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Systematic Review

Nursing Interventions for Adolescent Mental Health: A Systematic Mixed-Methods Review

by
Paula Segura-Daroca
1,2,
Vicente Gea-Caballero
3,
Raúl Juárez-Vela
4,*,
Elena Chover-Sierra
5,6,
Raquel María Martínez-Pascual
6,7 and
Antonio Martínez-Sabater
4,6,7
1
University Clinic Hospital, 46010 Valencia, Spain
2
Doctoral Program in Clinical and Community Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain
3
Research Group Community Health and Care SALCOM, Faculty of Health Science, Valencian International University, 46010 Valencia, Spain
4
Research Group in Care GRUPAC, Faculty of Health Sciences, Department of Nursing, University of La Rioja, 26006 Logroño, Spain
5
Internal Medicine Department, Consorci Hospital General Universitari, 46014 Valencia, Spain
6
Nursing Care and Education Research Group (GRIECE), Nursing Department, University of Valencia, 46010 Valencia, Spain
7
Care Research Group (INCLIVA), University Clinic Hospital of Valencia, 46010 Valencia, Spain
*
Author to whom correspondence should be addressed.
Adolescents 2026, 6(3), 46; https://doi.org/10.3390/adolescents6030046
Submission received: 19 March 2026 / Revised: 28 May 2026 / Accepted: 3 June 2026 / Published: 9 June 2026
(This article belongs to the Section Adolescent Health and Mental Health)
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Abstract

Mental health disorders among adolescents have risen significantly in recent years, particularly following the COVID-19 pandemic, highlighting the need for effective preventive and supportive interventions. Nurses play a key role in the promotion, early detection, and management of mental health issues in adolescents, both in school and community settings. This study aimed to synthesize quantitative and qualitative evidence on the role, effectiveness, and implementation of nursing interventions for adolescent mental health. A systematic mixed-methods review was conducted in accordance with the PRISMA 2020 guidelines. It was registered in PROSPERO (CRD42024502076). Databases including PubMed, Scopus, SciELO, Dialnet, BVS, and Cuiden were searched for studies published between 2014 and 2024. Twelve studies met the inclusion criteria, comprising randomized and non-randomized quantitative studies, qualitative studies, and previous reviews. The interventions identified included cognitive-behavioral therapy programs, resilience and life skills training, physical activity initiatives, digital interventions, and mental health literacy strategies. Overall, the findings suggest improvements in symptoms of anxiety and depression, coping skills, resilience, and knowledge about mental health, particularly in structured school-based programs. Qualitative evidence highlighted the importance of accessibility, multidisciplinary collaboration, cultural sensitivity, and sustained commitment for successful implementation. However, considerable heterogeneity was observed in study designs, interventions, and outcome measures. In conclusion, nursing interventions can make a positive contribution to adolescents’ mental health, particularly in school and community settings. However, further rigorous, long-term studies are needed to strengthen the evidence base.

1. Introduction

The increase in mental disorders in adolescence is a priority public health issue, responsible for 16% of the global disease burden in young people aged from 10 to 19 [1,2,3]. The COVID-19 pandemic has exacerbated this situation, causing an increase of up to 47% in mental disorders in minors and significantly raising the number of cases of anxiety, depression, attention deficit hyperactivity disorder, and suicidal behavior [4,5]. In Spain, adolescent mental health was already showing worrying figures before the pandemic, with rates of 20% in adolescents; these have worsened since 2020, with an increase in symptoms of depression, anxiety, self-harm, and suicide [6,7,8,9].
Various epidemiological studies indicate that a large proportion of mental disorders begin in the early stages of life. Population studies show that approximately 50% of lifetime mental disorders emerge before the age of 14, and about three-quarters begin before early adulthood, highlighting childhood and adolescence as critical periods for prevention and early intervention [10,11]. Anxiety disorders are among the earliest to appear, often beginning in late childhood. In contrast, obsessive-compulsive disorders and eating disorders typically emerge in mid-adolescence, and mood disorders, such as depression, usually develop from mid-adolescence to early adulthood [11]. In recent years, the severity and early onset of mental health problems in young people have increased, along with a greater demand for mental health services and hospitalizations in several countries. It is concerning that suicide has become a leading cause of death among young people globally, reflecting the growing burden of mental health problems during adolescence and early adulthood [12].
Furthermore, the COVID-19 pandemic has been associated with a substantial increase in mental health problems among adolescents, such as depression, anxiety, and eating disorders, further exacerbating an already critical public health situation [13]. Given that a large proportion of mental disorders originate during childhood and adolescence, early detection and intervention are essential strategies for reducing long-term disability, improving treatment outcomes, and fostering more resilient societies [10,11]. All of this also affects families, who bear the emotional stress, stigma, and financial burden of treatment, making it difficult to seek help [14,15].
In response to this situation, various international and national mental health promotion programs have proven useful in reducing stigma and promoting access to care. Early intervention is essential to prevent future complications and requires effective programs. In this context, nurses play a central role in prevention, detection, intervention, and specialized referrals, contributing to continuous evidence-based care [8,14,16].
A mental health nursing intervention for adolescents is operationally defined as a coordinated set of professional actions aimed at promoting psychological well-being, preventing mental disorders, detecting symptoms early, providing therapeutic support, facilitating psychosocial rehabilitation, and supporting functional reintegration, carried out in school, community, clinical, and digital settings. This definition aligns with the evidence supporting the strategic role of nursing in comprehensive youth mental health care through multilevel, contextually adapted interventions [17,18,19].
Therefore, a systematic mixed-methods review is needed to critically synthesize the available evidence, identify patterns of effectiveness and methodological weaknesses, and guide both nursing practice and future lines of research in adolescent mental health. This study aimed to synthesize quantitative and qualitative evidence on the role, effectiveness, and implementation of nursing interventions for adolescent mental health. As a secondary objective, we aim to analyze the instruments used to measure mental health literacy and changes in the stigma associated with mental disorders to assess the consistency and comparability of the results reported in the literature.

2. Materials and Methods

2.1. Study Design

In 2024, a systematic mixed-methods review of the scientific literature was conducted using mixed-methods approaches, in accordance with the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses) [20]. This approach was chosen to integrate quantitative evidence on effectiveness with qualitative evidence regarding experiences, acceptability, and implementation contexts of nursing interventions in adolescent mental health. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42024502076.

2.2. Search Strategy

The data retrieved for the review covered the last 10 years (1 January 2014, to 31 August 2024). A search was conducted in the following electronic databases: PubMed, Scopus, Scielo, Dialnet, BVS, and Cuiden. The DECS and MESH terms used were: “Mental health”, “adolescents”, “nursing care”, “health education”, “Salud mental”, “adolescentes”, “atención de enfermería”, and “educación en salud”. The search was limited to articles found in English, Spanish, or Portuguese. The selected articles were chosen based on study type and variables to identify and evaluate the evidence. The bibliographic manager used for the retrieved articles was Mendeley Reference Manager, through peer review, to ensure the methodological rigor and quality of the analyzed data.
Table 1 presents the search strategy used to retrieve eligible documents for this systematic review, the terms used in each database, the selected search period, and the articles obtained.

