BACKGROUND:Credible long-term outcomes from randomized trials evaluating the effectiveness and cost-effectiveness of preventive programs for mental health problems are needed. We compared long-term effects of the Mind My Mind (MMM) transdiagnostic cognitive behavioral therapy (CBT) program to management as usual (MAU). METHODS:The study was a pragmatic, multisite, randomized superiority trial (2017-2019) involving youths aged 6-16 years with anxiety, depressive symptoms, and/or behavioral disturbances, recruited through family self-referral. The MMM intervention included 9-13 weekly CBT sessions. The primary outcome was change from baseline in parent-reported impact of mental health problems at 3-year follow-up post-randomization using the Strengths and Difficulties Questionnaire (SDQ) impact scale. Register-based outcomes tracked youths' psychiatric diagnoses in mental health services. To assess cost-effectiveness, we calculated the incremental costs and incremental quality-adjusted life years (QALYs). All primary analyses followed the intention-to-treat (ITT) approach. CLINICAL TRIALS REGISTRATION:ID NCT04804917. RESULTS:Among 396 youths randomized (baseline mean [SD] age, 10.3 [2.4] years; 52.0% boys; MMM n = 197, MAU n = 199), the 3-year follow-up (median 167 weeks; range 124-203 weeks) primary outcome data were available in 69.0% and 59.3%, respectively. The decrease in SDQ-impact-score from baseline to 3-year follow-up (4.12→1.79 points [MMM] and 4.21→1.85 [MAU]) was similar (between-group difference, 0.06 [95% CI -0.41 to 0.52]; p = .81). An equal proportion (25%) of youths in MMM and MAU were diagnosed with any mental disorder during follow-up (HR 1.01, 95% CI 0.68-1.50). Total costs over the intervention period were higher in the MMM group (incremental costs 3,014 Euros [95% CI: 2.174-3.855]). Cost-effectiveness analyses favored MMM: QALY net gain 0.121 (95% CI 0.045-0.196); the cost-effectiveness ratio was 24,789 Euro/QALY. CONCLUSIONS:Although MMM was potentially cost-effective, the beneficial effects diminished over 3 years post-treatment. The findings highlight the need for strategies to sustain long-term effects.

Resettlement in a new cultural context can be experienced as challenging for refugees and some may need support to adapt to new circumstances. Previous studies indicate that refugee parents are at risk for economic hardship, which may influence their parenting practices via an increase in parental stressors. The aims of this study were to employ the conceptual framework of the Family Stress Model (FSM) to (1) investigate the level of economic hardship, parenting stress, psychological distress, resilience, and parents' approaches to parenting practices; (2) investigate correlations between these factors; (3) examine whether they were associated with parenting practices. The sample consisted of (N = 276) refugee parents settled across Norway. Descriptive analyses were conducted, and mixed-effects models were used to estimate associations with parenting practices. The results showed that some of the parents reported that economic hardship occurred, which was correlated with higher levels of psychological distress. Higher parenting stress was correlated with lower levels of resilience and higher levels of psychological distress. Harsh and inconsistent discipline was significantly associated with parenting stress (B = 0.013, p < 0.001) and psychological distress (B = 0.208, p = 0.042), while resilience was significantly associated with praise and incentives (B = 0.423, p = 0.005) and positive verbal discipline (B = 0.473, p < 0.001). These insights may enable health and welfare services to recognize families at risk and identify resources that can help refugee families in their resettlement into a new country.

