Introduction
Current Study
Methods
Selection Criteria
Search Strategy
Coding of Studies
Analysis of Effect Sizes
Publication Bias
Results
Study Selection
Authors | N | Age range, mean age (SD), grade, gender, ethnicitya | Study design | Target group (selection) | Intervention | Program target (stress reduction) | Stress outcomeb |
---|---|---|---|---|---|---|---|
Bennett and Dorjee (2016) | 24 | 16–18 years, 17.70 (0.73) 11–12th grade, 58% boys | Quasi-experimental | Self-selected (voluntary) | Mindfulness-based stress reduction | Direct | Psychological stress (DASS, 7 items), perceived stress (body barometer, 1 item) |
Bluth et al. (2016) | 27 | 17.0 9–12th grade, 59% boys, 82% minorities | RCT | Self-selected (voluntary) | Learning to BREATHE | Direct | Perceived stress (PSS, 10 items) |
Burckhardt et al. (2016) | 63 | 15–18 years 10–11th grade, 61% boys | Cluster RCT | Screened (high depression, anxiety, stress levels) | Strong Minds | Direct | Stress levels (DASS, 7 items) |
Butzer et al. (2017) | 209 | 12.64 (0.33) 7th grade, 37% boys, 47% minorities | Cluster RCT | Community | Kripalu Yoga in the schools | Direct | Perceived stress (PSS, 10 items) |
Campbell et al. (2019) | 1007 | 13–19 years, 15.96 (1.17) 9–12th grade, 50% boys, 30% minorities | Quasi-experimental | Community | .b (the Mindfulness in Schools Project) | Direct | Perceived stress (PSS, 9 items) |
Carreres-Ponsoda et al. (2017) | 30 | 16–18 years, 16.80 50% boys | RCT | Self-selected (voluntary) | Mindfulness-based stress reduction | Direct | Perceived stress (PSS, 14 items) |
Carter (2010) | 64 | 13–16 years, 14.70 (0.74) 9–10th grade, 45% boys, 22% minorities | Cluster RCT | Self-selected (self-identified and identified by others) | The Best of Coping program | Direct | Stress appraisal of challenge, threat and resources (SAMA, 4, 7 and 3 items) |
Cross et al. (2018) | 2945 | 13.0 8–9th grade, 50% boys | Cluster RCT | Community | Friendly Schools Program | Indirect | Stress scores (DASS, 7 items) |
Da Silva et al. (2019) | 20 | 11–14 years, 12.10 (1.50) 70% boys | RCT | Screened (ADHD) | Swimming-learning program | Indirect | Perceived stress (PSS, 14 items) |
De Anda (1998) | 54 | 12–14 years, 13.00 30% boys, 53% minorities | Quasi-experimental | Self-selected (voluntary) | Cognitive-behavioral stress management program | Direct | Degree of experienced stress (ASCM, 4 items) |
Dowling et al. (2019) | 675 | 15–18 years, 15.87 (0.69) 5th grade, 50% boys | Cluster RCT | Community | MindOut program | Direct | Levels of symptoms related to stress (DASS, 7 items) |
Ebrahmimi et al. (2015) | 40 | 14–18 years, 16.48 (1.10) 100% boys | Quasi-experimental | Self-selected (voluntary) | Spiritual intelligence training | Direct | Stress scores (DASS, 7 items) |
Eggert et al. (1995) | 105 | 15.86 (1.01) 9–12th grade, 42% boys, 72% minorities | Quasi-experimental | Screened (suicide risk) | Personal growth class | Direct | Perceived stress and pressure from others (4 items) |