2.3. Selection Criteria

2.3.1. Inclusion Criteria

We included studies published between January 2014 and August 2024 that examined mental health nursing interventions targeting adolescents. To ensure a comprehensive view of the phenomenon, we considered various research designs: systematic reviews, randomized controlled trials, observational studies, and cross-sectional studies. This approach allowed for an analysis of both clinical effectiveness and the implementation experiences and contexts essential to community practice.
Regarding the professional role, interventions were selected that were led directly by nursing staff or in which nurses played a primary, active, and collaborative role within a multidisciplinary team. Although the review was initially limited to primary studies led exclusively by nurses, the preliminary phase identified only three studies that strictly met this criterion. However, robust evidence was found highlighting the essential role of nursing in implementing multidisciplinary programs to equip adolescents with psychosocial, coping, and cognitive-behavioral skills. Therefore, an inclusive approach was adopted to highlight and synthesize the fundamental contribution of nursing in these collaborative settings. For this review, a mental health nursing intervention for adolescents was operationally defined as any school, community, clinical, or digitally based intervention in which nurses played a relevant role in the design, implementation, coordination, psychoeducation, prevention, or mental health support provided to adolescents. This definition includes nurse-led interventions and multidisciplinary programs that involve active nursing participation.
Finally, the inclusion of systematic reviews enabled comparison of current findings with accumulated historical evidence, identified knowledge gaps, and strengthened the critical discussion.

2.3.2. Exclusion Criteria

Studies focusing on adult, pediatric, or pre-adolescent populations were excluded, as were those using family-based or exclusively pharmacological interventions. Consequently, interventions whose primary therapeutic approach was based on pharmacotherapy (such as pharmacological treatments for ADHD or severe clinical depression) were not included. These criteria ensure that the review focuses strictly on behavioral, psychoeducational, and psychosocial nursing interventions. Editorials, letters, legal cases, interviews, book chapters, opinion or commentary articles, news items, non-systematic reviews, methodological texts, and duplicate studies were also excluded.

2.4. Data Extraction

Records were initially screened based on their titles and subsequently on their abstracts. Study selection and methodological quality assessment were conducted through an independent, double-blind review process. Two reviewers worked in parallel to identify, screen, and evaluate the methodological quality of the studies. Any discrepancies were resolved through discussion and consensus, and when necessary, a third reviewer was consulted to ensure the rigor and reliability of the selection process. To ensure the robustness of this review, we carefully selected a range of tools to analyze each study according to its nature and design. Firstly, we used CASPe as our framework for critical appraisal; its application was essential for confirming that the studies met minimum standards of design and validity and for assigning numerical scores (e.g., 0/11) that gave us a clear picture of their quality, particularly in the case of qualitative studies [21].

2.5. Data Summary Strategy

A narrative synthesis of the included studies’ findings was conducted, structured by intervention type, content, results, and participant characteristics. To assess methodological quality, the risk of bias for each study was assessed using validated tools. Randomized clinical trials were assessed using the RoB 2 tool (Cochrane Bias Methods Group, Bristol, UK), whilst non-randomized intervention studies were assessed using the ROBINS-I tool (Cochrane Bias Methods Group, Bristol, UK). Qualitative studies were critically analyzed using the CASPe Qualitative Checklist [22,23].

3. Results

A total of 79 records were identified in the databases. After removing duplicates and screening, 28 complete reports were assessed, and 12 studies were included. The selection process is shown in Figure 1.

3.1. Study Characteristics

In terms of study design, four quasi-experimental studies [24,25,26,27], one experimental study [28], two qualitative studies [29,30], one prospective longitudinal study [31], two systematic reviews [32,33], one randomized controlled trial [34], and one cohort study [35] were selected.
Regarding geographical distribution, two studies were conducted in Sweden [24,29], one in Turkey [25], one in Iran [28], two in China [31,34], one in Australia [26], one in Canada [27], one in Singapore [32], two in Norway [30,35] and one in Portugal [33]. Table 2 summarizes the main characteristics of the included studies.

3.2. Types of Intervention

The studies reviewed demonstrate a wide range of nursing interventions to improve adolescent mental health. Among cognitive–behavioral therapy-based programs, the DISA program stands out as a 10-week preventive intervention described by Garmy, Jakobsson et al., and Garmy, Berg et al. [24,29]. Similarly, the T-COPE program, designed for healthy adolescents and comprising 15 45 min sessions, addressed healthy lifestyles, self-esteem, stress management, and effective communication [25]. Other interventions focused on the development of psychosocial skills, such as the Life Skills Training program [28], which comprised 8 sessions aimed at reducing stress, violence, and the risk of addiction.
The use of sport as a therapeutic approach was reflected in the Sports Tutoring intervention, which demonstrated benefits for both physical and psychological well-being [34]. In terms of youth participation, the SONAR program stood out for promoting adolescents’ active involvement in mental health promotion and generating positive developmental outcomes [27].
Several programs focused on mental health literacy. The Coolminds program, evaluated by Thiang et al. [31], improves students’, parents’, and educators’ knowledge of mental health. Similarly, the MEST program offered seminars to develop mental health skills [35]. Informational interventions, such as videos and questionnaires, were also effective in improving knowledge and attitudes [32].
Finally, two studies evaluated fully digital interventions: the iCARER-R program, delivered through six weekly modules involving short group activities [26].
Table 3 shows the different interventions developed along the analyzed studies.

3.3. Effectiveness in Anxiety and Depression

Most interventions reported improvements in anxiety and depression symptoms. The DISA program showed a significant reduction in depressive symptoms in both sexes, with the improvement in women being maintained one year later [29]. In the case of MEST, participants scored higher on anxiety and depression than non-participants; however, girls showed a 9.7% increase in mental well-being after the intervention, a difference not observed in boys [35]. In the SONAR intervention, although 61.1% of participants reported emotional distress, only resilience showed a significant change between the initial and final assessments [27]. These results suggest varying effects depending on the type of intervention, its duration, and the level of participation.

3.4. Mental Health Literacy

Programs aimed at improving mental health knowledge used validated instruments. In MEST, the Mental Health Promoting Knowledge scale and the Hopkins Symptom Checklist were used to assess emotional symptoms [35]. The sports intervention used the Chinese version of the SF-12v2 to measure the physical and mental components [34].
In terms of results, literacy increased by 2.1% among young people who participated in MEST, although this increase was not sustained over time [35]. In addition, programs such as Coolminds [31] and the informational interventions of Tay et al. [32] showed significant improvements in mental health knowledge and understanding.

3.5. Stigma and Perceptions of Mental Health

Stigma reduction was a consistent finding in some studies. Informative interventions were shown to reduce negative attitudes toward mental disorders [32]. Similarly, Bjørnsen et al. [35] indicate the need for additional strategies to reinforce this behavior.

