The manosphere is an international network of social media influencers and communities promoting male supremacy and antifeminist ideologies. Young men are engaging with this extremist content at high rates. Despite growing concerns among educators, policymakers and researchers, systematic data on the long-term impact of the manosphere on young people's mental health and behaviour remains limited. However, preliminary data suggest that the manosphere is encouraging sexist attitudes, exacerbating existing inequalities in schools, and spreading dangerous messages about mental health. We discuss the current state of research, highlight the challenges of measuring engagement with online misogyny, and propose priorities for future work. Our commentary underscores the urgent need for multilevel interventions to counteract the negative effects of the manosphere on the attitudes of young men, and their downstream consequences for the mental health and well-being of women and girls.

Universal school-based mental health interventions present a promising approach to addressing youth mental health challenges; however, evidence suggests their effectiveness is often limited and unsustained. One contributing factor to this issue is the frequent superficial involvement of students in the design, implementation and evaluation of initiatives. In response, this paper advocates for the urgent prioritisation of student voice within these programmes, using in-depth and purposive qualitative approaches that empower youth to actively co-create and shape interventions. Research highlights that incorporating student voice can yield vital insights into what is effective and ineffective in programmes, particularly for marginalised groups. Moreover, engaging students in co-designing methodologies that help amplify their voices ensures research processes are better aligned with their needs and preferences, fostering greater ownership and improved outcomes. This shift, which repositions students as active collaborators rather than passive recipients, has the potential to enhance both the effectiveness and equity of initiatives.

Background

Animal-assisted interventions (AAIs) have emerged as a promising nonpharmacological intervention option for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, recent systematic reviews have been primarily narrative. Additionally, the pooled effectiveness of AAIs was absent from these systematic reviews.

Methods

We conducted a comprehensive systematic review and meta-analysis, searching multiple databases, including Web of Science, MEDLINE, CINAHL, Scopus, PsycINFO, EMBASE and Cochrane, from inception of the databases to March 2024. We retrieved 17 randomised controlled trials or quasi-experimental studies and used Review Manager 5.4.1 software to perform a meta-analysis of the effects of AAIs in treating children with ADHD. We conducted a set of random-effects meta-analyses to estimate standardised mean differences (SMD) with 95% confidence intervals (CI) using subgroup data by different outcome domains extracted from eight randomised controlled trials, in relation to changes in behavioural, mental and physical functioning in a total of 307 children with ADHD before and after the intervention.

Results

In comparison with non-AAI groups, AAIs significantly improved attention problems in children with ADHD (SMD = −0.42, 95% CI = −0.71 to −0.13), self-esteem (0.46, 0.14 to 0.78), learning and cognition problems (−0.69, −0.98 to −0.39) and motor proficiency (0.77, 0.11 to 1.42). The pooled effect of AAIs on the severity of ADHD symptoms in the experimental group was not significantly different from the effect of conventional treatments in the control group (0.10, −0.31 to 0.52). Similarly, AAIs had no significant positive effects on social interaction (−0.22, −0.51 to 0.06), social skills (−0.32, −0.87 to 0.24), problematic behaviours (−0.10, −0.54 to 0.35) or emotional problems, including depression and anxiety (−0.13, −0.51 to 0.24).

Conclusions

As an ADHD management strategy complementary to gold-standard approaches, such as medication or multimodal interventions, AAIs did not appear to be more effective in improving the majority of core ADHD outcomes in children. Future studies should incorporate rigorous study designs with large sample sizes and a standard protocol to achieve more valid and reliable conclusion.

In this article, we evaluate the current state of universal school-based mental health prevention. We argue that the field is at another pivotal turning point, with many unanswered questions. As youth mental health issues rise in prominence and prevalence, schools increasingly adopt mental health and well-being programmes. However, recent large-scale trials have reported varied effects, raising questions about their effectiveness. We critically analyse these findings and place them in a global context. We contend results in high-income countries should not be seen as a failure of universal prevention overall and unpack key learnings from trials that have not found significant preventive effects. A comprehensive perspective of the data reveals both negative and positive aspects, as well as some signposts for the way forward. We advocate for programme adaptation based on feedback, embracing proportionate universalism and exploring alternative prevention strategies without discarding universal prevention. We urge continued research with stakeholder involvement, emphasising a nuanced approach to universal school-based mental health prevention, is urgently needed to move the field forward.