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Frontiers in Public Health 01 frontiersin.org
Promotive and preventive
interventions for mental health
and well-being in adult
populations: a systematic umbrella
review
MaijaSaijonkari
1
*, ElsaParonen
1, TimoLakka
2,3, 4,
TommiTolmunen
5, IsmoLinnosmaa
1,6,
JohannaLammintakanen
1, JenniIsotalo
1, HannaRekola
7 and
TomiMäki-Opas
7,8
1 Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland, 2 Institute
of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland, 3 Department of
Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland, 4 Foundation for
Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio,
Finland, 5 Kuopio University Hospital, Kuopio, Finland, 6 Department of Public Health and Welfare,
National Institute for Health and Welfare, Helsinki, Finland, 7 Department of Social Sciences, University of
Eastern Finland, Kuopio, Finland, 8 Wellbeing Services Research Center, North Savo Wellbeing Services
County, Kuopio, Finland
Introduction: Mental health disorders are increasing worldwide, leading to
significant personal, economic, and social consequences. Mental health
promotion and prevention have been the subject of many systematic reviews.
Thus, decision makers likely face the problem of going through literature to find
and utilize the best available evidence. Therefore, this systematic umbrella review
aims to evaluate the eectiveness of interventions for promoting mental health
and mental well-being, as well as for the primary prevention of mental health
disorders.
Methods: Literature searches were performed in APA PsycInfo, Medline, and
Proquest Social Science databases from January 2000 to December 2021.
The search results were screened for eligibility using pre-defined criteria. The
methodological quality of the included reviews was evaluated using the AMSTAR
2 tool. The key findings of the included reviews were narratively synthesized and
reported with an emphasis on reviews achieving higher methodological quality.
Results: Out of the 240 articles found, 16 systematic reviews and four systematic
umbrella reviews were included. The methodological quality of included reviews
was low or critically low.
Discussion: This review suggests that interventions using cognitive-behavioral
therapy and those developing resilience, mindfulness, or healthy lifestyles can
beeective in the promotion of mental health and well-being in adult populations.
Motivational interviewing may reduce alcohol consumption in young adults.
Indicated or selective prevention is likely to becost-eective compared to universal
prevention. Parenting interventions and workplace interventions may be cost-
eective in terms of promoting mental health. Due to the low methodological
quality of the included reviews and substantial heterogeneity among the reported
results, the findings from the reviews wesummarized should beinterpreted with
caution. There is a need for further rigorous, high-quality systematic reviews.
OPEN ACCESS
EDITED BY
Lara Guedes De Pinho,
University of Evora, Portugal
REVIEWED BY
Naseem Akhtar Qureshi,
Al-Falah University, India
Manuel Lopes,
University of Evora, Portugal
*CORRESPONDENCE
Maija Saijonkari
maija.saijonkari@uef.fi
RECEIVED 06 April 2023
ACCEPTED 14 August 2023
PUBLISHED 31 August 2023
CITATION
Saijonkari M, Paronen E, Lakka T, Tolmunen T,
Linnosmaa I, Lammintakanen J, Isotalo J,
Rekola H and Mäki-Opas T (2023) Promotive
and preventive interventions for mental health
and well-being in adult populations: a
systematic umbrella review.
Front. Public Health 11:1201552.
doi: 10.3389/fpubh.2023.1201552
COPYRIGHT
© 2023 Saijonkari, Paronen, Lakka, Tolmunen,
Linnosmaa, Lammintakanen, Isotalo, Rekola
and Mäki-Opas. This is an open-access article
distributed under the terms of the Creative
Commons Attribution License (CC BY). The
use, distribution or reproduction in other
forums is permitted, provided the original
author(s) and the copyright owner(s) are
credited and that the original publication in this
journal is cited, in accordance with accepted
academic practice. No use, distribution or
reproduction is permitted which does not
comply with these terms.
TYPE Systematic Review
PUBLISHED 31 August 2023
DOI 10.3389/fpubh.2023.1201552
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 02 frontiersin.org
KEYWORDS
mental health, mental wellbeing, alcohol, promotion, prevention, cognitive behavioral
therapy, eectiveness, healthy lifestyle
1. Introduction
Mental health is dened by the World Health Organization
(WHO) as “a state of mental well-being that enables people to cope
with the stresses of life, realize their abilities, learn well and work well,
and contribute to their community” (1). WHO also states that “mental
health is an integral component of health and well-being and is more
than the absence of mental disorder” (1). Mental health disorders,
which also include substance addictions, are increasing worldwide,
and have signicant human, economic, and social consequences (2).
Although mental problems aect every social class, some
disadvantaged groups are particularly vulnerable to them (3). ese
groups, by denition, are lacking basic resources or conditions
necessary for an equal position in society (4).
e COVID-19 crisis has aected negatively the already
burdening mental health situation (5). In its recent report (5), the
Organization for Economic Co-operation and Development (OECD)
stressed the urgent need for integrated, mental health support
encompassing the whole of society and identied access to evidence-
based mental health promotion programs as one priority. Mental
health promotion oen refers to interventions aimed at improving
positive mental health and well-being, that strengthen and protect
mental health and may also prevent mental health disorders (6).
Prevention of mental disorders, on the other hand, focuses on the
causes and risk factors of mental health disorders. It can bedened as
primary, secondary, or tertiary prevention depending on whether the
strategy aims at (i) preventing the onset of symptoms or disorder, (ii)
reducing the prevalence of the disorder or (iii) reducing the severity,
course or duration of the disorder and associated disability,
respectively (6). Primary prevention activities can bedesigned as (i)
universal (for the general population), (ii) selective (for high-risk
groups), or (iii) indicated (for high-risk individuals displaying
symptoms of illness but not meeting full diagnostic criteria) (6–9). e
promotion of positive mental health and the primary prevention are
overlapping and complementary activities that can bepresent within
the same program (6).
When implementing new approaches for mental health and well-
being it is important to prioritize the delivery of eective interventions
(10). It is also important to understand for whom the intervention
works and under what conditions, to be able to embed new
interventions in normal activities and practices in a sustainable way
(11, 12).
Mental health promotion and prevention have been the subject of
many systematic reviews. us, decision makers likely face the
problem of going through literature to nd and utilize the best
available evidence. Some scoping reviews have mapped the body of
literature concerning mental health promotion and prevention (13,
14), but comprehensive umbrella reviews for this topic are scarce.