The rising prevalence of mental health problems presents economic and social challenges with youth anxiety and depression as major contributors. While strengthening preventive measures is essential to mitigate the impacts of these conditions, limited resources necessitate careful prioritization of interventions. This underscores the need for cost-effectiveness studies to inform resource allocation and decision-making. This study utilized data from a trial employing the MOST framework to optimize a targeted group CBT intervention for youths exhibiting anxiety and depressive symptoms. Experimental strategies were evaluated for cost-effectiveness using real-world data examining intervention costs, child mental health outcomes: anxious and depressive symptoms and quality-adjusted life-years (QALYs). Three intervention factors were examined: delivery format (16 sessions vs. 8 sessions + 8 web-based sessions), parental involvement (five sessions vs. parental brochure), and measurement feedback system (MFS) (feedback vs. no feedback), producing eight intervention strategies. The study included 701 children aged 8 to 12, recruited from 52 public schools in 39 municipalities in Norway. Statistical analysis was conducted using R. For depressive symptoms and QALYs, cost-effective strategies included the long in-person version with low parental involvement and no feedback, and the hybrid format (in-person + web-based sessions) with low parental involvement and no feedback. For depressive symptoms, the hybrid format with parental involvement and no feedback was a feasible strategy. For anxiety symptoms, cost-effective strategies involved the long in-person version with low parental involvement and feedback, and the hybrid format with low parental involvement and feedback. In resource-constrained environments, the least resource-intensive strategies can ensure symptom reduction at minimal cost. Parental involvement is a viable alternative under conditions of intermediate resources, balancing costs, and clinical benefits. When symptom reduction is prioritized, and cost is secondary, the long in-person format with low parental involvement and no feedback may be preferable. The study highlights trade-offs between cost containment, reach, and intervention effectiveness. Policymakers must weigh costs against desired levels of symptom reduction when making decisions. Trial registration number Clinical Trials NCT04263558 (Feb 11, 20, Jan 25. 21).

Parental factors such as parental symptomatology, family functioning, and parental practices are linked to child anxiety and depression. While most research focuses on clinical groups, this study examines these associations in an indicated sample, before and after a preventive intervention and at 12-month follow-up. Participants included 1043 parents of 650 children (8–12 years old) from the ECHO trial, aimed at optimizing a preventive program for anxious and sad children. Using cross-lagged panel models, we modelled the relationship between parent-reported children’s anxiety and depression symptoms and parental factors. Parental factors were parents’ symptoms of anxiety and depression, family functioning and parental practices (managing emotions, setting goals dealing with problems, and dealing with negative emotions). All variables were measured by parent-report questionnaires at baseline, post-intervention and 12-month follow-up. Positive associations were found between child anxiety and depressive symptoms, and parental anxiety and depressive symptoms and poorer family functioning. There were smaller, negative associations between children’s symptoms and positive parental practices. Parental factors were significantly associated with child anxiety and depression over time, with stronger links to parents’ anxiety and depressive symptoms and family functioning, than parental practices.

Prior research has linked parental factors such as parent psychopathology, family functioning, parenting style, and parental practices to child anxiety and depression. Parents are often involved in interventions for these disorders. However, previous research suggests that this does not always add to the effect of child treatment alone. Furthermore, little research report changes in known parental risk and protective factors. As part of the ECHO-trial, we examined two delivery formats of parental involvement in the Emotion intervention, an indicated school-based cognitive behavioral therapy (CBT) program to prevent child anxiety and depression. Parents received either five parent group sessions or a brochure, while their children attended group sessions. Parents ( N = 1028) completed our online survey at baseline, post-intervention, and/or 12-month follow-up. On average, parents showed small improvements in anxiety and depression symptoms and parental practices over time. There was no difference in parental factors between parents in the group sessions and the brochure condition. The trial was preregistered at https://www.clinicaltrials.gov/ (NCT04263558), in February 2020.

This review analyzes randomized controlled studies that investigated parent training interventions in Europe. Included studies had to have utilized interventions based on social learning theory and enrolled immigrant families. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and the review was pre-registered with PROSPERO. A search of nine databases identified 8286 publications, seven of which fulfilled the inclusion criteria. These articles were published between 2010 and 2017. Since 1996, extremely few effective trials have been conducted in Europe. The meta-analysis revealed a small but significant overall effect for child problem behaviors and positive and negative parenting (effect size = 0.26, 0.24, and 0.20, respectively), compared with the control conditions, thus favoring parent training. Only some studies have addressed the migration or cultural issues in family life-a barrier to the development of future programs. This review highlights issues such as cultural adaptation and intersectionality to assist evaluators and planners in improving the practice of their professions and their knowledge base. We call for more evidence regarding the effects of parental programs on immigrant families living in Europe.