Eslami et al. (2016) | 126 | 16.33 (7.02) 0% boys | RCT | Community | Assertiveness training program | Direct | Stress levels (DASS, 7 items) |
Fridrici and Lohaus (2009) | 904 | 12–18 years 8–9th grade, 50% boys | Cluster RCT | Community | Stress prevention intervention | Direct | General stress (3 items) |
Fung et al. (2019) | 145 | 13–15 years, 13.99 (0.36) 9th grade, 32% boys, 97% minorities | RCT | Screened (depressive symptoms) | Learning to breathe | Direct | Perceived stress (PSS, 9 items) |
Garcia et al. (2013) | 41 | 13–16 years, 14.80 (0.72) 9–10th grade, 0% boys, 100% minorities | RCT | Self-selected (voluntary) | Project Wing’s Girl’s group | Direct | Perceived stress (PSS, 14 items), level of stress symptoms (DASS, 14 items) |
Goodman and Newman (2014) | 60 | 9th or 12th grade 0% boys | RCT | Self-selected (voluntary) | Digital storytelling | Direct | Experienced daily stress (ASQ, 31 items) |
Hampel et al. (2008) | 320 | 10–14 years, 11.70 (1.18) 5–8th grade, 50% boys | Quasi-experimental | Community | Anti-stress training | Direct | Interpersonal, academic stress (7 items) |
Hiebert et al. (1989) Study 1 | 79 | 13–14 years 8th grade, 48% boys | Cluster RCT | Community | Progressive relaxation | Direct | Stress symptoms (SOSI, 59 items) |
Hiebert et al. (1989) Study 2 | 22 | 17–18 years 11–12th grade, 63% boys | Quasi-experimental | Self-selected (elective module) | Progressive relaxation | Direct | Stress symptoms (SOSI, 59 items) |
Jamali et al. 2016 | 100 | 13–14 years, 13.50 (1.01) 50% boys | RCT | Community | Life skills training | Indirect | Perceived stress (10 items) |
Jellesma and Cornelis (2012) | 54 | 8–13 years, 10.58 (1.58) 3th/6th grade, 65% boys | Cluster RCT | Community | Mind Magic Program | Direct | Psychological, mental stress (10-point scale) |
Jose and Sajeena (2017) | 60 | 8–10th grade | Cluster RCT | Self-selected | Yoga therapy | Direct | Perceived stress (PSS, 10 items) |
Khalsa et al. (2012) | 100 | 15–19 years, 16.80 (0.60) 11–12th grade, 58% boys, 10% minorities | Cluster RCT | Community | Yoga Ed program | Direct | Perception of stress (PSS, 10 items), social stress (BASC, 13 items) |
Kiselica et al. (1994) | 48 | 9th grade, 54% boys, 0% minorities | Cluster RCT | Screened (anxiety symptoms) | Stress inoculation training | Direct | Stress symptoms (SOSI, 118 items) |
Kraag et al. (2009) | 1437 | 10.30 (0.64) 5–6th grade, 50 % boys | Cluster RCT | Community | Learn Young, Learn Fair | Direct | Physiological, psychological stress symptoms (MUSIC) |
Kuyken et al. (2013) | 522 | 12–16 years, 14.80 (1.50) 70% boys, 28% minorities | Quasi-experimental | Community | Mindfulness in Schools Program | Direct | Perceived stress (PSS, 10 items) |
Lai et al. (2016) | 2304 | 14–16 years, 15.40 (1.00) 8–10th grade, 51% boys | Quasi-experimental | Community | The Little Prince is Depressed | Direct | Stress levels (DASS, 7 items) |
Lang et al. (2017) | 122 | 16.22 (1.12) 65% boys | Cluster RCT | Community | EPHECT coping training | Direct | Perceived stress (ASQ, 30 items) |
