Youth Mental Health Prevention and Promotion Programs in Chinese Societies: A Systematic Review and Meta-Analysis

Chinese societies, encompassing Hong Kong, mainland China, Macau, and Taiwan, face growing challenges concerning the mental health of youth. Despite increasing scholarly interest and governmental policy emphasis on youth mental health prevention and promotion programs to address such concerns, there remains insufficient evidence on the synthesized effectiveness of current programs across Chinese societies, due to the lack of thorough reviews and methodological limitation in existing analyses. This systematic review and meta-analysis identified and evaluated studies that used experimental or quasi-experimental designs to examine the characteristics, quality, implementation, and efficacy of existing evidence-based prevention and promotion programs targeting mental health and well-being among youth aged 12 to 18 in Chinese societies. The study screened 3,448 studies identified through searches in both English and Chinese databases, of which 52 met the systematic review inclusion criteria. Included studies encompassed 39255 youth residing in mainland China, Hong Kong, and Taiwan, as no studies were found in Macau. The majority of the included studies were school-based (n = 50), addressed multiple mental health outcomes (n = 46), used randomized trials (n = 37), and conducted in mainland China (n = 26). Overall risk of bias assessment indicated an average quality score of 7.33 (SD = 1.08) for all included studies, with several criteria on participant recruitment, follow-up, and data analysis remained significant threats across studies. While schoolteachers were the primary implementers for many programs (n = 30), scant information regarding implementation support and process was available. Pooled effects regressions by outcome across included studies (n = 30) showed statistically significant effect on reducing externalizing behaviors, particularly substance use among youth. Included programs also demonstrated small effects on youth’s coping skills (i.e., drug resistance and positive coping behaviors) and social and emotional competencies (i.e., self-esteem and self-efficacy). No effects were found on the reduction of internalizing problems and behaviors, including anxiety, stress, and depression. The findings show promise for high-quality youth mental health prevention and promotion programs in Chinese societies aimed at promoting mental well-being, whereas preventing internalizing symptoms remains challenging. Furthermore, findings reveal that the prevailing study quality risks and lack of attention on implementation issues might pose additional threats to many current programs. Future scholars should pay close attention to addressing methodological quality and implementation challenges when designing and delivering mental health prevention and promotion programs for youth across Chinese societies.