3.6. Risk of Bias

All the retrieved studies were included due to the limited availability of research on this topic. Overall, the methodological quality of the studies included was moderate, though some demonstrated greater rigor. The main sources of bias were related to the frequent use of convenience sampling, which may introduce selection bias, and the relatively small sample sizes, in some cases drawn from a single school. These limitations may affect the generalizability of the findings. Nevertheless, the available evidence provides relevant insights into the role of nursing interventions in adolescent mental health.

3.7. Assessment Instruments

Regarding the secondary objective, a wide range of measurement tools was identified for assessing mental health outcomes in adolescents. In the analysis of the included studies, considerable heterogeneity was observed in the tools used to measure mental health and the effectiveness of interventions. Assessment tools can be categorized into two main approaches: the measurement of clinical symptoms (pathogenic approach) and the assessment of well-being and knowledge (salutogenic approach), as well as qualitative approaches.
To assess clinical symptoms, standardized questionnaires designed to detect psychological distress were used. The study by Garmy, Jakobsson et al. [24]. used the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-administered questionnaire, to assess the frequency of depressive symptoms. For their part, Bjørnsen et al. [35] used the Hopkins Symptom Checklist (HSCL) to measure levels of anxiety and depression in adolescents.
In the salutogenic and well-being approach, the use of tools focused on mental health literacy and quality of life was highlighted. Bjørnsen et al. [35] used the Mental Health Promoting Knowledge Scale (MHPK) to assess preventive and health-promoting knowledge. Similarly, Ho et al. [29] assessed physical and mental well-being using the Chinese-validated SF-12v2 health questionnaire.
Finally, qualitative studies [29] opted for methodologies such as focus groups and interviews. These tools enabled the exploration of subjective experiences, satisfaction with programs (such as the DISA program), and perceived barriers, including language and confidence in seeking help.
Table 4 provides a comprehensive summary of these instruments, together with their psychometric properties.

4. Discussion

The objective of this study was to identify evidence-based nursing strategies and interventions for care, prevention, and treatment to improve adolescent mental health. The findings of this review are consistent with previous research, which shows that school-based interventions are among the most effective strategies for promoting adolescent mental health. The mixed-methods design enabled us not only to evaluate the intervention outcomes but also to identify contextual factors influencing feasibility, participation, and acceptability.
The systematic mixed-methods review identified 12 articles describing nursing interventions focused on mental health promotion [24,35], the relevance of the professional nursing role [24,27,30,33], as well as the impact of interventions on symptom reduction [24,27,35], increasing knowledge [34,35], and reducing stigma [32,35]. In line with current findings, several randomized controlled trials have demonstrated the effectiveness of cognitive-behavioral interventions applied in school settings to reduce anxiety and depressive symptoms in adolescents. For example, CBT programs in schools have shown significant reductions in anxiety symptoms and functional impairment, with effects that were maintained during follow-up periods [36].
Several systematic reviews have shown that programs implemented in educational institutions can improve emotional well-being, coping skills, and mental health literacy, and can help reduce symptoms of anxiety and depression [37,38]. Furthermore, the school environment offers a key opportunity for the early detection and prevention of mental disorders due to its accessibility and continuous contact with the adolescent population [36,37].
Several studies highlight the central role of nurses as key agents in promoting mental health during adolescence, emphasizing the comprehensive support they can offer from a biopsychosocial perspective [24,30,33]. In addition, Bringaker & Dahl [30] and Jenkins et al. [27] emphasized the importance of collaboration among public health nurses, families, and educational staff to address adolescents’ mental health needs effectively. In schools, nurses play a key role in planning and implementing health promotion, mental health literacy, and emotional support programs. Their contribution is particularly important, as school and community nurses are well-positioned to identify early signs and symptoms of mental health problems, provide psychoeducational interventions, and coordinate multidisciplinary support. In this regard, previous research indicates that nursing-led interventions can improve mental health literacy among adolescents and encourage them to seek help, thereby contributing to the early detection and prevention of mental disorders [39,40].
The interventions identified in this review are consistent with the existing literature and can be classified into four main categories. First, preventive programs based on cognitive–behavioral therapies aim to develop emotional regulation and behavioral management skills in adolescents [24,29]. Second, interventions focused on mental health promotion and resilience aim to enhance personal resources and improve overall psychological well-being among young people [26,28]. Third, programs based on physical activity and sport have demonstrated positive effects on mood and stress reduction [25,34]. Finally, mental health literacy programs aim to improve knowledge of mental disorders and reduce associated stigma [31,32,35].
In this regard, mental health literacy interventions represent a key strategy for improving adolescents’ ability to recognize symptoms, seek professional help, and reduce stigmatizing attitudes towards mental illness. Available evidence suggests that structured school-based educational programs can significantly increase knowledge of conditions such as depression and anxiety. However, their impact on stigma reduction may vary depending on program design, intervention duration, and pedagogical approaches.
Interventions aimed at promoting well-being and developing psychological skills appear to be better received by adolescents, who tend to report greater feelings of empowerment, motivation, and active participation in these programs. In this regard, Bjørnsen et al. [35] noted that approaches focused exclusively on disease prevention may be less effective than those that promote a positive view of mental health and the development of personal resources. This perspective aligns with the mental health promotion model, which emphasizes strengthening protective factors such as resilience, self-efficacy, and socio-emotional skills—key elements of psychological well-being during adolescence. Previous studies have shown that programs incorporating these components can significantly improve emotional well-being and reduce the onset of anxiety and depressive symptoms among adolescents [41,42].
The included studies consistently indicate that the school environment is a particularly suitable setting for implementing mental health promotion interventions, due to direct, continuous, and equal access to the youth population. Garmy et al. [24] and Ho et al. [34] emphasize that familiarity with the school environment promotes participation, adherence, and program continuity. In addition, the educational setting offers unique opportunities to integrate interventions into students’ daily lives, facilitating the development of emotional and social skills in a natural learning context. In this regard, various studies have emphasized that school programs can contribute to the early detection of mental health problems and to reducing barriers to seeking help [43,44]. However, there are also important challenges related to institutional bureaucracy, available resources, and the need for support from the education administration to ensure the long-term viability of the programs [24].
Gender emerges as an important differentiating factor in intervention outcomes. Most of the included studies report higher participation rates among girls than among boys, and the findings suggest that female adolescents may derive greater benefit from certain psychoeducational and well-being interventions [24,35]. This difference may be partly explained by variations in emotional socialization, greater willingness to engage in activities involving emotional expression, and a higher tendency among girls to seek social support. Previous research has also shown that boys tend to have lower participation rates in mental health programs, highlighting the need to design interventions better tailored to their interests and coping styles [45].
In addition, some studies report variability in outcomes depending on the interventions’ focus. For example, Tay et al. [32] found that informational interventions improved knowledge about anxiety but not depression, suggesting that certain disorders may require more complex educational approaches or tailored teaching strategies. Similarly, the lack of long-term evaluations in many studies limits understanding of the sustainability of program effects, making it difficult to determine whether the observed improvements are maintained over time. This limitation has also been highlighted in previous reviews, which emphasize the need for longitudinal studies to assess the sustained impact of interventions on adolescent mental health [46].
Finally, the types of intervention that showed the greatest evidence of effectiveness were those based on multi-component approaches, especially those combining educational strategies, social-emotional skills training, and continuous support. These programs enable simultaneous action on individual, contextual, and behavioral factors, promoting more comprehensive and sustainable changes in adolescents’ mental health. Their effectiveness seems to be explained by the integration of adaptive components that facilitate the transfer of what has been learned to everyday life, as well as by the use of theoretical models that guide the implementation and evaluation of interventions [24,31,33,35], In keeping with these results, several systematic reviews have pointed out that the most effective school programs tend to be those that integrate multiple strategies, involving different parties in the educational environment and developed over extended periods of time [43,47].
The various studies showed substantial heterogeneity in outcome measures, limiting direct comparisons and synthesis. Future trials should prioritize the use of validated, standardized instruments, to improve the comparability and feasibility of meta-analyses.

