Beyond Knowledge: A Mixed-Methods Evaluation of a School Mental Health Literacy Program

Abstract

The adolescent years represent a critical window for Mental Health Literacy (MHL) interventions, as this developmental period involves challenging transitions that often exacerbate emotional distress. With over 20% of Austrian youth meeting diagnostic criteria for mental health disorders [1], MHL programs offer essential prevention during these vulnerable years. The COMET4Kids project addresses this need through an evidence-based intervention combining embodiment and cognitive strategies to improve emotional awareness and regulation in fourth-graders. While existing MHL research predominantly assesses knowledge and attitude changes [2], physiological outcomes remain critically understudied. Our mixed-methods study addresses this gap by examining whether a classroom-based MHL program—delivered through five interactive modules (emotions, thoughts, coping, well-being, and mental health) in 12 sessions—demonstrates measurable effects through both physiological and psychosocial assessments.

The randomized controlled pilot involves twelve classes across four schools (six intervention, n=98; six control, n=95). Data collection occurs at pre- and post-intervention timepoints for all measures. Quantitative assessment includes continuous heart rate (BPM) monitoring via Polar Verity Sense during virtual Trier Social Stress Test for Children (VR-TSST-C) sessions, providing objective stress reactivity data. Qualitative components comprise: (1) Ecological Momentary Assessment (EMA) diaries tracking daily emotional states (3x/day for 5 consecutive days), (2) standardized psychosocial questionnaires, and (3) semi-structured interviews exploring participants' experiences. Additionally, the study collects (4) VR-TSST-C metrics (momentary emotion ratings, response accuracy) with post-task interviews. This multimodal approach captures physiological and subjective program impacts across pre-post intervention phases.

We hypothesize that the embodied MHL strategies will: improve self-reported emotional competencies and knowledge, as well as significantly attenuate BPM stress responses compared to controls. The VR assessment provides standardized physiological measures while qualitative data offer insights into real-world program effectiveness.

This research addresses four key gaps: (1) limited physiological evidence for MHL programs, (2) lack of prevention approaches for pre-adolescents, (3) need for sustainable school-based models, and (4) scarcity of mixed-methods evaluations in MHL research. The study's innovative combination of VR-based physiological measurement with extensive psychosocial data advances MHL research methodology. While the BPM data provides primary quantitative evidence, the EMA diaries, questionnaires, and interviews yield crucial qualitative insights into the program's perceived efficacy and implementation factors.

Positive results could inform policy decisions about implementing MHL curricula during this developmentally sensitive period. Future directions include developing teacher training protocols for scalable implementation and examining longitudinal outcomes. The study's combination of rigorous physiological measurement with rich qualitative data represents a novel approach to evaluating school-based mental health interventions.

References

[1] G. Wagner et al., “Mental health problems in Austrian adolescents: a nationwide, two-stage epidemiological study applying DSM-5 criteria,” European Child & Adolescent Psychiatry, vol. 26, no. 12, pp. 1483–1499, May 2017. doi: 10.1007/s00787-017-0999-6.‌

[2] J. Bale, C. Grové, and S. Costello, “Building a mental health literacy model and verbal scale for children: Results of a Delphi study,” Children and Youth Services Review, vol. 109, p. 104667, Feb. 2020. doi: 10.1016/j.childyouth.2019.104667.