Hence, a summary of existing research syntheses related to mental
health promotion and prevention interventions for the adult
population is needed. e aim of this systematic umbrella review was
to evaluate the eectiveness of intervention approaches among adult
populations aged 18–64 for:
• Promoting mental health and mental well-being, as well as,
• Primary prevention of mental health disorders, including
substance abuse problems.
In addition, weaimed to identify the cost-eectiveness of the
interventions as well as factors contributing to the eectiveness of
the interventions.
2. Methods
is study employed the Joanna Briggs Institute (JBI) umbrella
review method (also called review of reviews, overview of reviews),
which is an established way of bringing together and summarizing a
broad evidence-base utilizing all types of syntheses of research
evidence (15). An umbrella review provides a summary of existing
research syntheses related to a given topic and does not re-synthesize
the results of existing reviews with meta-analysis or meta-synthesis
(15). is review was carried out and reported using the Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)
guideline (16). A completed PRISMA checklist is included in
Supplementary Table S1 in the online supplementary materials.
2.1. Search strategy
Literature searches (Table1) were performed in cooperation with
social and health sciences information specialist in three databases,
APA PsycInfo, Medline, and ProQuest Social Sciences. e keywords
used in the searches were: “mental health,” “wellbeing” “well-being,”
“psych* well-being,” “mental illness,” “substance abuse,” “alcohol,”
“tobacco,” “drug*,” “promot*,” “prevent*,” “intervention,” “program.”
Search limiters that were used (when available) included systematic
reviews published between January 2000 to December 2021, and
human studies.
In addition, articles identied through relevant reviews were also
considered, and the reference lists of the selected articles were checked
to identify publications that might not have been found in the search.
2.2. Study selection and quality appraisal
e title and abstract of articles as well as the full text of potentially
relevant articles were screened against pre-dened eligibility criteria
(Table2) by two independent reviewers (MS, JI). Consensus on article
inclusion was reached via discussion.
Following the criteria of the Database of Abstracts of Reviews of
Eects (DARE), used in previous umbrella reviews (17, 18), a review
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 03 frontiersin.org
was deemed systematic if it fullled four of the following ve criteria
with Criteria 1–3 being mandatory: (1) Were inclusion/exclusion
criteria reported? (2) Was the search adequate? (3) Were the included
studies synthesized? (4) Was the quality of the included studies
assessed? (5) Are sucient details about the individual included
studies presented?
An umbrella review was included in this review if it reported
the effectiveness of the interventions studied. Otherwise, it was
used as a reference source. A review that was already included in
one of the umbrella reviews was excluded from this review to
avoid giving it too much weight. No separate search was
conducted on costs or cost-effectiveness of the interventions and
factors contributing to the success of the intervention, but any
reported information was collected from studies found in our
literature search.
e methodological quality of the included reviews was
appraised using the AMSTAR 2 tool (A MeaSurement Tool to
Assess systematic Reviews) (19), which has proven its reliability
and validity for systematic reviews that include both randomized
and observational studies. One reviewer (MS) evaluated the
included articles. Another reviewer (JI) independently evaluated
ve (23%) of the articles for quality control. Discrepancies were
resolved by consensus. Inter-rater reliability was calculated with
percentage of agreement between reviewers.
2.3. Data extraction and synthesis
e following data were extracted from the included reviews: title,
study type, amount, and type of included studies, population,
TABLE1 Search strategy.
Database Search strategy Search result
APA PsycInfo
(EBSCOhost)
S1: TI (“mental health” OR “psych* well-being”) AND TI promot* AND (program OR intervention) Limiters- Publication
Year: 1950–2021, Methodology: meta-analysis or systematic review or literature review.
S2: TI (“mental health” OR “psych* well-being”) AND TI promot* AND (program OR intervention) AND TI review*
Limiters- Publication Year: 1950–2021.
S1 OR S2 Limiters – Publication Year: 2000–2021 66
Social Sciences
(ProQuest)
S1: ti ("mental health" OR "psych* well-being") AND ti (promot*) AND no (program OR intervention). Limiters: (“Literature
Review” OR “Review” OR “Evidence Based Healthcare”) AND PEER(yes)
S2: ti("mental health" OR "psych* well-being") AND ti(promot*) AND no(program OR intervention). Limiters: (“Literature
Review” OR “Review” OR “Evidence Based Healthcare”) AND PEER(yes)
S1 OR S2 Limiters applied: 2000–2021 29
Pubmed (Medline) (“mental health”[Title] OR “psychological well-being”[Title]) AND promot*[Title] AND (program OR intervention) Filters:
Meta-Analysis, Review, Systematic Review, Humans, from 2000–2021 103
(“mental illness”[Title] OR “substance abuse”[Title] OR alcohol[Title] OR tobacco[Title] OR drug*[Title]) AND
(prevent*[Title]) AND (program[Title] OR intervention[Title]) Filters: Meta-Analysis, Review, Systematic Review, Humans,
from 2000–2021
25
Total 230
TABLE2 Inclusion and exclusion criteria.
Inclusion criteria Exclusion criteria
Population Non-clinical population A specic group of patients (e.g., mental health
promotion among cancer patients).
Aged 18–64 years (majority of study participants). –
Intervention Promotion of mental health or mental wellbeing or primary prevention of mental
health disorder or substance abuse.
Treatment of mental health disorder or substance abuse.
Comparison Systematic review included mainly studies with controls; any alternative approach to
support mental health, or no intervention.
–
Outcome Any measurable indicator of mental health, mental wellbeing or substance use/
substance use habits.
-
Success factor or cost data of the intervention.
Setting Community (not health care units) Health services unit
Western countries (Europe, UnitedStates, Canada, Australia, NewZealand) Non-Western countries
Follow-up At least one month Less than one month follow-up
Publication time 2000–2021 –
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 04 frontiersin.org
intervention, main ndings relevant to this review (data on mental
health, mental well-being, substance use/substance use habits of the
study participants, or success factors or cost data of the interventions),
time of searches, and funding sources. Data was extracted and
tabulated by one reviewer (MS) and checked in full by another (JI).
Key ndings of included reviews were narratively synthetized by
population type with evidence from higher methodological quality
reviews reported in greater detail (15).