4.1. Implications for Clinical Practice

These findings have important implications for clinical practice and public health policies, as they highlight the need to integrate structured mental health promotion programs into school health services to facilitate early detection and intervention and improve access to care. In this context, nurses play a key role in coordinating preventive strategies, implementing psychoeducational interventions, and supporting adolescents’ emotional development within interdisciplinary teams. Therefore, this review highlights the importance of reinforcing the role of nursing in adolescent mental health care, as the identified interventions demonstrate benefits in symptom reduction, improved knowledge, skill development, and reduced stigma. It is strongly recommended to implement mental health promotion programs from an early age to strengthen psychological resources and prevent future problems.

4.2. Limitations

The results were interpreted in light of the methodological quality and risk of bias of the included studies. The most robust conclusions were derived from randomized controlled trials and well-designed quasi-experimental studies, which demonstrated improvements in emotional symptoms, well-being, and mental health literacy. In contrast, studies with a higher risk of bias should be interpreted with caution.
The available evidence presents several important limitations, including heterogeneity in study designs and interventions, lack of standardized protocols, reliance on self-reported measures, short follow-up periods, and potential publication bias. These factors limit comparability across studies, reduce generalisability, and hinder the identification of causal relationships.
Future research should focus on developing replicable protocols, conducting randomized controlled trials with follow-up periods beyond 12 months, and implementing strategies that are sensitive to gender and cultural diversity. In addition, the use of digital and hybrid approaches may enhance access in rural or stigmatized communities. Integrating these interventions into health and education policies could facilitate the transition from pilot initiatives to sustainable programs.

4.3. Future Lines of Research

Future research should focus on conducting randomized controlled trials to rigorously evaluate the effectiveness of nursing interventions. It is also necessary to incorporate longitudinal evaluations to determine the sustainability of benefits over time. Further research is recommended on the influence of gender and other sociodemographic factors on responses to interventions, as well as on exploring new intervention modalities, including digital tools and hybrid approaches. Finally, it would be relevant to evaluate how to structurally integrate these interventions into educational and health policies, using a randomized clinical trial with a 12-month follow-up.

5. Conclusions

This systematic review indicates that school-based mental health interventions delivered by nurses can effectively improve adolescents’ emotional well-being, especially when tailored to the characteristics of the student population, incorporating gender and cultural diversity perspectives, and focusing on strengths. For effective implementation, schools should integrate structured preventive programs into the study plan, allocate dedicated time and spaces, involve health professionals, including nurses, in early detection and the coordination of multi-component interventions, and ensure adequate resources, continuous training, and systematic evaluation mechanisms. The findings clarify the application of previously ambiguous nursing interventions and show promising results. However, more rigorous, long-term follow-up studies are needed to confirm their sustained impact and guide evidence-based decisions.
Although this review’s findings suggest that nursing interventions can improve adolescents’ mental health, the high heterogeneity of research designs and the moderate methodological quality of a significant proportion of the evidence warrant a cautious interpretation of these benefits. To optimize their impact, schools and communities should implement structured, well-resourced preventive programs in which nurses play a central, coordinated role. Moving forward, the nursing discipline must prioritize the development of rigorous, standardized, long-term studies to strengthen the evidence base and guide sound clinical decisions.

Author Contributions

Conceptualization, P.S.-D. and A.M.-S.; methodology, P.S.-D. and A.M.-S.; software, P.S.-D., A.M.-S. and R.J.-V.; validation, V.G.-C., E.C.-S. and R.M.M.-P.; formal analysis, P.S.-D.; data curation, P.S.-D.; writing—original draft preparation, P.S.-D., A.M.-S. and R.J.-V.; writing—review and editing P.S.-D., A.M.-S. and R.J.-V.; visualization, V.G.-C., E.C.-S. and R.M.M.-P.; supervision, A.M.-S., R.J.-V. and V.G.-C.; funding acquisition, A.M.-S. and P.S.-D. All authors have read and agreed to the published version of the manuscript.

Funding

This study was funded through research promotion grants awarded by the Official College of Nursing of Valencia (COENV) code: inv_cge_2024_12, within the framework of the annual funding calls of the General Council of Nursing of Spain (CGE).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors on request.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
BVSBiblioteca virtual en salud
CASPeCritical Appraisal Skills Program
CBTCognitive Behavioral Therapy
CES-DCenter for Epidemiologic Studies Depression Scale
CFAConfirmatory Factor Analysis
CFIComparative Fit Index
DECSDescritores em Ciências da Saúde
DISADepression in Swedish Adolescents
GAD-7Generalized Anxiety Disorder-7
GHQ-28General Health Questionnaire-28
ICCIntraclass Correlation Coefficient
ICTinformation and communication technology
MESHMedical Subject Headings
MESTMental Health Promoting Knowledge scale
MHPKMental Health Public Knowledge
MHLMental Health Literacy
PRISMAPreferred reporting items for systematic reviews and Meta-analyses
PHQ-APHQ-A son las siglas de Patient Health Questionnaire-Modified for Adolescents
RCTsrandomized controlled trials
RoB 2Risk of Bias 2
ROBINS-IRisk of Bias in non-randomized studies of interventions
SDQStrengths and Difficulties Questionnaire
SF-12v212-Item Short-Form Health Survey version 2
SONARSocial Networking Action for Resilience
T-COPEhealthy lifestyles TEEN program
WHOWorld Health Organization

