Dr Lucy Foulkes
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lucyfoulkes.bsky.social
Dr Lucy Foulkes
@lucyfoulkes.bsky.social
8.5K followers 790 following 1.1K posts
Psychologist at University of Oxford | Adolescence + mental health

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lucyfoulkes.bsky.social
link to that paper here: link.springer.com/article/10.1...
Accounting for the adolescent social context in school mental health interventions
October 23, 2025 at 3:08 PM
lucyfoulkes.bsky.social
NEW PAPER from me and colleagues, reviewing negative effects found to date in universal school mental health interventions and considering what should happen next

www.sciencedirect.com/science/arti...

brief thread below
Potential harm from universal school-based mental health interventions: Candidate mechanisms and future directions Abstract Universal school-based mental health interventions involve lessons delivered to whole classes of young people irrespective of need, with the overall aim of improving mental health literacy, preventing mental health problems and/or reducing those that have already started. A number of high-quality trials show that universal interventions can have a range of negative effects, with participants in the intervention group experiencing worsening mental health or other negative outcomes. In this review, we summarise what we know so far about these negative effects, which we refer to as ‘potential harm’. Two important questions remain poorly understood. First, the mechanisms driving potential harm are unknown, including whether negative effects are driven by reporting phenomena, the content of the intervention itself, or both. Second, individual differences in susceptibility to these effects is unclear. In the second half of the paper, we explore whether further universal trials should be run and argue that, if they are, the crucial issue of negative effects must be considered at all stages. In particular, we recommend that trials be designed in such a way to test mechanisms and individual differences in response. Information can then be provided to schools and policymakers about why young people might respond in different ways to an intervention, and how to support vulnerable students. Ultimately, this will lead to more effective and less harmful interventions for everyone.
October 23, 2025 at 11:54 AM
lucyfoulkes.bsky.social
Instead, we may be better off focusing our efforts on targeted support (1:1 or small group) for those who want or need it

I argue this further in the paper below

acamh.onlinelibrary.wiley.com/doi/full/10....

(with thanks to Carolina et al for all their great work getting this paper out 🙏)
Debate: Where to next for universal school-based mental health interventions? Time to move towards more effective alternatives
October 10, 2025 at 3:36 PM
lucyfoulkes.bsky.social
Let's go back to this graph and look at the pink line. This line represents the students who were low in anxiety before the study, low in anxiety after it, and low 12 months later

76.6% of participants (5514 students) were in this
low-low-low group
October 10, 2025 at 3:36 PM
lucyfoulkes.bsky.social
To do this, Carolina conducted trajectory analysis, which enables us to split participants into subgroups based on their symptoms before, immediately after, and a year after the intervention

So, one subgroup might be high-high-high, one might be
high-low-low, etc

example visual below
trajectory analysis graph - anxiety symptoms
October 10, 2025 at 3:36 PM
lucyfoulkes.bsky.social
New paper from my group, led by Carolina Guzman Holst

This is a secondary analysis of data from the high-quality MYRIAD trial, a universal school-based mindfulness intervention

Summary below (🧵)

acamh.onlinelibrary.wiley.com/doi/10.1002/...
Adolescents' trajectories of mental health in the MYRIAD trial Abstract Background This study explored adolescent's mental health trajectories over the course of a school-based mindfulness-based intervention trial (MYRIAD). It examined whether intervention condition (mindfulness vs. teaching-as-usual), individual-level and contextual-level factors were associated with different trajectories. Methods This pre-registered study used data from 11- to 14-year-olds who participated in the MYRIAD trial. We used growth mixture models to examine distinct trajectories in risk for depression, social-emotional-behavioural functioning, and wellbeing (co-primary outcomes), and anxiety (secondary outcome), across pre-intervention, post-intervention and 12-month follow up (ns = 7198–7727). We then used multinomial and binomial logistic regression models to examine factors associated with individual trajectory membership. Results Distinct trajectories emerged for each outcome: A five-trajectory model best explained the changes in risk for depression, whilst four-trajectory models best explained changes in social-emotional-behavioural functioning, wellbeing, and anxiety. While 69%–80% of adolescents followed stable low-problem trajectories for each outcome, 11%–23% experienced stable high-problem trajectories, 2%–16% experienced increasing-problem trajectories and 1%–5% experienced decreasing-problem trajectories. Receiving the mindfulness intervention was not associated with any mental health trajectory in models adjusted for confounders. Several individual-level factors, including executive functioning difficulties and risk of mental health problems at baseline, and school-level factors, such as school climate, predicted adolescents' classification into different trajectories, but they did not vary according to intervention group. Conclusions Individual differences in mental health trajectories emerged over the course of a 1-year mindfulness-based intervention, with most adolescents experiencing low-stable problem trajectories for each outcome. However, the intervention itself had no impact on individual trajectory membership, mirroring null results found in the main trial. Our findings suggest that universal interventions may not be sensitive enough to address the diverse needs of all students, however, tailoring interventions to address a range of different individual and contextual factors might maximise their impact.
October 10, 2025 at 3:36 PM
lucyfoulkes.bsky.social
My book Coming Of Age: How Adolescence Shapes Us is out in paperback now