3. Results
Literature searches yielded 240 papers of which 63 were read in
full text. Of these, 43 articles were excluded (Supplementary Table S2
in the online supplementary materials) for reasons outlined in the
PRISMA ow chart in Figure1. Consequently, 20 articles (20–39)
were included (see Figure1 for PRISMA owchart and details).
3.1. Description of included reviews
e included reviews consisted of four systematic umbrella
reviews (29–32) and 16 systematic reviews (20–28, 33–39). Seven of
the reviews performed a meta-analysis (20, 21, 25, 33, 35–37). Of these
20 reviews, 18 addressed the eectiveness of mental health promotive
and preventive interventions (20–23, 25–38), one the cost-eectiveness
of such interventions (24), and one the eectiveness and cost-
eectiveness of such interventions (39).
3.2. Quality of included reviews
Critical appraisal using the AMSTAR 2 criteria
(Supplementary Table S3) revealed one weakness out of the seven
possible critical domains for nine reviews (20, 21, 24, 28, 33, 34,
36, 37, 39) meaning their methodological quality was low. Five
reviews had two (22, 23, 27, 29, 30), four had three (25, 26, 31, 38)
and two had four (32, 35) weaknesses in critical domains, pointing
toward critically low methodological quality. e agreement
between reviewers concerning ve articles assessed in duplicate
was 95%.
Across reviews, there were no or only slight weaknesses regarding
the comprehensiveness of the literature search strategy (domain 4)
(Supplementary Table S3). Regarding the appropriateness of risk of
bias assessment (domain 9), 16 reviews had no weaknesses (20–30, 33,
34, 36, 37, 39). On the contrary, only two reviews had no weaknesses
regarding the reporting of excluded studies (domain 7) (20, 28) and
eight reviews regarding a priori design (domain 2) (20, 21, 24, 28, 33,
34, 36, 37, 39). Critical domains 11 and 15 concerning statistical
methods and publication bias, respectively, were not relevant in 13
FIGURE1
Flow chart of the process of identifying and selecting studies (16).
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 05 frontiersin.org
reviews that did not perform a meta-analysis (22–24, 26–32, 34,
38, 39).
3.3. The eectiveness of interventions
Of the 19 reviews addressing the eectiveness of the
interventions, ve covered young adults (aged 18–25 years) (25, 31,
34–36), one parents and families (20), ve employees at work-
places (21, 28–30, 32), two disadvantaged groups (22, 38), and six
the general adult population (23, 26, 27, 33, 37, 39). A
meta-analysis was performed in seven of these reviews (20, 21, 25,
33, 35–37).
3.3.1. Interventions for young adults
We identied four systematic reviews (25, 34–36) and one
umbrella review (31) on the impact of mental health promotion and
prevention interventions for young adults aged 18–25 years (Table3).
Dawson et al. (36) included 40 randomized controlled trials
(RCTs) of mindfulness-based interventions for university students
and found a small but statistically signicant eect on distress and a
moderate eect on mindfulness compared to no intervention over
TABLE3 Characteristics and main findings of included reviews concerning interventions for young adults.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding
sources of
the review
Dawson, 2020 (36) systematic
review and meta-analysis
k = 40; RCTs (Until March
2017)
University
students
Mindfulness-based
interventions (MBI)
SMD −0.32; 95% CI −0.50 to −0.13; p = 0.0007 for distress and SMD
0.53; 0.33 to 0.73; p < 0.00001 for MBI compared to passive controls at
three months follow-up. Compared to active control groups (e.g.,
relaxation or self-awareness strategies), no follow-up data available.
e low methodological quality of most of the included trials
precludes making rm recommendations for practice, and the
variability of the eects means that some students in some contexts
may not benet from MBIs.
12; 1 NR
Lo, 2018 (25) systematic
review and meta-analysis
k = 24; RCTs (Until April
2016)
Health
profession
students
Group interventions
designed to enhance/
maintain mental health
CBT interventions reduced anxiety (SMD −0.26; 95% CI −0.5 to
−0.02), depression (SMD −0.29; 95% CI −0.52 to −0.05) and stress
(SMD 0.37; 95% CI −0.61 to −0.13). Mindfulness strategies reduced
stress (SMD −0.60; 95% CI 0.97 to −0.22) but not anxiety (95% CI
−0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI
−0.36 to 0.10). Relaxation strategies reduced anxiety (SMD -0.80; 95%
CI −1.03 to −0.58), depression (SMD −0.49; 95% CI −0.88 to −0.11)
and stress (SMD −0.34; 95% CI −0.67 to −0.01). Method quality was
generally poor.
10; 3 NR
Clarke, 2015 (34) systematic
review k = 28; RCTs and
quasi-experimental studies
(Jan. 2000–June 2013)
You th
(majority
over 18 years
of age)
Online Youth Mental
Health Promotion and
Prevention
Interventions
e evidence regarding mental health promotion gaming
interventions is weak, as a result of the absence of a control group and
high dropout rates in the two studies reviewed.
9; 1 Inspire Ireland
Foundation and
Young and Well
Cooperative
Research Centre,
Australia.
Online prevention interventions: promising evidence regarding
computerized CBT interventions and their impact on emerging adults’
anxiety and depression symptoms.
Conley, 2015 (35) systematic
review and meta-analysis
k = 90; RCTs, quasi-
experimental (Until Dec.
2012)
Higher
Education
Students
Universal mental health
promotion
interventions
Interventions with supervised skills practice: a signicant positive
eect at follow-up (median 12 weeks) (ES = 0.28, CI = 0.16 to 0.40;
k = 16), whereas psychoeducational interventions did not (ES = 0.08,
CI = −0.04 to 0.21; k = 10). e mean ES for the four studies of skills-
training interventions without supervised practice was not signicant
at follow-up (ES = 0.13, CI = −0.14 to 0.39).
4; 4 Loyola University
Chicago
Sandler, 2014 (31) review of
meta-analytic reviews k = 4
relevant reviews (of total of 48
reviews) (2000–2013)
College
students up
to age of 26
Prevention and
promotion programs to
prevent alcohol use
Motivational interviewing, blood alcohol content education,
normative comparison, and feedback on consumption: small,
signicant eects on alcohol use and alcohol-related problems at
short-term follow-up. Signicant eect on frequency of drinking days
and alcohol-related problems up to four years aer intervention.
Heterogeneous eects on alcohol-related problems at short-term
follow-up, other eects homogeneous.