References

  1. Kieling, C.; Buchweitz, C.; Caye, A.; Silvani, J.; Ameis, S.H.; Brunoni, A.R.; Cost, K.T.; Courtney, D.B.; Georgiades, K.; Merikangas, K.R.; et al. Worldwide prevalence and disability from mental disorders across childhood and adolescence: Evidence from the global burden of disease study. JAMA Psychiatry 2024, 81, 347–356. [Google Scholar] [CrossRef]
  2. Tian, J.; Yan, N.; Hu, X.; Tian, S.; Wang, Y.; Mackay, L.E.; Luo, Y.; Wang, Y.; Wang, Y.; Liu, Y.; et al. Global burden of mental disorders among adolescents and young adults, 1990–2021: A systematic analysis of the Global Burden of Diseases Study 2021. Gen. Psychiatry 2025, 38, e102278. [Google Scholar] [CrossRef] [PubMed]
  3. Castaldelli-Maia, J.M.; Ventriglio, A.; Torales, J. The global prevalence of mental disorders among adolescents: Focus on sex, regional and socio-demographic differences. Int. Rev. Psychiatry 2025, 37, 570–580. [Google Scholar] [CrossRef]
  4. Deng, J.; Zhou, F.; Hou, W.; Heybati, K.; Lohit, S.; Abbas, U.; Silver, Z.; Wong, C.Y.; Chang, O.; Huang, E.; et al. Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis. Ann. N. Y. Acad. Sci. 2023, 1520, 53–73. [Google Scholar] [CrossRef]
  5. Racine, N.; McArthur, B.A.; Cooke, J.E.; Eirich, R.; Zhu, J.; Madigan, S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021, 175, 1142–1150. [Google Scholar] [CrossRef]
  6. Soriano, V.; Ramos, J.M.; López-Ibor, M.I.; Chiclana-Actis, C.; Faraco, M.; González-Cabrera, J.; González-Fraile, E.; Mestre-Bach, G.; Pinargote, H.; Corpas, M.; et al. Hospital admissions in adolescents with mental disorders in Spain over the last two decades: A mental health crisis? Eur. Child Adolesc. Psychiatry 2025, 34, 1125–1134. [Google Scholar] [CrossRef] [PubMed]
  7. Soriano, V.; Ramos, J.M.; López-Ibor, M.I.; Chiclana-Actis, C.; Faraco, M.; González-Cabrera, J.; González-Fraile, E.; Mestre-Bach, G.; Pinargote, H.; Corpas, M.; et al. Trends in suicidal behavior among hospitalized adolescents in Spain over two decades. J. Affect. Disord. 2024, 363, 106–111. [Google Scholar] [CrossRef]
  8. Margaretha, M.; Azzopardi, P.S.; Fisher, J.; Sawyer, S.M. School-based mental health promotion: A global policy review. Front. Psychiatry 2023, 14, 1126767. [Google Scholar] [CrossRef]
  9. Casañas, R.; Mas-Expósito, L.; Teixidó, M.; Lalucat-Jo, L. Literacy programs for the promotion of mental health in the school setting. SESPAS Report 2020. Gac. Sanit. 2020, 34, 39. [Google Scholar] [CrossRef] [PubMed]
  10. Kessler, R.C.; Berglund, P.; Demler, O.; Jin, R.; Merikangas, K.R.; Walters, E.E. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 2005, 62, 593–602. [Google Scholar] [CrossRef]
  11. Solmi, M.; Radua, J.; Olivola, M.; Croce, E.; Soardo, L.; Salazar de Pablo, G.; Il Shin, J.; Kirkbride, J.B.; Jones, P.; Kim, J.H.; et al. Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Mol. Psychiatry 2022, 27, 281–295. [Google Scholar] [CrossRef]
  12. McGrath, J.J.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y.; Andrade, L.H.; Bromet, E.J.; Bruffaerts, R.; de Almeida, J.M.C.; Chardoul, S.; Chiu, W.T.; et al. Age of onset and cumulative risk of mental disorders: A cross-national analysis of population surveys from 29 countries. Lancet Psychiatry 2023, 10, 668–681. [Google Scholar] [CrossRef]
  13. Luginaah, N.A.; Dhillon, S.; Batung, E.S.; Ziegler, B.R.; Luginaah, I. The impact of the COVID-19 pandemic on children and adolescents eating disorders: A systematic review. Child. Youth Serv. Rev. 2025, 171, 108190. [Google Scholar] [CrossRef]
  14. Al-amer, R.; Dwekat, E.; Ali, A.; Abuzied, Y.; Alzahrani, N.S.; Alhowaymel, F.M.; Alharbi, H.F.; Lapadula, S.; AlBashtawy, M.; Hussein, M.M.; et al. Prevalence of stress and types of coping strategies among adolescents (14–18 years) in collectivist communities. J. Pediatr. Nurs. 2024, 77, e290–e297. [Google Scholar] [CrossRef] [PubMed]
  15. Teixeira, L.A.; Freitas, R.J.M.d.; Moura, N.A.d.; Monteiro, A.R.M. Mental health needs of adolescents and the nursing cares: Integrative review. Texto Contexto Enferm. 2020, 29, e20180424. [Google Scholar] [CrossRef]
  16. Nobre, J.; Oliveira, A.P.; Monteiro, F.; Sequeira, C.; Ferré-Grau, C. Promotion of Mental Health Literacy in Adolescents: A Scoping Review. Int. J. Environ. Res. Public Health 2021, 18, 9500. [Google Scholar] [CrossRef] [PubMed]
  17. Hoskote, A.R.; Croce, E.; Johnson, K.E. The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review. J. Sch. Nurs. 2023, 39, 51–71. [Google Scholar] [CrossRef]
  18. Wang, P.; Wang, Z.; Qiu, S. Universal, school-based transdiagnostic interventions to promote mental health and emotional well-being: A systematic review. Child Adolesc. Psychiatry Ment. Health 2024, 18, 47. [Google Scholar] [CrossRef]
  19. Das, J.K.; Salam, R.A.; Lassi, Z.S.; Khan, M.N.; Mahmood, W.; Patel, V.; Bhutta, Z.A. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. J. Adolesc. Health 2016, 59, S49–S60. [Google Scholar] [CrossRef] [PubMed]
  20. Page, M.J.; Mckenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
  21. Lopez, C.; Bautista, J. Plantilla Para Ayudarte a Entender un Ensayo Clínico. En: CASPe. Guías CASPe de Lectura Crítica de la Literatura Médica; CASPe: Alicante, Spain, 2005. [Google Scholar]
  22. Sterne, J.A.C.; Savović, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.Y.; Corbett, M.S.; Eldridge, S.M.; et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019, 366, l4898. [Google Scholar] [CrossRef]
  23. Sterne, J.A.C.; Hernán, M.A.; Reeves, B.C.; Savovi, J.; Berkman, N.D.; Page, M.J.; Higgins, J.P.T. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016, 355, 4919. [Google Scholar] [CrossRef] [PubMed]
  24. Garmy, P.; Jakobsson, U.; Carlsson, K.S.; Berg, A.; Clausson, E.K. Evaluation of a School-Based Program Aimed at Preventing Depressive Symptoms in Adolescents. J. Sch. Nurs. 2015, 31, 117–125. [Google Scholar] [CrossRef] [PubMed]
  25. Ardic, A.; Erdogan, S. The effectiveness of the COPE healthy lifestyles TEEN program: A school-based intervention in middle school adolescents with 12-month follow-up. J. Adv. Nurs. 2017, 73, 1377–1389. [Google Scholar] [CrossRef]
  26. McAllister, M.; Knight, B.A.; Hasking, P.; Withyman, C.; Dawkins, J. Building resilience in regional youth: Impacts of a universal mental health promotion programme. Int. J. Ment. Health Nurs. 2018, 27, 1044–1054. [Google Scholar] [CrossRef] [PubMed]
  27. Jenkins, E.K.; Bungay, V.; Patterson, A.; Saewyc, E.M.; Johnson, J.L. Assessing the impacts and outcomes of youth driven mental health promotion: A mixed-methods assessment of the Social Networking Action for Resilience study. J. Adolesc. 2018, 67, 1–11. [Google Scholar] [CrossRef]
  28. Jamali, S.; Sabokdast, S.; Sharif Nia, H.; Goudarzian, A.H.; Beik, S.; Allen, K. The Effect of Life Skills Training on Mental Health of Iranian Middle School Students: A Preliminary Study. Iran. J. Psychiatry 2016, 11, 269–272. [Google Scholar]
  29. Garmy, P.; Berg, A.; Clausson, E.K. A qualitative study exploring adolescents’ experiences with a school-based mental health program. BMC Public Health 2015, 15, 1074. [Google Scholar] [CrossRef]
