There is growing evidence about the positive impact of greenspaces on mental health and wellbeing. In their various forms, greenspaces such as parks, gardens, sports fields, and open spaces serve as crucial public amenities. This paper contributes to current debates on the mental health benefits of rural and urban environments by arguing for a nuanced and contextual understanding that goes beyond the urban–rural dichotomy, as access to these spaces has been shown to reduce stress and significantly improve mental wellbeing in both urban and rural settings. Through a critical examination of the literature, we focus on specific characteristics of greenspaces connected to mental health benefits. We then explore the ways in which specific urban environments and their qualities play crucial roles in mental health outcomes. The paper discusses the unique challenges and benefits of urban and rural greenspaces, emphasising the need for context-specific strategies. We argue that urban planning and policy must prioritise the quality of greenspaces, particularly in urban environments, to recognise them as fundamental public health infrastructure and maximise their mental health benefits.

Researchers and education leaders have suggested that universal school-based prevention programs could improve youth mental health at a population level, yet recent trials of universal school-based prevention programs (e.g., MYRIAD, CSC) found null or iatrogenic results. In this debate piece, we argue that these results must be contextualized alongside existing knowledge that universal programs are ideally implemented within multitiered systems, promoting student autonomy tends to promote uptake and adherence, and individual trials do not outweigh decades of academic and community expertise. We offer suggestions for moving forward in research on and implementation of universal school-based prevention programs.

Despite widespread research and academic pressures, mindfulness researchers have an ethical responsibility to take a careful and considered approach to their work, particularly when investigating the mental health of children. This Letter to the Editor addresses an earlier debate article published in the journal by further elaborating on the issues raised by a recent large trial of a mindfulness-informed school-based intervention, and the ethical implications for mindfulness research.

We have engaged in work that aligns with the call from Birrell et al. (Child and Adolescent Mental Health, 2024), particularly in terms of thinking about co-design with young people to develop new outcomes and targets of universal school-based interventions. We engaged young people in a Cochrane systematic review and co-designed the outcomes for this review. What emerged was the need for research led by young people to develop and evaluate innovative universal school-based interventions that focus on creating environments that build and support young people's ability to cope by expressing and managing emotions. Whole-of-school approaches that ensure compassionate and caring responses can support the development of coping skills to manage distress, mental illness, self-harm and suicidal ideation.

Child and Adolescent Mental Health, Volume 30, Issue 1, Page 112-114, February 2025.

Child and Adolescent Mental Health, Volume 30, Issue 1, Page i-iv, February 2025.

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.