5; 3 NR
Face-to-face interventions: small, signicant eect on alcohol use at
three- and six-month follow-ups. Motivational interviewing and
personalized feedback for heavy drinkers: large signicant eects on
alcohol consumption and alcohol problems one year aer
participation. e eects for both outcomes were heterogeneous.
Meta-analysis of 14 trials of programs that challenged alcohol
expectancies: small, signicant eects at post-test, but the eects were
non-signicant at follow-ups greater than a month.
CBT, cognitive behavioral therapy; CI, condential index; k, number of studies; NR, not reported; RCT, randomized controlled trial; SMD, standard mean dierence.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 06 frontiersin.org
3 months. Compared to active control conditions, which typically
utilize alternative interventions, no results about follow-up data were
available. e authors stressed the low methodological quality of most
of the included studies and the variability of the eects. On the other
hand, the review by Lo et al. (25) including 24 RCTs found that
mindfulness strategies reduced stress but not anxiety, depression, or
burnout among health professional students. In addition, cognitive-
behavioral interventions showed a signicant positive eect on
anxiety, depression, and stress, and relaxation-strategy interventions
on anxiety, depression, and stress. Again, the quality of included trials
was generally poor.
Clarke et al. (34), summarizing 28 RCTs and observational
studies, found promising evidence for computerized cognitive
behavioral therapy interventions for the prevention of anxiety and
depression in emerging adults. e evidence regarding mental health
promotion gaming interventions is weak.
Conley et al. (35) included 90 RCTs and quasi-experimental
studies on mental health promotion among higher education students.
Interventions with supervised skills practice had a signicant positive
eect on mental health, whereas psychoeducational interventions and
skills-training interventions without supervised practice had a
nonsignicant eect.
Sandler et al. (31) summarized four meta-analytic reviews of
prevention and promotion programs to prevent alcohol use among
college students, and found that motivational interviewing, blood
alcohol content education, normative comparison, and feedback on
consumption have small, statistically signicant, but partly
heterogeneous eects on alcohol use and alcohol-related problems at
short-term follow-up. e eects diminished over time, but the eect
on frequency of drinking days and alcohol-related problems remained
signicant and were homogenous up to 4 years aer the intervention.
Motivational interviewing and personalized feedback for heavy
drinkers had large signicant eects of reduced alcohol consumption
and alcohol problems 1 year aer participation, but the eects on both
outcomes were heterogeneous. Programs that challenged alcohol
expectancies had no signicant eects at follow-ups greater than
a month.
Overall, statistically signicant benecial eects were found for
mindfulness-based interventions on mindfulness, distress, and
stress and for computerized or group-based cognitive behavior
techniques, as well as for relaxation strategies on anxiety,
depression, and stress among young adults. However, the ndings
are limited due to the low methodological quality and insucient
number of included primary studies, and the variability of the
results. Skills-based mental health promotion interventions with
supervision had a signicant eect on overall mental health among
young adults. Motivational interviewing and personalized feedback
were eective in reducing alcohol consumption and
alcohol problems.
3.3.2. Interventions for parents and families
We identied one systematic review of mental health promoting
interventions for parents and families (20) (Table4).
Barlow etal. (20) included 48 RCTs and concluded that group-
based behavioral, cognitive-behavioral, or multi-modal parenting
programs improve parental depression, anxiety, stress, anger, guilt,
condence, and satisfaction with the partner relationship statistically
signicantly at 2–6 months follow-up. Programs were eective at
6 month follow-up in relieving stress and improving condence but
eects on all outcomes disappeared at 1 year follow-up. No eects on
self-esteem were found.
Overall, group-based behavioral, cognitive-behavioral, or multi-
modal parenting programs were found to improve parental mental
health in the short term.
3.3.3. Workplace interventions
We identied three systematic umbrella reviews (29, 30, 32) and
two systematic reviews (21, 28) of studies exploring eects of mental
health promoting interventions at the workplace (Table5).
Bartlett etal. (21) combined the results of 23 RCTs of mindfulness
training delivered in the work context and found it benecial for
anxiety, psychological distress, sleep, mindfulness, stress, and well-
being compared to active comparators. e authors could not draw
conclusions for burnout due to ambivalence in results and for
depression due to publication bias.
Otto etal. (28) conducted a systematic review of physical activity,
cognitive-behavioral, and organizational interventions among nursing
sta in older adult care. Based on three RCTs, the authors found that
cognitive-behavioral and multicomponent interventions had positive
eects on nurses’ mental health. However, they reported that there are
not enough high-quality studies to make rm conclusions about the
eectiveness of studied interventions in this target group.
TABLE4 Characteristics and main findings of included reviews concerning interventions for parents and families.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding
sources of the
review
Barlow, 2014 (20) systematic
review and meta-analysis
k = 48; RCTs (Until 2011)
Parents Group-based
behavioral, cognitive-
behavioral or multi-
modal parenting
program
Statistically signicant short-term (2–6 months) improvements in
parental depression (standardized mean dierence (SMD) -0.17,
95% condence interval (CI) −0.28 to −0.07), anxiety (SMD −0.22,
95% CI −0.43 to −0.01), stress (SMD −0.29, 95% CI −0.42 to
−0.15), anger (SMD −0.60, 95% CI −1.00 to −0.20), guilt (SMD
−0.79, 95% CI −1.18 to −0.41), condence (SMD −0.34, 95% CI
−0.51 to −0.17) and satisfaction with the partner relationship (SMD
-0.28, 95% CI -0.47 to −0.09). However, only stress and condence
continued to bestatistically signicant at six-month follow-up, and
none were signicant at one year. ere was no evidence of any
eect on self-esteem (SMD −0.01, 95% CI −0.45 to 0.42).
14; 1 UK Cochrane Centre.
e University of
Warwick, UK. e
Institute of Mental
Health, Nottingham,
UK. NHS Cochrane
Programme Grant
Scheme, UK.
CI, condential index; k, number of studies; RCT, randomized controlled trial; SMD, standard mean dierence; UK, UnitedKingdom.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 07 frontiersin.org
Proper etal. (30) summarized the results of six reviews of mental
health promotion interventions at the workplace. ey concluded that
there was strong evidence based on high quality reviews indicating
that the use of cognitive behavior techniques yields positive eects on
employees’ mental health. e reports by Pieper etal. (29) including
(30) and Bhui etal. (32), including 28 systematic reviews came to the
same conclusion. Proper etal. (30) also reported that there was strong
evidence regarding e-health interventions. Pieper etal. (29) found
physical training and yoga eective in prevention of stress and anxiety.
