Outcomes of School-Based Mental Health Screening Programs: A Systematic Review

Background: Mental health problems are common in children and adolescents, yet many affected young people are never identified or treated. Schools reach almost all children, which makes them a practical setting for systematic screening. This review aimed to evaluate the effects of school-based mental health screening programs on mental health indicators, access to and use of mental health services, and academic outcomes, compared with no screening or usual care. Methods: Following the PRISMA guidelines, we searched PubMed, MEDLINE, PsycINFO, Scopus, Web of Science, and Google Scholar for English-language studies of school-based mental health screening programs in children and adolescents aged 5–18 years that reported mental health, service-use, or academic outcomes. Because study designs, screening instruments, and outcome measures were heterogeneous, the findings were synthesized narratively. Results: Twenty-two studies met the inclusion criteria: ten randomized or cluster-randomized trials, six quasi-experimental studies, three retrospective cohort studies, one cross-sectional study, and two systematic reviews. Screening approaches included self-report questionnaires such as the Patient Health Questionnaire-9 (PHQ-9), teacher-rated tools such as the Systematic Screening for Behavior Disorders, school-based health center access, and web-based platforms. In the largest trial, universal PHQ-9 screening increased the odds of identifying depressive symptoms (OR 5.92) and of initiating treatment (OR 2.07) compared with targeted referral. One cluster trial reported gains in social skills (p < .05) over three years. Service use generally increased, including an adjusted prevalence ratio of 2.6 for mental health visits, and one quasi-experimental study reported lower odds of suicidal ideation (OR 0.66) and suicide attempts (OR 0.71). Effects on anxiety and depressive symptoms were inconsistent, and several trials found no between-group difference. Evidence on academic outcomes was limited and mixed: teacher-rated academic competence improved in one trial (d = 0.29), whereas a large quasi-experimental study found no effect on standardized test scores or attendance. Program duration ranged from 12 weeks to 5 years. Conclusion: School-based screening consistently improves the identification of students with mental health needs and is generally associated with greater service use, but its effects on symptoms and academic outcomes are less certain. Because study quality was not formally appraised and designs were heterogeneous, these findings should be interpreted with caution. Well-designed trials that link screening to accessible follow-up care are needed.