Lau and Hue (2011) | 48 | 14–16 years, 15.83 38% boys 0% minorities | Quasi-experimental | Self-selected (voluntary) | Mindfulness program | Direct | Perceived stress (PSS, 10) |
Lee et al. (2018) | 20 | 10–11 years, 10.50 | RCT | Screened (emotional and behavioral problems) | Horticulture-related activities | Indirect | Stress levels: social, school stress (PSS, 10 items) |
Livheim et al. (2015) | 32 | 14–15 years 28% boys | RCT | Screened (depressive symptoms) | Acceptance and Commitment Therapy | Direct | Perceived stress (PSS, 10 items), stress levels (DASS, 7 items) |
Manjushambika et al. (2017) | 65 | 11–17 years, 14.50 42% boys | Quasi-experimental | Screened | Jacobson’s Progressive Muscle Relaxation | Direct | Educational stress (ESSA, 16 items) |
Marsland et al. (2019) | 70 | 8–14 years, 10.65 (1.49) 3–8th grade, 54% boys, 70% minorities | RCT | Screened (asthma) | I Can Cope | Direct | Perceived stress (PSS, 10 items) |
Metz et al. (2013) | 216 | 16.45 (0.95) 10–12th grade, 34% boys, 11% minorities | Quasi-experimental | Community | Learning to Breathe | Direct | Perceived stress level (1 item) |
Noggle et al. (2012) | 51 | 17.20 (0.70) 11–12th grade, 46% boys, 8% minorities | Cluster RCT | Community | Kripula yoga | Direct | Perceived stress (PSS, 10 items) |
Norlander et al. (2005) | 95 | 11.31 (1.09) 44% boys | Quasi-experimental | Community | Relaxation | Direct | Experienced stress levels (10 items) |
Puolakanaho et al. (2019) | 205 | 15.27 (0.39) 9th grade, 51% boys | RCT | Community | Youth COMPASS | Direct | Overall stress (1 item), school stress (4 items) |
Quach et al. (2016) | 149 | 12–15 years, 13.18 (0.72) 7–9th grade, 38% boys, 99% minorities | RCT | Community | Mindfulness meditation and hatha yoga | Direct | Perceived stress (PSS, 10 items) |
Reiss (2013) | 40 | 16–18 years, 17.25 (0.54) 12th grade, 65% boys | Quasi-experimental | Self-selected (voluntary) | Mindfulness meditation treatment | Direct | Perceived stress (PSS, 10 items) |
Rentala et al. (2019) | 60 | 16–19 years, 17.13, 0% boys | RCT | Screened (high stress levels) | Holistic group health promotion program | Direct | Stress levels (DASS, 7 items), educational stress (ESSA, 16 items) |
Ruiz-Aranda et al. (2012) | 147 | 13–16 years, 14.18 (0.64) 40% boys | RCT | Community | Emotional intelligence education program | Indirect | Social stress (BASC, 13 items) |
Sibinga et al. (2013) | 41 | 11–14 years, 12.50 7–8th grade, 100% boys, 95% minorities | RCT | Community | Mindfulness-based stress reduction | Direct | Perceived stress (PSS, 10 items) |
Sibinga et al. (2016) | 300 | 12.00 5–8th grade, 49% boys, 100% minorities | Cluster RCT | Community | Mindfulness-based stress reduction | Direct | Perceived stress (PSS, 6 items) |
Silbert and Berry (1991) | 145, 178 | 14–18 years, 15.00 10th grade, 50% boys, 70% minorities | Quasi-experimental | Screened, community | Suicide prevention unit | Indirect | Subjective experience of stress (SSS, 14 items) |