Bhui et al. (32) found that physical activity programs showed
convincing positive eects on absenteeism.
Overall, workplace mindfulness training was benecial in
promoting employees’ mental health compared to active comparators.
Based on three umbrella reviews, cognitive behavior techniques were
eective in mental health promotion.
3.3.4. Interventions for disadvantaged groups
We identied two systematic reviews of studies concerning mental
health promotion and prevention interventions for disadvantaged
groups (Table6).
Koopman etal. (22) summarized 24 RCTs on the eectiveness of
mental health promotion interventions among unemployed people,
TABLE5 Characteristics and main findings of included reviews concerning interventions at workplace.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding sources
of the review
Otto, 2021 (28) systematic
review k = 3 relevant RCTs (of
total of 6) (Until Nov. 2020)
Nursing sta
in older adult
care
1. Physical activity
interventions
First positive eects can bedemonstrated concerning CBT
interventions and multicomponent interventions.
10; 1 No external funding
2. CBT interventions ere is no strong evidence for any type of intervention
aecting physical and mental health. e heterogeneity of
the studies regarding all aspects of the interventions and
assessed outcome measures makes interpretation more
dicult.
3. Organizational
interventions (resources,
working methods, tasks,
or the environment)
Pieper, 2019 (29) review of
reviews k = 38 relevant
reviews (of total of 74) (April
2012 – Oct. 2017)
Male and
female
employees in
dierent age
groups
Workplace interventions
(resilience or
mindfulness training,
CBT, relaxation
techniques and
organizational-level
workplace interventions)
Mindfulness and cognitive-behavioral training as well as
peer supervision appeared to help reduce stress.
Additionally, organizational interventions including
reduction of work impact and exible worktime seemed to
lower stress and burn-out-symptoms. Overall, multi-
component programs were more eective than single-
component interventions. e authors found cognitive-
behavioral programs eective at reducing depression,
anxiety, and burnout as well as to improve well-being. One
moderate-quality review assessed physical training and
yoga-interventions and found them eective in the
prevention of stress and anxiety.
7; 2 No external funding
Proper, 2019 (30) review of
reviews k = 6 relevant reviews
(of total of 23) (2009–2018)
Working
population
Worksite mental health
promotion interventions
Based on high-quality reviews, there is strong evidence that
workplace psychological interventions, especially those that
use e-health and cognitive behavior techniques, yield
positive eects on mental health.
8; 2 European Union, in the
framework of the Health
Program (2014–2020),
grant agreement number
761307.
Bartlett, 2019 (21) systematic
review and meta-analysis
k = 23 RCTs (Until 2016)
Employees in
the workplace
Mindfulness training
delivered in the work
context
Workplace-delivered mindfulness training: benecial eects
for anxiety (g = 0.62, p = 0.001, I2 = 0), psychological distress
(g = 0.69, p = 0.001, I2 = 20), sleep (g = 0.26, p = 0.003, I2 = 0),
mindfulness (g = 0.45, p = 0.001, I2 = 54), stress (g = 0.56,
p = 0.001, I2 = 79) and well-being (g = 0.46, p = 0.002, I2 = 66).
Benecial eects for psychological distress, depression,
anxiety, and wellbeing also remained stable at three-month
follow-up. No conclusions could bedrawn from pooled data
for burnout due to ambivalence in results, for depression
due to publication bias, or for work performance due to
insucient data. e study that reported null results for
mindfulness, wellbeing, and engagement following a six-
month mindfulness program saw a continuing absence of
eect 12 months from baseline.
14; 1 NR
Bhui, 2012 (32) review of
reviews k = 23 reviews (1990
– July 2011)
Employees in
the workplace
Individual,
organizational, and
mixed interventions on
mental health and
absenteeism
CBT was the most eective individual targeted intervention
for mental health.
6; 4 Department of Health, UK.
e only organizational intervention to show convincing
eects on absenteeism (the main cause of which are anxiety
and depression) was physical activity programs.
CBT, cognitive behavioral therapy; g, eect size; I2, heterogeneity; k, number of studies; NR, not reported; RCT, randomized controlled trial; SMD, standard mean dierence; UK,
UnitedKingdom.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 08 frontiersin.org
while Gottlieb etal. (38) reviewed 11 RCTs and two cohort studies on
the impact of contextual interventions on depression. Studies of
pre-employment training included in the review of Gottlieb etal. (38)
were also included in Koopman etal. (22).
Koopman etal. (22) reported that the evidence was strongest for
combined interventions (CI) consisting of psychological interventions
that strengthen psychological resilience and vocational skills training
aiming at re-employment: all the included CI studies reported
positive eects on mental health and two of these studies were of
high quality.
Most studies of community-level preventive interventions for
unemployed people reviewed by Gottlieb etal. (38) suggested long-
term eects of pre-employment training on decreasing depressive
symptoms and psychological distress among participants,
particularly among those depressed at baseline. Of the four studies
focusing on housing interventions for homeless people or people
living in public housing, one large study identied a signicant
improvement in depressive symptoms whereas three studies
demonstrated an improvement in other markers of psychological
distress. ree of the four other advocacy interventions, including
anti-poverty programs and shelter programs, demonstrated
improvements in depressive symptoms.
Overall, vocational skills training combined with resilience-
building interventions were eective in the promotion of unemployed
adults’ mental health. Housing interventions for homeless people,
anti-poverty programs and shelter programs, had a benecial eect on
some mental health outcomes.
3.3.5. Interventions for the general adult
population
We identied six systematic reviews of interventions promoting
mental health of the general adult population (23, 26, 27, 33, 37, 39)
(Table7).
Galante etal. (37) included 136 RCTs on the eectiveness of
mindfulness-based programs (MBP) in non-clinical settings.
Compared to passive control (no intervention or wait list), MBPs on
average had a moderate positive eect on psychological distress,
depression, and anxiety, as well as on well-being but to a lesser
extent. Compared with taking nonspecic action, MBPs had a
moderate positive eect on depressive symptoms and the
relationship with the self (e.g., self-esteem, self-compassion). ere
was no statistically signicant evidence for improving anxiety or
distress and no reliable data on well-being. When compared with
specic active control conditions, no signicant evidence for MBPs’
superiority was found. Given the overall high risk of bias in the
included trials and the heterogeneity between studies, there was no
certainty that the results represent the true eects and that MBPs
work in every setting.
