such as concerns about confidentiality or a
lack of exposure to mental health discussions—can further discourage help-seeking [9,40].
In some cases, the presence of mental health problems within families was linked to
increased secrecy and reluctance to talk openly [42].
It can be concluded, that the results demonstrate considerable heterogeneity. Some
outcomes, such as knowledge and general stigma reduction, were consistently positive,
while others, such as attitudes and self-stigma, showed mixed or limited effects. Differences
also arose based on the type of intervention, who delivered it, cultural and gender factors,
and whether the intervention targeted general mental health literacy or specific challenges.
Comparing effectiveness between the identified, school-based MHL interventions is
difficult as notable variation emerged in focus areas, specific aims and implementation of
the interventions as well as study designs, settings, population, participants and outcome
measures. Most studies used previously validated measurement tools, but surprisingly,
some of these tools were used in different studies to assess different outcomes. Moreover,
some articles lacked a clear description of the research methodology resulting in the
impossibility of assessing the quality of the data and validity of the reported results.
4.2. Implication for Practice and Future Research Directions
The studies reviewed were conducted in a variety of sociocultural contexts (e.g., Iran,
the UK, Nicaragua, Egypt, the USA, Portugal), underscoring how cultural norms, values,
and health beliefs shape the implementation and reception of MHL interventions. One may
Int. J. Environ. Res. Public Health 2025, 22, 1578 19 of 23
speculate that deeply rooted cultural factors associated with stigma may necessitate more
context-specific anti-stigma strategies whereas promoting knowledge and help-seeking
behaviors may be more universally transferable. Future research would benefit from
directly comparing culturally adapted and standardized MHL interventions, along with
their culturally validated measurement tools, across different regions. Additionally, it
would be valuable to examine which components, such as peer-led sessions, teacher
facilitation, or community involvement, are most effective in specific cultural contexts.
It would also be recommended to assess teacher- and professional pathways as well as
gender-specific effects of MHL interventions in different socio-cultural environments.
While randomized controlled trials (RCTs) are recommended for evaluating interven-
tion effectiveness [43–45], the exclusion of studies without control groups may reduce the
diversity of evidence and introduce a bias favoring RCTs and non-randomized controlled
trials (NRCTs), potentially overlooking valuable insights from alternative study designs.
Consequently, some potentially relevant pre–post studies were not included in the review,
which may have impacted on the comprehensiveness of the findings. Nevertheless, to
determine long-term impacts and the sustainability of the outcomes, further follow-up
studies are required. Many interventions demonstrated short-term benefits, but only a few
studies assessed outcomes beyond several months. Longitudinal well established RCTs in-
cluding follow-ups, ideally over multiple years, are essential to capture sustained changes
in knowledge, behavior, stigma, resilience, and other psychosocial outcomes evolving
throughout adolescence.
Peer-led approaches have shown promise in enhancing MHL [23,40]. However, only a
few peer-led interventions were identified in this review, highlighting a notable gap for
further exploration. Future research should compare the outcomes of peer-led interventions
with those led by teachers or professional facilitators to determine their relative effectiveness
and feasibility. Such comparisons would help clarify whether peer-led models can improve
engagement, reduce stigma, and contribute meaningfully to sustainable MHL initiatives in
secondary schools.
Although school-based MHL interventions are often seen as cost-effective due to
their broad reach and use of existing infrastructure, their long-term viability warrants
closer examination. Teachers may require specialized training and support, and updating
program materials can add costs. Sustaining these initiatives beyond the research phase is
also challenging. Without continued funding or institutional backing, benefits may fade.
4.3. Strengths and Limitations
One of the strengths of this review lies in a relatively high number of included studies
(n = 16) and the contribution to the previous evidence base concerning varied impacts of
MHL interventions. Notably, the literature search applied no geographical restrictions,
thereby incorporating evidence from a wide range of countries across different continents.