  30. Bringaker, A.O.; Dahl, B.M. Public health nurses’ experiences with mental health promotion for adolescent immigrants in schools: A qualitative study. Scand. J. Caring Sci. 2024, 38, 417–425. [Google Scholar] [CrossRef]
  31. Thiang, O.; Ho, G.W.K.; Chiu, J.; Lee, N.; Hsu, S.G. Mental Health Promotion in Hong Kong: A Service Evaluation of the Coolminds Pilot Study. J. Sch. Health 2024, 94, 830–837. [Google Scholar] [CrossRef]
  32. Tay, J.L.; Tay, Y.F.; Klainin-Yobas, P. Effectiveness of information and communication technologies interventions to increase mental health literacy: A systematic review. Early Interv. Psychiatry 2018, 12, 1024–1037. [Google Scholar] [CrossRef] [PubMed]
  33. Silva, E.M.V.B.; Silva, D.; Aparicio, G.; Bica, I.; Albuquerque, C.; Cunha, M. Promotion of children’s mental health: Nurses’ contributions. Acta Paul. Enferm. 2020, 33, eAPE20180254. [Google Scholar] [CrossRef]
  34. Ho, F.K.W.; Louie, L.H.T.; Wong, W.H.; Chan, K.L.; Tiwari, A.; Chow, C.B.; Ho, W.; Wong, W.; Chan, M.; Chen, E.Y.H.; et al. A Sports-Based Youth Development Program, Teen Mental Health, and Physical Fitness: An RCT. Pediatrics 2017, 140, e20. [Google Scholar] [CrossRef]
  35. Bjørnsen, H.N.; Ringdal, R.; Espnes, G.A.; Eilertsen, M.B.; Moksnes, U.K. Exploring MEST: A new universal teaching strategy for school health services to promote positive mental health literacy and mental well-being among Norwegian adolescents. BMC Health Serv. Res. 2018, 18, 1001–1013. [Google Scholar] [CrossRef]
  36. Zhang, Q.; Wang, J.; Neitzel, A. School-based Mental Health Interventions Targeting Depression or Anxiety: A Meta-analysis of Rigorous Randomized Controlled Trials for School-aged Children and Adolescents. J. Youth Adolesc. 2023, 52, 195–217. [Google Scholar] [CrossRef] [PubMed]
  37. Cilar, L.; Štiglic, G.; Kmetec, S.; Barr, O.; Pajnkihar, M. Effectiveness of school-based mental well-being interventions among adolescents: A systematic review. J. Adv. Nurs. 2020, 76, 2023–2045. [Google Scholar] [CrossRef]
  38. Haugland, B.S.M.; Haaland, Å.T.; Baste, V.; Bjaastad, J.F.; Hoffart, A.; Rapee, R.M.; Raknes, S.; Himle, J.A.; Husabø, E.; Wergeland, G.J. Effectiveness of Brief and Standard School-Based Cognitive-Behavioral Interventions for Adolescents With Anxiety: A Randomized Noninferiority Study. J. Am. Acad. Child Adolesc. Psychiatry 2020, 59, 552–564.e2. [Google Scholar] [CrossRef] [PubMed]
  39. Seedaket, S.; Turnbull, N.; Phajan, T.; Wanchai, A. Improving mental health literacy in adolescents: Systematic review of supporting intervention studies. Trop. Med. Int. Health 2020, 25, 1055–1064. [Google Scholar] [CrossRef]
  40. Morgado, T.; Loureiro, L.; Rebelo Botelho, M.A.; Marques, M.I.; Martínez-Riera, J.R.; Melo, P. Adolescents’ Empowerment for Mental Health Literacy in School: A Pilot Study on ProLiSMental Psychoeducational Intervention. Int. J. Environ. Res. Public Health 2021, 18, 8022. [Google Scholar] [CrossRef]
  41. Clarke, A.M.; Kuosmanen, T.; Barry, M.M. A Systematic Review of Online Youth Mental Health Promotion and Prevention Interventions. J. Youth Adolesc. 2015, 44, 90–113. [Google Scholar] [CrossRef]
  42. Barry, M.M.; Clarke, A.M.; Jenkins, R.; Patel, V. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health 2013, 13, 835. [Google Scholar] [CrossRef] [PubMed]
  43. Weare, K.; Nind, M. Mental health promotion and problem prevention in schools: What does the evidence say? Health Promot. Int. 2011, 26, 29. [Google Scholar] [CrossRef] [PubMed]
  44. Fazel, M.; Hoagwood, K.; Stephan, S.; Ford, T. Mental health interventions in schools in high-income countries. Lancet Psychiatry 2014, 1, 377–387. [Google Scholar] [CrossRef]
  45. Rice, S.M.; Purcell, R.; McGorry, P.D. Adolescent and Young Adult Male Mental Health: Transforming System Failures into Proactive Models of Engagement. J. Adolesc. Health 2018, 62, S9–S17. [Google Scholar] [CrossRef]
  46. O’Reilly, M.; Svirydzenka, N.; Adams, S.; Dogra, N. Review of mental health promotion interventions in schools. Soc. Psychiatry Psychiatr. Epidemiol. 2018, 53, 647–662. [Google Scholar] [CrossRef] [PubMed]
  47. Durlak, J.A.; Weissberg, R.P.; Dymnicki, A.B.; Taylor, R.D.; Schellinger, K.B. The Impact of Enhancing Students’ Social and Emotional Learning: A Meta-Analysis of School-Based Universal Interventions. Child Dev. 2011, 82, 405–432. [Google Scholar] [CrossRef]
Adolescents 06 00046 g001
Figure 1. Selection process flow chart [20].
Figure 1. Selection process flow chart [20].
Adolescents 06 00046 g001
Table 1. Search strategy.
Table 1. Search strategy.
DatabasesSearchRecords ObtainedAfter FiltersFull Articles ReviewFinal Included
PUBMED (17 August 2024)mental health AND adolescents AND nursing care AND health Education20441444638
SCIELO (26 August 2024)mental health AND adolescents AND nursing care AND health education161011
salud mental AND adolescentes AND atención de enfermería AND educación en salud
CUIDEN (26 August 2024)salud mental AND adolescentes AND atención de enfermería AND educación en salud503000
BVS (26 August 2024)salud mental AND atención de enfermería AND educación en salud AND adolescentes1536293131
DIALNET (30 August 2024)mental health AND adolescents AND nursing care AND health education281322
salud mental AND atención de enfermería AND educación en salud AND adolescentes
SCOPUS (30 August 2024)mental health AND adolescents AND nursing care AND health education57822900
TOTALS 7912
Table 2. Summary table.
Table 2. Summary table.
Author, Year, and CountryStudyObjectivesSampleResultsROBINS-IRoB 2CASPe
Garmy, Jakobsson, et al., 2015, Sweden. [24]Quasi-experimental study. To evaluate the implementation of a universal school-based cognitive-behavioral program.62 students and seven tutors.The DISA program is a depression prevention program based on cognitive-behavioral therapy, conducted over 10 weeks in 90-min sessions. The CES-D questionnaire, a self-administered questionnaire on the frequency of 20 depressive symptoms, had to be completed at the first and last sessions, as well as at 12 months. Most students and all tutors expressed satisfaction with the intervention. Both female and male students scored lower on measures of recent depressive symptoms after the course, and for women, this remained the case one year after the intervention. The importance of the school nurse in promoting mental health in schools was emphasized.Moderate.--
Garmy, Berg, et al., 2015, Sweden. [29]Qualitative study.Exploring adolescents’ experiences with a prevention program based on cognitive behavioral therapy.89 adolescents between the ages of 13 and 15.The DISA program is a depression prevention program based on cognitive behavioral therapy. It was considered beneficial for intrapersonal strategies such as guided thinking, improved confidence, stress management, and positive activities. School is seen as the appropriate environment for this type of program. However, the complexity of structuring these programs day to day is highlighted. Some students found the program manual incomprehensible, while others found it valuable. In most focus groups, participants expressed the opinion that the program focused excessively on negative topics.--9/10