Lampert et al. (23), Hunter etal. (39), and Bowler et al. (33)
focused on green space interventions. Lampert summarized eight
cross-sectional studies and concluded that community gardeners,
when compared with their neighbors who were not engaged in
gardening activities, had statistically signicantly better health
outcomes in terms of life satisfaction, happiness, general health,
mental health, and social cohesion. Hunter etal. (39), reviewing 38
TABLE6 Characteristics and main findings of included reviews concerning interventions for disadvantaged groups.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target group Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding sources
of the review
Koopman, 2017 (22)
systematic review k = 24,
RCTs (NR)
Unemployed people 1. Occupational skills training
(OST)
5/8 OST studies reported positive eects
and 3/8 no eect on mental health
8; 2 NR
2. Psychological interventions
(PSI)
7/9 PSI studies reported positive eects
and 2/9 no eect on mental health
3. Combined (OST + PSI) 6/6 Combined studies (including two
high-quality studies) reported positive
eects on mental health.
Gottlieb, 2011 (38)
systematic review k = 13,
RCTs and cohort studies
(1997–2008)
Unemployed people Pre-employment training (e.g.,
employment workshops)
Most community-level preventive
interventions for unemployed adults
suggested long-term eects of pre-
employment training on decreasing
depressive symptoms and psychological
distress among participants, particularly
among those depressed at baseline.
6; 3 NIMH (National Institute
of Mental Health) grant
#R25MH060288–09.
Homeless people and
people living in public
housing
Housing interventions 1/4 studies (the largest study): signicant
improvement in depressive symptoms.
Low-income women,
mothers, and victims of
domestic violence
Anti-poverty programs, parenting
programs, shelter programs
3/4 studies: no improvement in depressive
symptoms, but an improvement in other
markers of psychological distress,
including calmness and peacefulness,
self-perception of depressive symptoms,
paranoia, hostility, and obsessiveness.
3/4 interventions demonstrated
improvements in depressive symptoms.
k, number of studies; NR, not reported; OST, occupational skills training; PSI, psychological interventions; RCT, randomized controlled trial.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 09 frontiersin.org
RCTs or quasi-experimental studies, reported strong evidence to
support park-based and greenway/trail interventions employing a
dual approach (i.e., a physical change to the urban green space and
promotion/marketing programs), as well as interventions related to
the greening of vacant lots promoting health and well-being. Based on
(30) studies, Bowler etal. (33) found that exposure to the natural
environment compared to the synthetic environment reduced negative
emotions such as anger, fatigue, and sadness, and had a positive eect
on attention. ere were no signicant eects on energy scores,
anxiety, and tranquility.
TABLE7 Characteristics and main findings of included reviews concerning interventions for general adult population.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding
sources of
the review
Galante, 2021 (37) systematic
review and meta-analysis
k = 136; RCTs (From inception
to Aug. 2020)
Any target
group
Mindfulness (MBP) Compared with no intervention, in most but not all scenarios MBPs
improved average anxiety (8 trials; SMD = −0.56; 95% CI −0.80 to −0.33;
p-value <0.001; 95% PI −1.19 to 0.06), depression (14 trials; SMD = −0.53;
95% CI −0.72 to −0.34; p-value <0.001; 95% PI −1.14 to 0.07), distress (27
trials; SMD = −0.45; 95% CI −0.58 to −0.31; p-value <0.001; 95% PI −1.04
to 0.14), and well–being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-
value = 0.003; 95% CI −0.29 to 0.94).
14; 1 National Institute
for Health
Research (NIHR).
Compared with nonspecic active control conditions, in most but not all
scenarios MBPs improved average depression (6 trials; SMD = −0.46; 95%
CI −0.81 to −0.10; p-value = 0.012, 95% PI −1.57 to 0.66), with no
statistically signicant evidence for improving anxiety or distress and no
reliable data on well–being. Compared with specic active control
conditions, there is no statistically signicant evidence of MBPs’
superiority.
Lampert, 2021 (23) systematic
review k = 8; obser vational
studies (Until Nov. 2020)
Non-
clinical
population
Community
gardening (gardening
activities)
Community gardeners had signicantly better health outcomes (life
satisfaction, happiness, general health, mental health, and social cohesion)
than their neighbors not engaged in gardening activities.
7;2 Instituto de Sau’de
Ambiental.
Hunter, 2019 (39) systematic
review k = 38; RCTs or quasi-
experimental studies (NR)
Any target
group
Urban green space
interventions
(greenways, trails and
park-based
interventions)
Strong evidence for park-based (7/7 studies) and greenway/trail (3/3
studies) interventions employing a dual approach (i.e., a physical change
to the urban green space and promotion/marketing programs) on health
and wellbeing.
9; 1 WHO Regional
Oce for Europe.
National Institute
of Health
Research (NIHR).
Strong evidence for greening of vacant lots (4/4 studies) for health and
wellbeing (e.g., reduction in stress).
Macedo, 2014 (26) systematic
review k = 13; RCTs and CTs
(Until Jan. 2013)
Non-
clinical
samples of
adults
Resilience promotion
programs
RCTs: 6/7 statistically signicant positive change in resilience, hardiness
or resilience surrogates (e.g., coping or self-esteem).
4; 3 CNPq* and
FAPERJ*
CTs: 5/5 statistically signicant positive change in resilience or hardiness
or regarding only some of the resilience surrogates.
Open trial: statistically signicant positive change in the levels of stress
and depression, but not in well-being and distress
Mammen, 2013 (27)
systematic review k = 30;
prospective, longitudinal
studies (Jan.1976–Dec2012)
Nonclinical
sample,
11–
100 years
Physical activity (PA)
in the prevention of
depression.
25/30 studies: a signicant, inverse relationship between baseline PA and
follow-up depression.
5; 2 e Canadian
Institute for
Health Research
(CIHR).
5/30 studies: no relationship between PA and subsequent depression
4/30 studies: women, and not men, who participated in PA were less likely
to report depression at follow-up.
Among the studies that found a protective role, the majority were
considered high (k = 17) or modest (k = 6) methodologic quality. Among
studies that revealed null eects, three were of modest, one of low and one
of high quality.
