***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background With the burden of mental illness estimated to be costing the English economy alone around £ 22.5 billion a year [ 1 ] , coupled with growing evidence that many mental disorders have their origins in adolescence , there is increasing pressure for schools to address the emotional well-being of their students , alongside the stigma and discrimination of mental illness . A number of prior educational interventions have been developed and evaluated for this purpose , but inconsistency of findings , reporting st and ards , and method ologies have led the majority of review ers to conclude that the evidence for the efficacy of these programmes remains inconclusive . Methods / Design A cluster r and omised controlled trial design has been employed to enable a feasibility study of ' SchoolSpace ' , an intervention in 7 UK secondary schools addressing stigma of mental illness , mental health literacy , and promotion of mental health . A central aspect of the intervention involves students in the experimental condition  interacting with a young person with lived experience of mental illness , a stigma reducing technique design ed to facilitate students ' engagement in the project . The primary outcome is the level of stigma related to mental illness . Secondary outcomes include mental health literacy , resilience to mental illness , and emotional well-being . Outcomes will be measured pre and post intervention , as well as at 6 month follow-up . Discussion The proposed intervention presents the potential for increased engagement due to its combination of education and contact with a young person with lived experience of mental illness . Contact as a technique to reduce discrimination has been evaluated previously in research with adults , but has been employed in only a minority of research trials investigating the impact on youth . Prior to this study , the effect of contact on mental health literacy , resilience , and emotional well-being has not been evaluated to the authors ' knowledge . If efficacious the intervention could provide a reliable and cost-effective method to reduce stigma in young people , whilst increasing mental health literacy , and emotional well-being . Trial registration IS RCT N : IS RCT Stigmatizing , or discriminatory , perspectives and behaviour , which target individuals on the basis of their mental health , are observed in even the youngest school children . We conducted a systematic review of the published and unpublished , scientific literature concerning the benefits and harms of school-based interventions , which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization . Forty relevant studies were identified , yet only a qualitative synthesis was deemed appropriate . Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions : poor reporting quality , a dearth of r and omized controlled trial evidence , poor methods quality for all research design s , considerable clinical heterogeneity , and inconsistent or null results . Nevertheless , certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development , implementation and evaluation of a curriculum , which fosters the development of empathy and , in turn , an orientation toward social inclusion and inclusiveness . These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct , structured contact with an infant , and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties . The possible value of using educational activities , material s and contents to enhance hypothesized benefits accruing to direct contact also requires investigation . Overall , the curriculum might serve as primary prevention for some students and as secondary prevention for others PURPOSE This study examined the effectiveness of an intervention to reduce explicit and implicit stigma-relevant attitudes toward mental illness and treatment-seeking and behavioural indicators of willingness to seek treatment . METHODS Adolescents were r and omly assigned to the experimental ( education about mental illness and treatment involving psychoeducation and contact ( via DVD ) with an affected individual ) or control intervention ( education about tobacco ) . RESULTS Findings suggest the stigma intervention was effective at reducing explicit but not implicit stigma-relevant attitudes . As hypothesized , participants receiving the experimental intervention reported less explicit stigma toward treatment and greater openness to personally seek treatment if they had also reported prior mental health treatment . CONCLUSIONS AND IMPLICATION S These findings support the potential for a brief educational intervention among adolescents to reduce negative attitudes toward mental health treatment , but raise questions about how to effectively address implicit stigma as well as the importance of translating stigma reduction into behavior changes The purpose of this school-based cluster-r and omized trial was to determine the initial acceptability , feasibility , and efficacy of an existing community-based intervention , In Our Own Voice , in a sample of US adolescent girls aged 13 - 17 years ( n = 156 ) . In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma . This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy . Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study . Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed . The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up . The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up . The intervention did improve mental health literacy at 4 and 8 weeks follow up . Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults ; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States . This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents BACKGROUND A school mental-health programme has been developed as a component of the community mental-health programme in Rawalpindi , Pakistan . It has the objective of improving the underst and ing of disorders of mental health in the rural community . We aim ed to assess the impact of a school mental-health programme on the awareness of schoolchildren , their parents , friends who were not attending school , and neighbours . METHODS We chose two secondary schools for boys and two for girls that were similar in terms of size , staff-pupil ratio , and drop-out rates . 100 children aged 12 - 16 years ( 25 girls and 25 boys in each of the study and control groups ) , 100 parents ( one for each child ) , 100 friends who did not attend school ( one for each child ) , and 100 neighbours ( one for each child )  were given a 19-item question naire before and after the study group had had a 4-month programme of mental-health education . The maximum score for the question naire was 16 points . FINDINGS Before the school mental-health programme the awareness of mental-health issues was poor ( mean score 5.7 - 7.6 ) in the four groups of participants . In the study group there was a significant improvement in the mean scores after the school programme in the schoolchildren ( mean improvement 7.6 [ 95 % CI 6.7 - 8.5 ] , p<0.01 ) , their parents ( 5.3 [ 4.5 - 6.1 ] , p<0.01 ) , friends ( 5.1 [ 4.1 - 6.1 ] , p<0.01 ) , and neighbours ( 3.4 [ 2.6 - 4.2 ] , p<0.01 ) . In the control group the difference in awareness was significant only in schoolchildren ( 1.5 [ 0.5 - 2.3 ] , p=0.01 ) and their friends ( 0.8 [ 0.3 - 1.3 ] , p<0.01 ) . INTERPRETATION The school programme succeeded in improving awareness of mental health in schoolchildren and the community . The schoolchildren were receptive to the programme , and shared their new underst and ing with family , friends , and neighbours . Mental-health planners who wish to improve community awareness of mental health , particularly in areas with low literacy rates , should consider setting up school mental-health programmes This study evaluated the effectiveness of a cognitive behaviour therapy Internet program ( MoodGYM ) for depressive symptoms , attributional style , self‐esteem and beliefs about depression , and on depression and depression‐vulnerable status in male youth . A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to st and ard personal development activities . Outcomes were measured before commencement , post‐program and 16 weeks post‐program . There were no significant between‐group differences in change scores pre‐ to post‐ or pre‐ to follow‐up using the intention to treat sample or for participants with post‐ and /or follow‐up data . For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms ( Effect Size , ES = 0.34 ) , attributional style ( ES = 0.17 ) and self‐esteem ( ES = 0.16 ) at post‐program , although only the effect for self‐esteem was sustained at follow‐up . Both groups showed improvement in their beliefs about depression at follow‐up , with the control group showing a moderate relative benefit ( ES = 0.40 ) . While the numbers are small , there was a reduction in the risk of being depressed in the MoodGYM group of 9 % at post‐treatment compared with a slightly increased risk for the control group . The risk of being classified as vulnerable to depression reduced by 17 % in the MoodGYM group at post‐treatment compared with no change in risk for the control group . These reductions in risk for the MoodGYM group were not sustained at follow‐up . The limitations of the study highlight several important challenges for MoodGYM and other self‐directed Internet cognitive behaviour therapy programs . These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it , and how to enhance the sustainability of any benefits BACKGROUND This study evaluates the benefits of a self-directed Internet intervention for depression ( MoodGYM ) delivered as a part of the high school curriculum . METHOD One hundred and fifty-seven girls , aged 15 and 16 years , were allocated to undertake either MoodGYM or their usual curriculum . MoodGYM 's impact on depressive symptoms , risk of depression , attributional style , depression literacy and attitudes toward depression was examined using r and om effect regression . RESULTS MoodGYM produced a significantly faster rate of decline in depressive symptoms over the trial period than the control condition . The effect size for MoodGYM was not significant immediately after the intervention ( Cohen 's d=.19 , 95 % CI -.18-.56 ) but was moderate and significant 20 weeks after the intervention ( d=.46 , 95 % CI .10-.82 ) . Girls with high depression scores before intervention showed the strongest benefits on self-reported depression at follow-up ( d=.92 , 95 % CI .10 - 1.38 ) . There were no significant intervention effects on depression status , attributional style , depression literacy , and attitudes . Approximately 70 % of girls in the MoodGYM group completed less than three of its modules and completion of fewer modules was related to high depression score before intervention . CONCLUSIONS The findings suggest that there are benefits from MoodGYM on self-reported depressive symptoms but has low rates of completion highlight problems in ensuring adherence to Internet programs for depression 
    Output:
    
There is currently no strong evidence to support previous conclusions that these types of intervention work for children and adolescents .