School programs targeting stress management in children and adolescents: A meta-analysis

IntroductionThis meta-analysis evaluates the effect of school programs targeting stress management or coping skills in school children.MethodsArticles were selected through a systematic literature search. Only randomized controlled trials or quasi-experimental studies were included. The standardized mean differences (SMDs) between baseline and final measures were computed for experimental and control groups. Experimental groups were groups that either received an intervention of (a) relaxation training, (b) social problem solving, (c) social adjustment and emotional self-control, or (d) a combination of these interventions. If no baseline measurement was available, SMDs were calculated between final measures of the groups. The overall pooled effect size was calculated and the pooled effect sizes of improvement on stress, coping, (social) behavior, and self-efficacy by random effects meta-analysis. The dependence of the results on study characteristics (i.e. methodological quality and type of intervention) was evaluated using meta-regression analysis.ResultsNineteen publications met the inclusion criteria of controlled trials for class programs, teaching coping skills or stress management. Overall effect size for the programs was − 1.51 [95% confidence interval (CI) − 2.29, − 0.73], indicating a positive effect. However, heterogeneity was significant (p < .001). Sensitivity analyses showed that study quality and type of intervention were sources of heterogeneity influencing the overall result (p values < .001). The heterogeneity in quality may be associated with methodological diversity and differences in outcome assessments, rather than variety in treatment effect. Effect was calculated per intervention type, and positive effects were found for stress symptoms with a pooled effect size of − 0.865 (95% CI: − 1.229, − 0.502) and for coping with a pooled effect size of − 3.493 (95% CI: − 6.711, − 0.275).ConclusionIt is tentatively concluded that school programs targeting stress management or coping skills are effective in reducing stress symptoms and enhancing coping skills. Future research should use clear quality criteria and strive for less diversity in methodology and outcome assessment.