Bowler, 2010 (33) systematic
review and meta-analysis
k = 25; RCTs and observational
studies (NR)
Any target
group
Exposure to natural
environment
ere was evidence of benecial eects of activity in a natural
environment compared to the synthetic environment in terms of reduced
negative emotions such as anger (Hedges g = 0.46; 95% CI = 0.23, 0.69),
fatigue (g = 0.42; 0.07, 0.76) and sadness (g = 0.36; 0.08, 0.63) and positive
eect on attention (g = 0.32; 0.06, 0.58). No statistically signicant eects
for energy scores (g = 0.28; −0.01, 0.57), anxiety (g = 0.12; −0.34, 0.58) and
tranquility (g = 0.39; −0.08, 0.86).
13; 1 Natural England
Contract FST20-
84-037 to ASP*.
Benecial changes (before-aer) on feelings of energy ES 0.76 (95% CI
0.30 to 1.22); anxiety 0.52 (0.25, 0.79), signicant heterogeneity; anger
0.35 (0.07, 0.64); fatigue 0.76 (0.41, 1.11); and sadness 0.66 (0.16, 1.16)
CBT, cognitive behavioral therapy; CI, condential index; g, eect size; MBP, mindfulness based program; k, number of studies; NR, not reported; PA, physical activity; PI, predictive interval;
RCT, randomized controlled trial; SMD, standard mean dierence; WHO, World Health Organization. *Abbreviations not explained in the article.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 10 frontiersin.org
Mammen and Faulkner (27) conducted a systematic review of 30
prospective studies focusing on physical activity in the prevention of
depression. Twenty-ve of the studies found a statistically signicant,
inverse relationship between baseline physical activity and follow-up
depression. According to the authors, there is sucient evidence to
conclude that physical activity may prevent depression.
Macedo etal. (26) performed a qualitative synthesis of 13 trials,
which reported some degree of improvement in resilience-like variables
among populations participating in most resilience-promoting
programs. Authors concluded there is evidence pointing towards some
degree of eectiveness of resilience promotion programs, despite
substantial heterogeneity in study designs and measurements.
Overall, evidence suggests eectiveness of mindfulness-based
programs in promoting mental health as well as resilience promotion
programs in improving resilience-like variables among the average
non-clinical adult population. However, due to the overall high risk of
bias and great heterogeneity in the included studies, these conclusions
should beinterpreted with caution. Green space interventions had
benecial eects on some mental health and well-being outcomes
studied. Physical activity prevented the onset of depression.
3.4. Cost-eectiveness of the interventions
Two systematic reviews (24, 39) considered cost-eectiveness of
mental health promotion and prevention interventions (Table8).
Le etal. (24) summarized evidence of the cost-eectiveness of
mental health promotion and prevention interventions from 2008
onwards. e evidence concerning adults aged 18–64 years is based on
35 economic studies, the majority of which achieved fair to high
methodological quality. e review found that indicated or selective
prevention was likely to be cost-eective compared to universal
prevention. Strong evidence supported cost-eectiveness of screening
combined with psychological interventions in preventing mental
disorders in adults. In addition, workplace interventions targeting
employees in general were also considered to be cost-eective.
Parenting interventions showed good evidence of cost-eectiveness in
mental health promotion. e included return on investment studies,
in turn, provided evidence suggesting that preventive interventions for
depression and substance abuse in adults produce considerable returns.
Hunter et al. (39) summarized four preliminary economic
evaluations of urban green space interventions. ree of the
evaluations found interventions to be cost-eective based on the
increased physical activity of park users. Authors of the fourth study
found increased walking and cycling attributable to investment in
trails for walking and cycling and concluded that the investments may
have signicant benet–cost ratios. Overall, Hunter et al. (39)
concluded, that urban green space interventions aiming to increase
physical activity were relatively cost-eective.
However, the uncertainties relating to the quality of the included
health-economic evaluations likely limits the generalizability of
conclusions relating to cost-eectiveness which can be drawn from
these two qualitative reviews.
3.5. Intervention success factors
Among the key success factors gleaned from this review was the use
of supervised practice in universal skills-oriented programs that aimed
to promote mental health (35) (Table9). In the prevention of depression,
anxiety, antisocial behavior, and substance abuse, the best results were
achieved by programs that used interactive methods to teach the skills
needed to bring about the change (31). Methods that engaged
participants, such as discussing the materials distributed in the programs
and practicing the skills to betaught, also produced better results than
simply sharing information (31). Adherence to web-based mental health
interventions, which is oen poor, could beimproved with the provision
of face-to-face or online support (34). In studies focusing on alcohol use,
largest program eects were achieved for populations with a higher
percentage of women; programs delivered face-to-face versus on a
computer; and interventions that utilized motivational interviewing,
decisional balance exercises, normative feedback, and feedback on
expectancies and/or motives for drinking (31).
4. Discussion
In this systematic umbrella review, evidence was found for the
eectiveness of cognitive-behavioral, resilience, mindfulness, and
physical activity interventions in promoting mental health and
TABLE8 Characteristics and main findings of included reviews reporting economic analyses.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding sources
of the review
Hunter, 2019 (39) systematic
review k = 38; RCTs or quasi-
experimental studies (NR)
Any target
group
Urban green space
interventions (park-
based interventions,
greenways, and trails)
Four studies undertook preliminary economic evaluations and
found that urban green space interventions were relatively
cost-eective. Cost eectiveness of the three park-based
interventions was reported to be$0.14 to $2.40 per Metabolic
Equivalent of Task (MET) hours/year (cost eectiveness judged
on whether the cost was less than between $0.50 and $1.00 per
MET-hour)
9; 1 WHO Regional Oce for
Europe. National Institute
of Health Research
(NIHR).
Le, 2021 (24) systematic
review k = 35 relevant
economic studies (of total of
65) (2008–2020)
Adults
(18–64)
Mental health
promotion and
prevention interventions
Targeted (indicated or selective) prevention was likely to becost-
eective compared to universal prevention. Parenting
interventions had good evidence in mental health promotion.
Strong evidence supported screening plus psychological
interventions for mental disorder prevention, while workplace
interventions targeting employees in general were cost-eective.
