The Effectiveness of Interventions to Improve Mental Health Literacy, Helping Behaviours and Stigmatizing Attitudes in Schoolteachers and Staff in Asian Countries: A Systematic Review and Meta-analysis

Introduction: Mental health literacy (MHL) has been defined as the knowledge and beliefs about mental disorders which aid their recognition, management or prevention.
Objectives: To assess the effectiveness of interventions to improve MHL, helping behaviours and stigmatizing attitudes in schoolteachers and staff in Asian countries  
Methods: This review was registered in the PROSPERO and followed PRISMA Guidelines. Medline, ERIC, PsycINFO, CINHAL and Web of Science databases were searched using predefined search strategies. Studies with randomized controlled trial (RCT), quasi experimental or cluster randomized experimental designs, published as a peer reviewed journal article and or as a report in English from 2000 till February 2022 were selected. Risk of bias (ROB) assessments were conducted with Cochrane ROB V2 tool and ROBINS-I criteria for randomized and non-randomized interventions, respectively. Meta-analyses were performed with Review Manager 5.4 .  
Results: At the initial search, 11547 articles were identified and eight were subsequently selected for synthesis of findings. There were four RCTs (n=496) and four, before and after studies without a comparator group (n=251). Most RCTs studies were of low ROB while other studies with ROB of some concern/critical. The findings of the meta-analysis using four RCTs indicated that there was a large improvement in knowledge (SMD=1.3; 95% CI: 0.95, 1.7), a moderate improvement in stigma (SMD=-0.6; 95% CI: -0.8, -0.3) and a large improvement in helping behaviour (SMD=0.8; 95% CI: 0.5, 1.2).  
Conclusions & Recommendations: Our review indicates that interventions targeting schoolteachers and staff had large effects upon knowledge of mental illnesses and helping behaviour and moderate effects upon stigma.