www.penguin.co.uk/books/451093...
Cover of Coming Of Age: How Adolescence Shapes Us by Lucy Foulkes. Out now in paperback
July 14, 2025 at 1:58 PM
lucyfoulkes.bsky.social
I’m especially grateful for David’s review here - all positive reviews are lovely of course, but this one felt particularly special because I felt like he really captured what I hoped the book was about...
July 7, 2025 at 9:19 AM
lucyfoulkes.bsky.social
I had no idea about this list so this was such a nice surprise when a pal spotted this and sent it to me yesterday 🥹 — Coming Of Age is one of the Guardian’s best paperbacks out this month

www.theguardian.com/books/ng-int...
The Guardian This month’s best paperbacks July
July 7, 2025 at 9:19 AM
lucyfoulkes.bsky.social
I’m looking for a small number of secondary schools to help us with a research study exploring self-diagnosis of mental health problems in young people

For more info or to express interest, please email @nhigsonsweeney.bsky.social:

nina.higson-sweeney [at] psych.ox.ac.uk

Or DM us! Thank you 🙏🏼
Secondary schools! Can you help? We're looking for research participants We're looking for UK secondary schools to help us with a project about self-diagnosis. For more info or to express interest, please DM me or email Nina at nina.higson-sweeney@psych.ox.ac.uk
June 6, 2025 at 12:29 PM
lucyfoulkes.bsky.social
acamh.onlinelibrary.wiley.com/doi/10.1111/...
Scoping review: potential harm from school-based group mental health interventions
June 3, 2025 at 8:45 AM
lucyfoulkes.bsky.social
I’m so grateful to all the very kind reviews I’ve had so far — thank you 💛

/3
May 30, 2025 at 11:12 AM
lucyfoulkes.bsky.social
It’s a bid to take adolescents more seriously, and to take the conversation about them beyond “social media” —there’s so much more happening at this time and so much more to talk about

/2
Back cover Contents list
May 30, 2025 at 11:12 AM
lucyfoulkes.bsky.social
Really happy to receive my first paperback copy of Coming Of Age 🎉

I wrote this book to examine the emotional power of the adolescent years – I explore why adolescents behave the way they do, but also about why events from those years continue to affect who we are, even many years later

1/
Me with Coming Of Age: How Adolescence Shapes Us
May 30, 2025 at 11:12 AM
lucyfoulkes.bsky.social
Very interesting from Estonia: no phone bans in schools, just rules about when and how to use them.

Instead of total bans, they are pragmatic about the role of tech in young people's current and future lives

would be good to see research on what young people think of this!

tinyurl.com/mryz498x
Kallas said there were no mobile phone bans in schools in Estonia. On the contrary: a smartphone is seen as part and parcel of Estonia’s highly successful digital education policy. “I’ve not heard of any problems, to be honest,” she said. “The schools establish the rules, which are followed on a local level. We use mobile phones for learning purposes.” She added: “We have local elections coming in October this year. In local elections, 16-year-olds can vote, and they can vote online through their mobile phones. So we want them to use mobile phones to do their civic duty, to participate in an election, to get the information, to analyse the political platforms. “It’s a little bit strange if we would not allow them to use them in school, in an educational setting. That would be a very confusing message to 16-year-olds – vote online, vote on a mobile, but don’t use ChatGPT on your phone to do education learning.” Kallas insisted: “We are not banning. We’ve given guidelines, especially regarding younger children – younger than 12 and 13 years old – when it comes to how mobile phones should be used or should not be used, but most schools have regulated it themselves. “They have regulated it so that mobile phones are not used during the breaks, and in the lessons they are used when the teacher asks for the phones to be taken out because there is some assignment or exercise that is done with the help of phones.”
May 28, 2025 at 8:16 AM
lucyfoulkes.bsky.social
Our online meetings are held once a month. They feature a short talk on a relevant research output or idea, followed by an open discussion

