Promoting Health Preventing Disease

Protecting mental health, preventing depression 217
worldwide at any moment in time, including about 33.4 million people in
the WHO European Region. The costs are substantial, with costs for major
depression in 30 European countries estimated to be $108 billion (€92 billion in
2010), while costs for all anxiety disorders accounted for a further $87 billion
(€74 billion in 2010) (Olesen et al. 2012).
What do we know about the economic case for promoting mental
health and preventing depression in school settings?
The consequences of poor mental health and behavioural problems in childhood
can reverberate well into adulthood, with many personal, social and economic
consequences such as reduced rates of employment, poorer career trajectories
and greater likelihoods of contact with social welfare and criminal justice
systems (Fergusson et al. 2005; Knapp et al. 2011a; McDaid et al. 2014; Suhrcke
and Kenkel this volume). With an estimated prevalence of up to 2.5 per cent
in children and up to 8.3 per cent in adolescents, depression is a frequent
condition associated with poor psychosocial and academic outcomes and an
increased risk for other mental disorders (Birmaher et al. 1996). Furthermore,
clinically relevant depressive symptoms that do not meet criteria for major
depressive disorders are found in up to 30 per cent of adolescents (Ryan
2005). These, in turn, increase risks of future mental health problems. From
a public health perspective, actions within the school setting can therefore
be particularly helpful in both promoting better mental health and emotional
well- being and preventing the early onset of depression, given that school
is an ideal place to reach large numbers of the target group in a logistically
convenient way.
Mental health promotion
In terms of promoting emotional health and well- being in school, a review of
reviews of evidence in schools uncovered 52 systematic reviews and metaanalyses
(Weare and Nind 2011). The interventions identified had a wide
range of beneficial effects on children, families and communities and on a
range of mental health, social, emotional and educational outcomes. Effect
sizes associated with most interventions were generally small to moderate
in statistical terms, but large in terms of real- world impacts. However, the
effects associated with interventions were variable and their effectiveness could
not always be relied on. The characteristics of more effective interventions
included: teaching skills, focusing on positive mental health; balancing
universal and targeted approaches; starting early with the youngest children
and continuing with older ones; operating for a lengthy period of time and
embedding work within a multi- modal/whole- school approach which included
such features as changes to the curriculum including teaching skills and
linking with academic learning, improving school ethos, teacher education,
liaison with parents, parenting education, community involvement and
coordinated work with outside agencies. Interventions were only effective