10; 1 National Mental Health
Commission, Australia.
k, number of studies; MET, metabolic equivalent of task; NR, not reported; RCT, randomized controlled trial; WHO, World Health Organization.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 11 frontiersin.org
well-being of adult populations. However, the clinical signicance of
the eects could not beassessed thoroughly, as the umbrella review
methodology employed in this review does not allow for a re-synthesis
of the results. e eect sizes of the impacts of the interventions could
bedrawn from eight meta-analytical reviews and are presented in
Tables 3–5, 7.
More research literature was found on reducing symptoms of
depression and anxiety than on promoting resilience and overall
mental well-being, which is in line with a scoping review of Enns etal.
(13). However, we found three systematic reviews of resilience
interventions (21, 22, 26) published later than the literature search of
Enns et al. (13) which points toward a stronger evidence base of
resilience interventions in the current literature compared to previous.
e results of this review can be applied to mental health
promotion programs targeted at the adult working-age population in
Western countries. e preliminary results of this review formed the
theoretical framework and development of applied interventions for
a mental health promotion program in North Savo, Finland, funded
by the European Social Fund. In the future, interventions that prove
to beeective during the program will beimplemented more widely
in the region. As the importance of mental health promotion is likely
to increase in the coming years, high quality primary studies and
systematic reviews are needed to inform the choice of the most
eective interventions. Because of the complexity of the phenomenon,
a systemic, multilevel approach is needed to support implementation
of the interventions, to monitor their eectiveness, and to involve
people and communities in the selection, development, and evaluation
of the interventions.
4.1. Study strengths and limitations
is systematic umbrella review is relevant to current
policymakers and stakeholders, as it evaluated the available evidence
of promotive and preventive interventions for mental health and well-
being, currently considered a priority in public health. e strengths
of this review include the rigorous JBI and PRISMA guidelines, which
wefollowed in carrying out and reporting our work. Weincluded both
systematic reviews and umbrella reviews, performed a quality
appraisal of included reviews, tabulated the data, and reported the
results in as much detail as possible.
e main limitation of this review is the poor methodological
quality of the included reviews. e condence in the results of the
included reviews was diminished most oen by the lack of a priori
design and limited information and justication of the excluded
studies. In addition, the methodological quality of the primary studies
that were included in the reviews was oen poor. Also, when
conducting this review, we made some eligibility decisions with
undesirably thin data. us, some of the included reviews may contain
participants in clinical settings or studies with inadequate follow-up
time, although weaimed to exclude reviews focusing on participants
with a clinical diagnosis as well as studies with less than 1 month of
follow-up.
5. Conclusion
is review suggests that interventions using cognitive-behavioral
therapy and those developing resilience, mindfulness, or healthy
lifestyles can beeective in the promotion of mental health and well-
being in adult populations aged 18–64. Skills-based mental health
interventions with supervision may promote the mental health of
young adults and vocational skills training combined with resilience-
building interventions may beeective in promoting the mental
health of unemployed adults. Motivational interviewing may reduce
alcohol consumption in young adults. Indicated or selective
prevention are likely to be cost-eective compared to universal
prevention. Strong evidence supports the cost-eectiveness of
screening combined with psychological interventions in preventing
mental disorders in adults. Parenting interventions and workplace
interventions may be cost-eective in mental health promotion.
Preventive interventions for depression and substance misuse in
TABLE9 Characteristics and main findings of included reviews reporting intervention success factors.
Publication; Study
type; Amount and
type of included
studies (Search’s
time span)
Target
group
Intervention(s)
reviewed Main findings
Overall
methodological
quality rating;
Weaknesses in
critical domains
Funding
sources of the
review
Clarke, 2015 (34) systematic
review k = 28; RCTs and
quasi-experimental studies
(Jan. 2000–June 2013)
You th
(majority over
18 years of
age)
Online Youth Mental
Health Promotion and
Prevention
Interventions
Some evidence that participant face-to-face or web-based
support is an important feature of online interventions in
terms of participant adherence and program outcomes.
9; 1 Inspire Ireland
Foundation and Young
and Well Cooperative
Research Centre,
Australia.
Sandler, 2014 (31) review of
meta-analytic reviews k = 4
relevant reviews (of total of 48
reviews) (2000–2013)
College
students up to
age of 26
Prevention and
promotion programs to
prevent alcohol use
Programs that involved more active strategies, such as
discussion of the program material and practice of program
skills, had larger eects than those that did not include these
strategies. Program eects were larger for samples that
contained a higher percentage of women; programs delivered
in person versus on a computer; and interventions that
included motivational interviewing techniques, normative
feedback, and feedback on expectancies and/or motives for
drinking or a decisional balance exercise. Face-to-face
interventions also had greater eects than computer-based
interventions in studies that directly compared them.
5; 3 NR
k, number of studies; NR, not reported; RCT, randomized controlled trial.
Saijonkari et al. 10.3389/fpubh.2023.1201552
Frontiers in Public Health 12 frontiersin.org
adults may produce considerable returns on investment. Due to the
low quality of the included reviews and the great heterogeneity among
the reported results, these conclusions should be interpreted with
caution. ere is a need for further rigorous, high-quality systematic
reviews on promotive and preventive interventions for mental health
and well-being. Above all, reviews focusing on the enhancing of
mental well-being instead of reducing symptoms of mental problems
are needed.
Data availability statement
e original contributions presented in the study are included in
the article/Supplementary material, further inquiries can bedirected
to the corresponding author.
Author contributions
MS, EP, TL, TT, IL, JL, and TM-O contributed to conception
and design of the study. MS and JI analyzed the data. MS wrote the
rst dra of the manuscript. TM-O wrote sections of the
manuscript. All authors contributed to the article and approved the
submitted version.
Funding
is work was part of the Feel Good North Savo program funded
by the European Social Fund (#2014/11114/09020101/2020).
Acknowledgments
We thank information specialist Maarit Putous (e University of
Eastern Finland) for her advice and help in developing the search
strategy and performing the searches. Wealso thank M.D., Ph.D.,
M.Sc. Marjukka Mäkelä for valuable comments and suggestions
concerning the methodology of the review.
Conflict of interest
e authors declare that the research was conducted in the
absence of any commercial or nancial relationships that could
beconstrued as a potential conict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors
and do not necessarily represent those of their aliated organizations,
or those of the publisher, the editors and the reviewers. Any product
that may be evaluated in this article, or claim that may be made by its
manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
e Supplementary material for this article can befound online
at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1201552/
full#supplementary-material
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