Today, we're joined by the excellent Carolina Guzman Holst who will be talking about negative effects from school MH interventions

(cont)
Abstract: This talk will be based on our newest scoping review (link below), where we set out to investigate the types of potential harms and adverse events reported in school-based mental health interventions; the subgroups of children and adolescents at heightened risk; and the proposed explanations for these potential harms. The talk will then broadly discuss the pros and cons of universal mental health interventions, emphasizing the importance of implementation and careful monitoring of programs in educational settings. Lastly, using findings from my own research, I will explore how evaluating universal interventions using non-traditional methods can give us insights into for whom interventions work and don't work. Bio: Dr. Carolina Guzman Holst is a NIHR Research Fellow at the University of Oxford. Her research focuses on understanding individual differences in how young people respond to school-based mental health interventions. This includes investigating how and for whom these interventions work (or do not work), identifying those most at risk, and exploring risk and protective factors that may predict these outcomes. She is currently analysing and compiling data from multiple school intervention trials to address these questions using different types of data-driven approaches. Carolina holds a PhD and MSc in Experimental Psychology from Oxford and a BSc in Psychology from Brown University. She is also a Visiting Research Fellow at King’s College London.
May 8, 2025 at 9:39 AM
lucyfoulkes.bsky.social
ONLINE TALK TODAY

I run an online special interest group (SIG), which brings together people from a range of disciplines and backgrounds who are interested in critically evaluating research into adolescent mental health and school mental health interventions.

(cont)
Foulkes Special Interest Group
May 8, 2025 at 9:39 AM
lucyfoulkes.bsky.social
Are you a UK psychiatrist with views to share about self-diagnosis?

We’re looking for UK-based psychiatrists who work with young people aged 10–24 and would be available to take part in a 45-minute online interview

(cont below)

PLEASE SHARE WIDELY 🤩
University of Oxford. What do you think about self-diagnosis of mental disorders? Are you: - A UK based psychiatrist who works with adolescents (aged 10-24 years) - Available for a 45 minute online interview Come take part in our study! Contact: sara.svobodova@bnc.ox.ac.uk or lucy.foulkes@psych.ox.ac.uk for more information
May 7, 2025 at 2:56 PM
lucyfoulkes.bsky.social
I've just come across this, published last year, and the findings are surprising and important

Public attitudes towards people with mental health problems improved from 2008 to 2019 - but then *decreased*. Found across three measures of stigma.

Why?

