Promotion and Prevention of Early and Middle-Aged Children Mental Health in Chinese Societies: A Systematic Review and Meta-Analysis

Background: In recent years, Chinese societies, including Hong Kong, Macau, Taiwan, and Mainland China, have faced growing challenges of young children’s mental wellbeing (Chen et al., 2020; Zhu et al., 2020). Given the significant consequences of not addressing early childhood mental health challenges (Agnafors et al., 2021), it is imperative to address such pressing concerns in Chinese societies. While interests and efforts are growing in child mental health promotions and preventions over the past two decades, there remains limited review studies on synthesizing the evidence of these programs targeting young children in Chinese communities. This systematic review and meta-analysis seek to calibrate the quality, efficacy, and implementation of prevention and promotion initiatives that used experimental or quasi-experimental designs targeting early and middle-aged children within Chinese communities.

Methods: Following the PICOS and PRISMA guidelines, literature searches were conducted via EBSCOhost, ProQuest, Web of Science, and checking reference lists and grey literature through lists of keywords. Inclusion criteria for eligible studies were a) utilization of experimental or quasi-experimental design with control or comparison groups, b) main target of early and middle-aged children between 3 and 13 in Chinese societies, c) primary focus on reducing mental illness-related risks and behaviors, and promoting adapting skills or mental well-being, and, d) publication in English before December 1^st, 2023. Relevant program characteristic, outcome results, as well as implementation data from included studies were further extracted, analyzed, and synthesized for quality assessment and meta-analysis . Overall and subgroup pooled effect sizes on mental health outcomes were estimated for studies containing sufficient statistical data.

Findings: The study screened 3,447 studies identified through searches, of which 47 met the systematic review inclusion criteria. Included studies involved 17,562 toddlers, preschoolers, and school-aged children in mainland China, Hong Kong, Macau, and Taiwan. Most of the included studies used randomized control trials (N=29), targeted kindergarten and lower elementary-level children (N=21), and focused on children’s social and emotional wellbeing (N=27). Regarding study quality, the studies demonstrated an average score of 7.02 (SD=1.34) on a 10-point research quality scale. In terms of study implementation, nearly half of the studies (N=22) were carried out by the research team and were given careful consideration to assessing study fidelity (N=20). Pooled effects regressions by outcome showed statistically significant small effects in enhancing young children’s perceived overall quality of life (ES=0.298; 95% CI: 0.099, 0.498), medium to large effects in boosting their self-esteem (ES=0.528; 95% CI 0.087, 0.969), as well as small to medium effects in decreasing their depressive symptoms (ES=-0.316; 95% CI, -0.590, -0.042). Nevertheless, no effects were found on young children’s self-efficacy (ES=0.107; 95% CI -0.527, 0.741).

Conclusions & Implications: The findings show promise for Chinese-based programs aimed at promoting young children’s positive emotional wellbeing such as self-esteem, quality of life, and preventing them from developing depression. Future research needs to seek strategies to address variances in terms of study design, methodological quality, and implementation of preventive and promotive efforts at multisystemic levels to advance mental health for early and middle-aged children in Chinese societies.