In addition, the inclusion of diverse study designs may offer a broader insight into the
effectiveness of MHL interventions.
While this review provides valuable insights into school-based MHL interventions,
several limitations must be acknowledged. The wide variety of interventions, methodolo-
gies and measurement tools used to assess similar concepts, causes evidence to be scattered.
The heterogeneity in definitions of MHL and the varying components of interventions
across studies may impede robust meta-level conclusions. Establishing consensus on core
MHL constructs would support more accurate comparisons of outcomes. Moreover, the
validity of exclusion of studies, lacking a control group design, may have led to the omis-
sion of potentially strong evidence, thus narrowing the analytical scope of this review. It
may be considered that this review was affected by publication and cultural bias. Because
Int. J. Environ. Res. Public Health 2025, 22, 1578 20 of 23
studies with strong research methods were selected and differences in available resources
exist between countries, not all regions or backgrounds may be represented. As a result,
the perspectives and contexts represented may be limited.
One may also point out the wide variety of study participant number and age range as
potential limitations on validity of the summarized study outcomes. The review was limited
to studies published primarily in English, potentially excluding effective interventions
reported in other languages or in the gray literature.
Future systematic reviews should aim to expand their scope by searching additional
databases, extend the publication timeframe, and explicitly focus on specific features, such
as peer-led MHL programs to address current gaps in the literature.
5. Conclusions
Based on the evidence synthesized in this review, school-based mental health literacy
(MHL) interventions appear to be effective and may serve as a valuable component in
broader efforts to promote adolescent mental health. These findings reinforce existing
evidence and provide a foundation for practical implications.
This review highlights various factors, including lesson plan standardization, peer-
support elements, and curricular integration. These factors can inform the practical design
and implementation of MHL programs in secondary schools. The evidence is, however,
still scattered. Several school-based MHL interventions have been identified, but the
effectiveness of these interventions has been reported mainly in only one or very few
studies. Future research should adopt longitudinal follow-ups and solid research designs
and methods to validate and extend findings, ensuring that MHL initiatives remain both
feasible and effective in diverse educational settings.
Author Contributions: A.A. was primarily responsible for data collection and analysis. M.K. and J.K.
supervised the development of the review, including data collection, analysis, and interpretation of
the findings. J.K. ensured the conceptual and methodological integrity of the review. C.L. reviewed,
corrected, and revised the drafted results. E.S. (Evanthia Sakellari) and K.E. contributed to the
evaluation and improvement of the manuscript. E.S. (Elina Santala) guided the formulation of the
research questions and the overall focus of the review as part of a broader EU-funded project. All
authors meet the authorship criteria as defined by the latest guidelines of the International Committee
of Medical Journal Editors (ICMJE). All authors have read and agreed to the published version of
the manuscript.
Funding: This review forms part of the European Union co-funded Erasmus+ project “wExchange—
Promoting mental well-being through online exchange in secondary schools” (2022-1-FI01-KA220-
SCH-000087764). This publication reflects the authors’ views. The European commission cannot be
held responsible for any use of the information contained herein.
Institutional Review Board Statement: This systematic review was conducted in accordance with
established ethical principles and codes of research integrity. Core values such as human dignity,
confidentiality, justice, and beneficence were upheld throughout all stages of the review process, in
line with recognized ethical guidelines [46–48]. This study was originally developed as part of a
bachelor’s thesis. A reflective report related to the thesis, written as a demonstration of competence,
has been previously published. However, this report focused solely on the author’s learning process
and the procedural aspects of conducting the thesis. It did not include any research findings or results.
Accordingly, all results and analyses presented in this manuscript are previously unpublished and
entirely original.
Informed Consent Statement: This systematic review did not involve vulnerable individuals or real
people; therefore, informed consent was not required.
Conflicts of Interest: The authors declare no conflicts of interest.
Int. J. Environ. Res. Public Health 2025, 22, 1578 21 of 23
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