Singhal et al. (2014) | 19 | 13–18 years 9th grade, 0% boys | Quasi-experimental | Screened (sub-clinical depression) | Coping skills program | Direct | Academic stress (SAAS) |
Singhal et al. (2018) | 120 | 13–18 years 8th, 9th and 11th grade | Cluster RCT | Screened (sub-clinical depression) | Coping skills program | Direct | Academic stress (SAAS) |
Solar (2013) | 10 | 14–18 years, 16.00 (1.25) 9–12th grade, 70% boys, 30% minorities | RCT | Screened (emotional / learning disability or other health impairment) | Mindfulness meditation | Direct | Perceived stress (PSS, 10 items) |
Terjestam (2011) | 393 | 12–15 years, 13.90 7–9th grade, 48% boys | Cluster RCT | Community | Meditation based technique for stillness | Direct | General stress (3 items) |
Terjestam et al. (2010) | 119 | 13–14 years, 13.18 7th grade, 49% boys | Quasi-experimental | Community | Qigong | Direct | General stress (3 items) |
Terjestam et al. (2016) | 307 | 5–8th grade 52% boys | Cluster RCT | Community | Compas program | Direct | Stress levels (General Stress Scale, 3 items) |
Van der Gucht et al. (2018) | 390 | 13–20 years, 15.40 (1.20) 9–11th grade, 37% boys | Cluster RCT | Community | Mindfulness group training | Direct | Stress symptoms (DASS, 7 items) |
Van Ryzin and Roseth (2018) | 1449 | 7th grade 52% boys, 24% minorities | Cluster RCT | Community | Cooperation in the classroom | Indirect | Perceived stress (PSS, 4 items) |
Zafar and Khalily (2015) | 100 | 12–18 years 50% boys | RCT | Screened (high depression, anxiety, stress levels) | Didactic therapy | Direct | Stress levels (DASS, 14 items) |
Overall Effect
Outcome | N studies (samples) | N ES | N participants | Mean d (SE) | 95% CI | t-value | LRT | % var | Fail-safe N (cv) |
---|---|---|---|---|---|---|---|---|---|
Psychological stress | 54 (61) | 123 | 16,475 | 0.543 (0.133) | 0.279-0.806 | 4.082*** | Level 2: 16.32*** | Level 1: 1.5% | 16,223 (280) |
Level 3: 100.41*** | Level 2: 1.2% | ||||||||
Level 3: 97.3% |
Sensitivity Analysis
Publication Bias
Moderator Analyses
Moderator | N samples | N ES | B0 (95% CI) | t0 | B1 (95% CI) | t1 | F(df1, df2) | p |
---|---|---|---|---|---|---|---|---|
Study characteristics | ||||||||
Type of stress | F (1, 13) = 4.754 | 0.048 | ||||||
School stress (RC) | 5 | 10 | 2.739 (1.465–4.012) | 4.646*** | ||||
Social stress | 3 | 5 | 0.531 (−1.247 to 2.309) | 0.646 | −2.207 (−4.394 to −0.020) | −2.180* | ||
Publication year (continuous) | 61 | 123 | 0.539 (0.276–0.801) | 4.061*** | 0.020 (−0.013 to 0.054) | 1.198 | F (1, 121) = 1.436 | 0.233 |
Publication status | F (1, 121) = 1.557 | 0.215 | ||||||
Published (RC) | 58 | 114 | 0.579 (0.310–0.848) | 4.266*** | ||||
Not published | 3 | 9 | −0.210 (−1.433 to 1.012) | −0.340 | −0.789 (−2.041 to 0.463) | −1.248 | ||
Design | F (1, 121) = 0.566 | 0.453 | ||||||
(Cluster) RCT (RC) | 41 | 74 | 0.613 (0.291–0.936) | 3.765*** | ||||
Quasi-experimental | 20 | 49 | 0.400 (−0.060 to 0.859) | 1.723 | −0.213 (−0.775 to 0.348) | −0.752 | ||
Type of comparison condition | F (1, 121) = 1.336 | 0.250 | ||||||
Passive control (RC) | 36 | 80 | 0.671 (0.328–1.014) | 3.872*** | ||||