Ardic & Erdogan, 2016, Turkey. [25]Quasi-experimental study. To evaluate the applicability and long-term effectiveness of the T-COPE program for healthy adolescents on adolescent health.87 adolescents.The T-COPE program is a cognitive-behavioral therapy-based program for healthy adolescents. It was conducted in 15 45 min sessions, adapted to Turkish culture. Topics such as healthy lifestyles, strategies for building self-esteem, stress management, and effective communication were covered. Several scales were used to assess the program’s effectiveness. The adolescents who participated demonstrated healthy nutritional behaviors, increased physical activity, and improved stress management skills, which they maintained for 12 months.Moderate.--
Jamali et al., 2016, Iran. [28]Experimental study.To study the effect of life skills training on the mental health of Iranian high school students.100 students.An 8-session program in which results revealed that life skills training significantly improved participants’ mental health. They highlighted the need to implement these programs in schools to support the mental health of adolescents.Moderate.--
Ho et al., 2017, China. [34]Randomized controlled trial.To evaluate the effectiveness of a sports mentoring program based on positive youth development on the physical and mental well-being of adolescents recruited in a community setting.664 students.Sports mentoring program based on positive youth development for minors aged 12 and older, with 18 weekly sessions lasting 90 min each. Students randomly assigned to the control group received exclusive access to a web-based health education game with 400 questions about healthy lifestyles. Measurements were taken using the Chinese version of the SF-12v2. This trial showed that this intervention improved mental well-being, psychological assets, physical fitness, and physical activity levels in healthy adolescents.-Low.-
McAllister et al., 2018, Australia. [26]Quasi-experimental study.Effect of the intervention on resilience, coping, and self-efficacy in young people.850 young people.iCARER-R program, consisting of a 6-week module involving short group activities exploring well-being, the challenges of adolescence, social strategies for building strengths and connections, and resilience. After completing the program, there was a significant increase in self-efficacy and the number of positive coping strategies used by the young participants. The data indicated that participants benefited from the collaboration between the health and education sectors.Moderate.--
Jenkins et al., 2018, Canada. [27]Quasi-experimental study.Exploring youth-led mental health promotion in a rural community. 175 students.175 students.SONAR illustrates the feasibility of involving young people in mental health promotion and a range of positive effects for youth development. More than half of the sample (61.1%) met criteria for emotional distress. Among demographic determinants, only gender was associated with distress, with girls showing a greater tendency toward clinically significant levels. Mental health measures were also examined before and after the intervention, with results showing that resilience is the only mental health characteristic that changed among participants.Moderate.--
Tay et al., 2018, Singapore. [32]Systematic review.To assess the effectiveness of information and communication technology interventions on adolescents’ mental health literacy.19 studies.Informative interventions were useful and included active components such as videos or questionnaires. They succeeded in increasing mental health literacy and reducing stigma. However, they did not improve help-seeking behavior.Moderate.--
Bjørnsen et al., 2018, Norway. [35]Cohort study.Investigate mean differences in positive mental health literacy and mental well-being outcomes between adolescents who participated in the MEST program and those who did not, over the course of a school year.357 adolescents.The MEST program is a strategy to improve mental health literacy through seminars on sleep hygiene, stress management, relaxation techniques, and body image. Measurements were taken using the Mental Health Promoting Knowledge scale, and symptoms of mental health disorders were assessed using the Hopkins Symptom Checklist scale. They observed that more women had participated. All scored 2.1% higher in mental health literacy than those who did not. Participants scored higher on anxiety and depression than those who did not. When estimating the average effect of MEST treatment on mental well-being, girls showed a significant 9.7% increase in average outcomes compared with those who did not attend. In contrast, no significant change was observed among boys.Moderate.--
Silva et al., 2020, Portugal. [33]Systematic reviewDescribe nursing interventions to promote children’s mental health.15 articles.The studies reviewed demonstrated the importance of nursing professionals in promoting children and adolescents’ mental health through education, awareness-raising, and support programs addressing psycho-emotional, biological, and social needs.Moderate.--
Bringaker & Dahl, 2024, Norway.
[30]		Qualitative studyExploring the experiences of public health nurses in promoting the mental health of immigrant adolescents in lower secondary school and upper secondary school.13 female nurses in three municipalities in western Norway.The study explores nurses’ experiences in promoting mental health among immigrant adolescents. Language barriers and issues of trust often prevent adolescents from seeking help for mental health problems. Public health nurses should establish strong relationships with families, implement follow-up programs, and advocate for policies that address adolescents’ mental health needs.--9/10
Thiang et al., 2024, China. [31]Multi-methodEvaluate the Coolminds program, which promoted literacy by engaging students, parents, and educators in secondary schools.2903 students, 395 parents, and 325 teachers participated.In the Coolminds program, significant improvements in mental health knowledge were observed following the workshops. This study emphasized the need for mental health promotion in school settings.--9/10
Table 3. Summary of developed interventions.
Table 3. Summary of developed interventions.
StudyMethods and PopulationIntervention and Nurses Specific RoleResultsChallenges and Barriers Identified
Bjørnsen et al. (2018) [35]Quasi-experimental cohort (n = 357); adolescents aged 15–21, Norway.MEST: A universal strategy led by school nurses. Teaching positive mental health literacy (MHL).A 2.1% increase in positive MHL. A 9.7% increase in mental well-being among girls.There is a need for strategies that are more appealing to men.