tinyurl.com/mvuhvz3r

(cont)
Fig. 2 Marginal estimates of stigma-related attitudes (CAMI), knowledge (MAKS) and desire for social distance (RIBS intended behaviour), by year (95% confidence intervals). CAMI, Community Attitudes toward the Mentally Ill scale; MAKS, Mental Health Knowledge Schedule; RIBS, Reported and Intended Behaviour Scale.
May 2, 2025 at 10:41 AM
lucyfoulkes.bsky.social
Agree with all you say here - but also, there wasn't an improvement in the high engagers relative to controls anyway, see below.
A contrast comparing the high engagement group with the control group showed a significant difference in depression change from baseline to post-intervention, by 0.18 points (95%CI:.14 to.89, p<.01). Interpretation of this differential change is complicated by symptom differences at baseline. However, this effect was due to convergence of the control group from a significantly higher mean at baseline to a lower value post-intervention that was not significantly different from the high engagers. See Figure below. There was no difference in change scores at the 6- or 12-month follow-up time points between the high engagement group and control group (all ps>.05). This pattern of results was similar for a contrast comparing change in the high and no engagement group, with a difference in change from baseline to post-intervention, 95%CI: .34 to 1.19, p<.001, but no difference in score at this time point (p>.05), and again was not found at 6 or 12 months (ps>.05).
April 25, 2025 at 3:16 PM
lucyfoulkes.bsky.social
That's not the case - there was a difference between high engagement vs controls, but this was driven by higher baseline symptoms in the control group then dropping post-intervention (see graph). It's not that high engagement group improved more
A contrast comparing the high engagement group with the control group showed a significant difference in depression change from baseline to post-intervention, by 0.18 points (95%CI:.14 to.89, p<.01). Interpretation of this differential change is complicated by symptom differences at baseline. However, this effect was due to convergence of the control group from a significantly higher mean at baseline to a lower value post-intervention that was not significantly different from the high engagers. See Figure below. There was no difference in change scores at the 6- or 12-month follow-up time points between the high engagement group and control group (all ps>.05). This pattern of results was similar for a contrast comparing change in the high and no engagement group, with a difference in change from baseline to post-intervention, 95%CI: .34 to 1.19, p<.001, but no difference in score at this time point (p>.05), and again was not found at 6 or 12 months (ps>.05).
April 25, 2025 at 3:14 PM
lucyfoulkes.bsky.social
Intervention engagement Of participants allocated to SPARX, 87% installed the app, 57% completed the first module and 12% completed all seven modules. 43% of participants comprised the ‘no engagement’ group (zero modules completed), 35% were in the ‘low engagement’ group (1–3 modules) and 22% in the ‘high engagement’ group (4+ modules). Females were more likely to be high engagers compared with males (OR=1.26, 95% CI: 1.03 to 1.54), as were those with no previous diagnosis of a mental health condition (OR=1.37, 95% CI: 1.07 to 1.74). An MMRM was conducted using these engagement categories and the control group as a between-group factor. There were no differences in depression symptom change between the intervention and the control group, nor between the no and low engagement groups at any of the assessment points (all p values>0.05). A contrast comparing the high engagement group with the control group showed a significant difference in depression symptom change from baseline to post intervention (t(342.16)= −0.52; 95% CI: 0.14 to 0.89, p<0.01). However, symptom differences at baseline between these groups preclude firm conclusions being drawn from this finding, t(349.756)= −1.97; CI: −1.40 to 0.00, p<0.05. See online supplemental file 4 for full details.
April 25, 2025 at 9:36 AM
lucyfoulkes.bsky.social
For me, these new findings are exceptionally useful for suggesting we should stop universal MH interventions in schools, and focus on one-to-one, targeted and directed interventions instead. @jackandrews.bsky.social and I argue this is more detail below

doi.org/10.1111/camh...
Debate: Where to next for universal school-basedmental health interventions? Time to move towardsmore effective alternativesJack L. Andrews & Lucy FoulkesDepartment of Experimental Psychology, University of Oxford, Oxford, UKThere is an urgent need to improve mental health outcomes among young people. One approach taken toaddress this problem has been the design and delivery of universal school-based prevention, based on thera-peutic models such as CBT and mindfulness. Such interventions are delivered to groups of young people, irre-spective of risk or need. However, in this commentary, we argue that the initial appeal of universalinterventions has not been supported by the evidence: universal school-based prevention is less effective thantargeted approaches, often leads to null or unsustained positive effects, has the potential to elicit negativeeffects and is not well liked by young people themselves. In addition, many young people in each classroomalready meet the criteria for a mental disorder, meaning that prevention approaches may not be appropriateor effective for this group. In this commentary, we respond to Birrell et al.’s (2025) paper by arguing that thefield should move away from universal prevention and instead invest our limited resources in the refinementand dissemination of interventions with a stronger evidence base, such as one-to-one, targeted and indirectapproaches.
April 25, 2025 at 8:30 AM
lucyfoulkes.bsky.social
In response to null findings like these, people often say 'We need to improve engagement'. Do coproduction, make the app more fun, etc

I advocate for an alternative: young people are telling us they don't like or want this, and we should listen to them.
Universal prevention is not well accepted and does not give young people autonomy and choice Paragraph taken from Andrews & Foulkes (2024). Debate: Where to next for universal school-based mental health interventions? Time to move towards more effective alternatives
April 25, 2025 at 8:30 AM
lucyfoulkes.bsky.social
This is a *key* new paper in the world of school mental health interventions

A very large trial (N=6388) testing a universal CBT-based app for adolescent depression (13-14y)

No effects found (on depression, anxiety, distress or insomnia)

(🧵)

mentalhealth.bmj.com/content/28/1...
Future Proofing Study: a cluster randomised controlled trial evaluating the effectiveness of a universal school-based cognitive–behavioural programme for adolescent depression
April 25, 2025 at 8:30 AM