A scoping review of school-based mental health nursinginterventions for the early identification and management ofanxiety and depression among adolescents

Abstract

Anxiety and depression are among the most common mental health problems affecting adolescents and are associated with impaired academic performance, social withdrawal, absenteeism, reduced quality of life, self-harm, and increased suicide risk. Despite the growing burden of adolescent mental health problems, many young people remain unidentified or experience delays in accessing specialized mental health services. Schools provide an accessible and less stigmatizing environment for early identification and intervention, while school nurses are strategically positioned to recognize psychological distress, conduct screening, provide brief supportive interventions, and coordinate referrals. This scoping review aimed to map and synthesize the available evidence on school-based mental health nursing interventions used for the early identification and management of anxiety and depression among adolescents. A scoping review approach was used to examine literature concerning nursing-led and nurse-involved mental health interventions delivered within school settings. The review focused on adolescents and interventions addressing the identification, prevention, or management of anxiety and depressive symptoms. Evidence relating to mental health screening, psychoeducation, cognitivebehavioral strategies, mindfulness, stress management, resilience-building, referral pathways, family engagement, and multidisciplinary collaboration was examined. The extracted evidence was organized according to intervention characteristics and reported outcomes. The reviewed evidence demonstrated that school-based mental health nursing interventions encompass a broad continuum of care, ranging from universal mental health promotion and systematic screening to targeted brief interventions and referral for specialized care. Frequently reported approaches included the use of validated screening instruments, nurse-led psychoeducation, low-intensity cognitive-behavioral techniques, mindfulness and emotional regulation activities, stressmanagement education, resilience-building programs, and coordinated referral pathways. Across the literature, these interventions were associated with improved early recognition of psychological distress, reductions in anxiety and depressive symptoms, enhanced coping and resilience, improved mental health literacy, and greater help-seeking behavior. However, implementation was influenced by high nursing workloads, limited specialist mental health training, privacy constraints, inconsistent intervention protocols, and variations in school resources. School nurses can play a significant role in the early identification and management of adolescent anxiety and depression by integrating screening, brief evidence-based interventions, mental health education, and coordinated referral within routine school health services. A structured multi-tiered model of care may strengthen the integration of mental health support into educational settings. Further research is needed to standardize nurse-led intervention protocols, evaluate long-term outcomes, and determine how these approaches can be adapted to schools with limited healthcare resources.