Against this backdrop, a new narrative review published in Discover Mental Health by Remedios Aguilar-Moya, Raquel Ibáñez-Martínez and David Melero-Fuentes of the Catholic University of Valencia asks a deceptively simple question: what does the scientific literature actually tell us about school-based programmes that try to prevent mental disorders and addictions together? The question matters because the two problems are deeply intertwined. Addictions frequently function as coping mechanisms for psychological distress, and substance use typically begins early, at precisely the developmental stage when the brain, family dynamics and social identity are all in flux. Yet, as the authors note, most school prevention programmes have historically addressed mental health and addictions as separate silos, evaluating their outcomes independently even though the two conditions co-occur in school-aged adolescents.

To map the field, the researchers searched PubMed, PsycINFO and ERIC without date restrictions, retrieving 2,096 records. After removing 778 duplicates and screening 1,322 titles and abstracts, they examined 31 full-text articles and supplemented the pool with four additional studies identified through citation searching. The final sample comprised 16 studies, including three programme protocols and a cluster of linked evaluations of the same interventions. The methodological approach was a narrative synthesis organised around categories such as aim, sample, target disorders, intervention provider, procedures, components and outcomes, with data extracted independently by two authors and discrepancies resolved by consensus.

The geography of the evidence is strikingly narrow. Australia dominates with eight of the 16 studies, concentrated in New South Wales, Queensland and Western Australia, followed by the United States with five studies in Minnesota, Baltimore, Virginia and Oregon. Canada, Italy and Finland contribute one study each. Ten of the articles focus on just three programmes: CLIMATE Schools, PreVenture and the Good Behavior Game. The authors caution that this concentration on high-income, largely English-speaking Western countries severely limits generalisability to low- and middle-income settings and to educational systems with different cultural structures, a gap they argue demands cross-cultural research incorporating socioeconomic variables.

Age targeting is equally concentrated. Most interventions, nine of the 13 non-protocol articles, focus on students aged roughly 13 to 15, the window when mental health and substance use problems typically first emerge and when early intervention is considered crucial. A handful of programmes reach younger children from age six, including the Good Behavior Game evaluations, which followed two cohorts into young adulthood at ages 19 to 21. Notably, no studies were found working with children under six. The developmental logic of the programmes also shifts with age: for children, protective factors centre on socio-emotional development with strong family and school involvement, including parent-child communication training, whereas adolescent programmes largely drop the family and rely on teachers and health professionals, sometimes adding selective components tailored to personality style, problematic coping behaviours, stress management or stigma reduction.

The content of the interventions clusters into four main blocks: addiction prevention, present in 11 articles; reduction of anxiety, depression and stress, in five; mental health promotion through reinforcement of emotional competence, in ten; and social skills training, in five. Anxiety appears as a target in 12 of the 16 articles and depression in 10, reflecting their status as the most prevalent and most researched disorders in youth populations. On the addiction side, alcohol prevention leads with 14 articles, followed by cannabis with eight, with tobacco and other drugs appearing less frequently. Only two studies address non-substance addictions, covering internet abuse, pathological gambling and compulsive shopping, a striking gap given that 34 percent of adolescents play digital video games daily, at least 22 percent play four or more hours a day, and 12 percent show risk of problematic play, with documented links to lower life satisfaction and psychological distress.

Delivery of these programmes rests overwhelmingly on teachers working in collaboration with external health experts, a model present in 12 of the 14 student-focused articles. Teachers participate in 13 of the 16 studies, supported in some cases by nurses, community workers, consultants or school health centre staff. The review highlights an unresolved tension here: some evidence suggests that external professionals specialised in depression achieve better outcomes than teachers alone, yet reviews of teacher-delivered programmes show little sustained impact on pupil mental health, and it remains unclear which type of school prevention officer is most effective for addictions specifically. Implementation research adds further caveats, identifying barriers such as disengaged management teams, unstable teaching staff and insufficient training as factors that can undermine even well-designed programmes.

Perhaps the most consequential finding concerns prevention strategy itself. Most reviewed interventions take a universal approach, delivered to entire classrooms without differentiation by need or risk. Yet the evidence increasingly questions whether one-size-fits-all models serve all students. The review cites work showing that universal strategies may be ineffective, or even inappropriate, for young people with existing mental disorders, and that certain universal programmes can produce iatrogenic effects, actually increasing clinical symptoms in some students. Universal, therapeutically based interventions appear less effective than targeted approaches, and some universal addiction programmes may achieve little benefit even in the short term. The selective PreVenture programme, which tailors content to personality-based risk profiles, represents one of the few evaluated alternatives in the sample.

The long-term picture is sobering. Only seven papers included longitudinal evaluation beyond immediate post-intervention measures, ranging from six-year outcomes for the Early Risers programme to 30-month and 72-month follow-ups of the CLIMATE Schools Combined trial. The 72-month results deserve particular attention: the programme, one of the first worldwide to jointly address anxiety, depression and substance use, showed significant preventive effects during adolescence, but by early adulthood there were no significant differences between the experimental and control groups in the predicted probability of alcohol use, leading the authors to conclude that universal prevention in adolescence alone is not sufficient for lasting effects. Other unexpected results complicate the narrative of success: one Good Behavior Game study found no programme impact among women, a Finnish psychoeducational intervention produced no change in stigma reduction, and another study pointed to the need for whole-community involvement beyond the classroom.

The authors conclude that the field stands at a point of unquestionable reflection. Preventive initiatives in schools can plausibly reduce the rates and costs associated with mental health and addictions, but they must be redirected on the basis of solid scientific evidence adjusted to the realities of target populations, with clearer decision rules about when universal approaches suffice and when selective or indicated interventions are required. Their recommendations for programme design are concrete: early intervention, training in social-emotional skills, building teacher literacy in mental health and addiction risk signals, hybrid universal-plus-selective models adapted to specific sociocultural and socioeconomic contexts, and genuine integration of teachers with mental health and addiction professionals. They also call on policymakers to promote comprehensive prevention models that account for differential vulnerabilities, noting that the current evidence base, skewed toward wealthy Western nations and a handful of flagship programmes, cannot yet tell the world’s schools, especially those in low- and middle-income countries, what will actually work for their students. Until that evidence gap closes, the promise of school-based prevention remains real but unproven at scale.

Subject of Research: School-based preventive interventions for mental disorders and addictions in children and adolescents

Article Title: A narrative review of school-based preventive interventions on mental disorders and addictions

Article References: Aguilar-Moya, R., Ibáñez-Martínez, R., & Melero-Fuentes, D. (2026). A narrative review of school-based preventive interventions on mental disorders and addictions. Discover Mental Health, 6(1), Article 188. https://doi.org/10.1007/s44192-026-00532-2

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00532-2

Keywords: school-based prevention, adolescent mental health, addictions, depression, anxiety, substance use, CLIMATE Schools, PreVenture, Good Behavior Game, universal interventions, selective prevention, narrative review