Active control | 25 | 43 | 0.359 (−0.051 to 0.769) | 1.732 | −0.312 (−0.847 to 0.223) | −1.156 | ||
Authors | F (1, 108) = 1.115 | 0.293 | ||||||
Independent (RC) | 27 | 54 | 0.665 (0.292–1.038) | 3.534*** | ||||
Dependent | 25 | 56 | 0.380 (−0.003 to 0.763) | 1.967 | −0.285 (−0.820 to 0.250) | −1.056 | ||
Time of measurements | F (1, 121) = 6.693 | 0.011 | ||||||
Post-intervention (RC) | 44 | 93 | 0.522 (0.257–0.786) | 3.906*** | ||||
Follow-up | 17 | 30 | 0.672 (0.390–0.953) | 4.724*** | 0.150 (0.035–0.265) | 2.587* | ||
Time to follow-up (continuous) | 17 | 30 | 0.964 (0.037–1.891) | 2.131* | 0.006 (−0.017 to 0.028) | 0.504 | F (1, 28) = 0.254 | 0.618 |
Study quality (continuous) | 61 | 123 | 0.546 (0.280–0.812) | 4.063*** | 0.019 (−0.096 to 0.134) | 0.327 | F (1, 121) = 0.107 | 0.744 |
Sample characteristics | ||||||||
Target group | F (1, 121) = 7.065 | 0.009 | ||||||
Selected (RC) | 29 | 58 | 0.908 (0.537–1.280) | 4.844*** | ||||
Not-selected | 32 | 65 | 0.234 (−0.104 to 0.572) | 1.370 | −0.674 (−1.177 to 0.172 | −2.658** | ||
Selection method | F (1, 56) = 3.119 | 0.083 | ||||||
Screened (RC) | 16 | 31 | 1.406 (0.676–2.135) | 3.860*** | ||||
Self-selected | 13 | 27 | 0.443 (−0.370 to 1.256) | 1.091 | −0.963 (−2.055 to 0.129) | −1.766 | ||
% boys (continuous) | 58 | 119 | 0.491 (0.245–0.737) | 3.949*** | 0.000 (−0.009 to 0.010) | 0.096 | F (1, 117) = 0.009 | 0.924 |
% low SES (continuous) | 20 | 41 | 0.233 (0.015–0.451) | 2.163* | −0.000 (−0.004 to 0.004) | −0.034 | F (1, 39) = 0.001 | 0.973 |
% minorities (continuous) | 22 | 41 | 0.110 (0.007–0.213) | 2.164* | 0.001 (−0.001 to 0.003) | 0.986 | F (1, 39) = 0.972 | 0.330 |
Mean age (continuous) | 61 | 123 | 0.548 (0.284–0.813) | 4.101*** | 0.039 (−0.090 to 0.169) | 0.601 | F (1, 121) = 0.361 | 0.549 |
Intervention characteristics | ||||||||
Component mindfulness | F (1, 121) = 1.644 | 0.202 | ||||||
Yes (RC) | 21 | 31 | 0.360 (−0.020 to 0.740) | 1.874 | ||||
No | 40 | 92 | 0.633 (0.341–0.926) | 4.281*** | 0.274 (−0.149 to 0.696) | 1.282 | ||
Component relaxation | F (1, 121) = 3.288 | 0.072 | ||||||
Yes (RC) | 25 | 42 | 0.828 (0.422–1.233) | 4.040*** | ||||
No | 36 | 81 | 0.345 (0.008–0.682) | 2.025* | −0.483 (−1.010 to 0.044) | −1.813 | ||
Component cognitive-behavioral | F (1, 121) = 2.613 | 0.109 | ||||||
Yes (RC) | 28 | 78 | 0.772 (0.388–1.156) | 3.983*** | ||||
No | 33 | 45 | 0.345 (−0.010 to 0.700) | 1.923 | −0.427 (−0.950 to 0.096) | −1.617 | ||
Intensity (continuous) | 53 | 100 | 0.489 (0.222–0.756) | 3.632*** | −0.000 (−0.000 to 0.000) | −0.256 | F (1, 98) = 0.065 | 0.799 |
Type of instructors | F (1, 110) = 2.445 | 0.121 | ||||||
Specialized (RC) | 22 | 47 | 0.603 (0.271–0.934) | 3.601*** | ||||
Other | 35 | 65 | 0.270 (0.010–0.53) | 2.056* | −0.333 (−0.754 to 0.089) | −1.564 | ||
Program target | F (1, 121) = 0.089 | 0.765 | ||||||
Direct (RC) | 53 | 111 | 0.559 (0.274–0.844) | 3.879*** | ||||
Indirect | 8 | 12 | 0.440 (−0.289 to 1.170) | 1.196 | −0.118 (−0.902 to 0.665) | −0.299 |