McAllister et al. (2018) [26]Program evaluation (n = 850); 23 rural schools, Australia.A resilience program co-facilitated by nurses, counselors, and teachers. An interactive approach.A significant increase in self-efficacy and the use of adaptive coping strategies,Complex logistics in rural areas and maintaining staff motivation.
Ho et al. (2017) [34]Randomized clinical trial (n = 664); students, Hong Kong.Sports coaching: 18 weeks. Healthcare staff oversee participants’ overall and physical well-being.Increases in mental well-being (d = 0.25), self-efficacy (d = 0.22) and resilience (d = 0.19)Difficulty maintaining adherence in the long term (18-week intervention).
Thiang et al. (2024) [31]Mixed-methods study (n = 3623); students, parents, and teachers, Hong Kong.Coolminds: MHL workshops. Healthcare and nursing staff as expert content facilitators.A significant improvement in knowledge of mental health was observed in the three groups assessed.School bureaucracy and a reactive approach (acting only in crisis).
Bringaker & Dahl (2024) [30]Phenomenological qualitative study; 13 public health nurses, Norway.Promoting mental health among immigrant adolescents. A focus on cultural competence.The role of nurses as an essential ‘cultural bridge’ for integration.Language barriers and a lack of trust on the part of immigrant families.
Silva et al. (2020) [33]Comprehensive global literature review.Nurses as key advocates in early childhood and school-age education: screening and education.Nursing care is essential for building resilience and preventing illness.A lack of policies that clearly define school nurses’ autonomy.
Garmy et al. (2015) [29]Qualitative (n = 89); adolescents aged 13–15, Sweden.Depression prevention program based on cognitive behavioral therapy.Positive assessment of stress management techniques, but a feeling of being academically “overwhelmed.”Perception of the intervention as ‘just another school assignment’ (negative framing)
Garmy, Jakobsson, et al., (2015) [24]Quasi-experimental study with 62 students (14 years old) in Sweden.The DISA program, preventing depressive symptoms in adolescents, is an important school nursing issue. School nurses are well-positioned to implement mental health promotion programs in schools.The students, both females and males, rated their depressed symptoms as significantly lower after the course, and for the females, this was maintained 1 year postintervention.They highlighted practical issues: the course was quite time-consuming and required full support from the school administration during implementation.
Tay et al. (2018) [32]Systematic review (19 studies); International.ICT-based interventions. The nurse as a guide in digital health.Effective in improving knowledge of disorders (MHL), but not in seeking help.Technology alone cannot replace human contact in clinical practice.
Jenkins et al. (2018) [27]Mixed methods (n = 175); rural community, Canada.SONAR: A youth-led social media campaign promoting resilience.Proven effectiveness of youth engagement. Mixed quantitative results regarding resilienceThe sustainability of youth participation and variability in the measurement of resilience.
Jamali et al. (2016) [28]Preliminary experimental study (n = 100); secondary school, Iran.Life Skills Training (8 sessions). Health promoters/nurses.A significant improvement in overall mental health scores (GHQ-28).Limitations of the sample and the need for long-term follow-up.
Ardic & Erdogan, (2016) [25]Quasi-experimental study, Turkey. N = 87 (45 in intervention group, 42 in control group)T-COPE Healthy TEEN program on adolescent health. School health nurses and public health nurses can use the program.The applicability of the T-COPE Healthy TEEN program for adolescents and its effectiveness on their health behaviors, nutrition, physical activity knowledge, and stress management were revealed in this study.The lack of school nurses in public schools and the inadequate administration of school health services render adolescent obesity prevention efforts ineffective.
DISA: Depression in Swedish Adolescents; GHQ-28: General Health Questionnaire-28; ICT: information and communication technology: MEST: Mental Health Promoting Knowledge scale; MHL: Mental Health Literacy; SONAR: Social Networking Action for Resilience; T-COPE: healthy lifestyles TEEN program.
Table 4. Assessment Instruments identified.
Table 4. Assessment Instruments identified.
Author (Year)Scale/Instrument UsedConstruct MeasuredValidityReliabilityPractical Use in Nursing Interventions
Garmy, Jakobsson, et al. (2015) [24]CES-D (Center for Epidemiologic Studies Depression Scale)Frequency of depressive symptoms (20 items).Construct and criterion validity have been extensively demonstrated for screening in the general population.High internal consistency (Cronbach’s alpha of 0.88 in the study).Screening depressive symptoms pre/post intervention
Ho et al. (2017) [34]SF-12v2 (Chinese version)Quality of life in terms of physical and mental health.Confirmatory Factor Analysis (CFA) validated the two-factor structure (physical and mental).Cronbach’s alphas ranged from 0.76 to 0.86 for the subscales; excellent test–retest reliability (ICC > 0.75).Broad well-being outcome measure
Bjørnsen et al. (2018) [35]Mental Health Promoting Knowledge scale (MHPK-10)Mental health literacy.Structural validity confirmed via CFA (unifactorial model with good fit: CFI = 0.99).Strong internal consistency, with a Cronbach’s alpha of 0.84.Evaluates literacy gains after psychoeducation
Bjørnsen et al. (2018) [35]Hopkins Symptom Checklist (HSCL)Symptoms of anxiety and depressionCriterion validity compared to clinical diagnoses of emotional distress and psychological distress.Very good internal consistency (Cronbach’s alpha of 0.87 in the study sample)Monitoring emotional distress
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Segura-Daroca, P.; Gea-Caballero, V.; Juárez-Vela, R.; Chover-Sierra, E.; Martínez-Pascual, R.M.; Martínez-Sabater, A. Nursing Interventions for Adolescent Mental Health: A Systematic Mixed-Methods Review. Adolescents 2026, 6, 46. https://doi.org/10.3390/adolescents6030046

AMA Style

Segura-Daroca P, Gea-Caballero V, Juárez-Vela R, Chover-Sierra E, Martínez-Pascual RM, Martínez-Sabater A. Nursing Interventions for Adolescent Mental Health: A Systematic Mixed-Methods Review. Adolescents. 2026; 6(3):46. https://doi.org/10.3390/adolescents6030046

Chicago/Turabian Style

Segura-Daroca, Paula, Vicente Gea-Caballero, Raúl Juárez-Vela, Elena Chover-Sierra, Raquel María Martínez-Pascual, and Antonio Martínez-Sabater. 2026. "Nursing Interventions for Adolescent Mental Health: A Systematic Mixed-Methods Review" Adolescents 6, no. 3: 46. https://doi.org/10.3390/adolescents6030046

APA Style

Segura-Daroca, P., Gea-Caballero, V., Juárez-Vela, R., Chover-Sierra, E., Martínez-Pascual, R. M., & Martínez-Sabater, A. (2026). Nursing Interventions for Adolescent Mental Health: A Systematic Mixed-Methods Review. Adolescents, 6(3), 46. https://doi.org/10.3390/adolescents6030046

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