[Accepted Manuscript] Stigma related to targeted school-based mental health interventions: a systematic review of qualitative evidence

Background School-based mental health services have been advocated to increase access to psychological support for children and adolescents. However, concerns have been raised about the potential stigma associated with selection of students and the visibility of school-based service contact. Methods This review assessed findings from qualitative studies to identify potential stigmatising effects of participation in targeted school-based mental health interventions for students attending primary- or secondary-level education. Eight articles (reflecting seven studies) were identified through electronic database searches (PsycInfo, EMBASE, Medline, CINAHL, ERIC), supplemented by citation and reference searches and expert consultations. Data were synthesised according to established guidelines for thematic synthesis. Results Three overarching themes were identified: “anticipated and experienced stigma”, “consequences of stigma” and “mitigating strategies”. These findings illustrate how pervasively stigma can compromise efforts to increase access to mental health care through targeted school-based provision, but also outline strategies endorsed by students for alleviating the risk and/or impact of stigma. Limitations These findings need to be considered in view of the relative scarcity of surveyed evidence. Furthermore, as all evidence came from high-income and Western countries, the applicability to other contexts is unclear. Conclusions This synthesis reflects the first overview of qualitative evidence regarding stigmatising experiences and concerns associated with students’ engagement with targeted school-based mental health interventions. The findings can inform efforts to mitigate stigma-related barriers to students’ engagement in targeted mental health support, and serve to guide future research in this area