IntroductionThe present paper explores how Norwegian primary school teachers’ reason and reflect when assessing students’ general school functioning in Teacher’s Report Form (TRF), where teachers are asked to compare students of concern with what is perceived as a typical student at the same age, regarding work effort, behavior, learning capacity and mood.MethodsThe teachers in the sample (n = 7) had recently filled out the TRF as part of their participation in The Echo Study, utilizing the cognitive behavior therapy program Emotion for sad and anxious children.ResultsThe results show that teachers base their assessments much on person-relative, rather than group- or age relative comparisons, e.g., what is normal for the individual student. It is also identified that a safe psychosocial environment where students feel confident speaking up and exploring new ideas, is recognized as essential or optimal school functioning and attendance. This is especially important for children experiencing sadness or anxiety.DiscussionBy understanding more of how teachers reason when assessing students’ general school functioning, we can aid their efforts to identify students of concern. Poor school functioning is related to school absenteeism, and teachers are front-line professionals to observe early warning signs based on their understanding of whether a student’s behavior lies within or outside the range of typical functioning.

Norway’s integration programme for newly arrived refugees is mandatory and is offered by all municipalities. The programme offers courses in social studies, Norwegian language and parental guidance. In 2023, it was decided to allow municipalities to adapt and shorten the latter course for families from Ukraine due to capacity constraints. To make informed adaptations, the municipalities need more information about the needs of parents from Ukraine. This article aims to provide knowledge that can help decision-makers plan and implement further adaptations to social and health services by examining living conditions, emotional problems, parental stress and resilience. The participants were Ukrainian refugees with children aged 6–12 from seven municipalities who completed an electronic questionnaire that included questions on the Hopkins Symptom Checklist (short version), the Resilience Scale for Adolescents, and the Parenting Stress Index (short version). We found that economic living conditions among Ukrainian refugees were low, and that 26 per cent of the sample reported symptoms of anxiety and depression. Despite this, parents demonstrated resilience through their social resources, family cohesion, and low levels of parental stress. However, it is important to note that mental health issues and increased parental stress can emerge sometime after flight and settlement in Norway, and that poor economic conditions can exacerbate these concerns. Keywords: parenting programmes, refugees, Ukraine, poor economic conditions

This qualitative study explored the challenges faced by refugee children in Norway and analyzed how they coped with them. We conducted interviews with 23 children between the ages of 7 and 13. The findings showed that these children struggle with language barriers, outsiderness, bullying, and longing. They utilized both personal and interpersonal resources through active and passive methods to cope. The findings indicated that the experiences of these children were influenced by larger societal structures that limited their autonomy. We recommend incorporating the perspectives of refugee children at all levels of the system to empower them and enhance their well-being.

Beskrivelse: The Revised Child Anxiety and Depression Scale (RCADS) er et spørreskjema utviklet av Bruce F. Chorpita og kollegaer. Spørreskjemaet er oversatt til norsk av Marianne A. Villabø og Hanne Kristensen. Instrumentet er tilgjengelig i en fullversjon med 47 ledd og i en kortversjon med 25 ledd. Begge versjonene kartlegger kliniske symptomer på både angst og depresjon. RCADS er tilgjengelig i barne- og foreldreversjon. RCADS er gratis tilgjengelig på rcads.ucla.edu, men bruk av testen i en tjeneste eller til forskning krever skriftlig avtale. Litteratursøk: Litteratursøket ga 691 treff etter dublettsjekk. Fjorten publikasjoner oppfylte kriteriene og ble inkluderte (2 norske og 12 svenske eller danske studier). Antall deltakere i studiene varierte fra 92 til 667. Barnas alder varierte fra 1 til 22 år, og fem av studiene inkluderte foreldre. Seks av studiene hadde utvalg fra den generelle populasjonen, mens to studier hadde utvalg med både en klinisk gruppe og en kontrollgruppe. Seks studier undersøkte kun kliniske populasjoner. Psykometri: For barneversjonen var reliabilitet dokumentert i form av indre konsistens i ni studier for RCADS-47, og i to publikasjoner for RCADS-25. For foreldreversjonen av RCADS-47 rapporterte tre publikasjoner indre konsistens. Skalaene hadde tilfredsstillende til utmerket indre konsistens i alle publikasjoner. Flere publikasjoner rapporterte også funn som støttet opp om RCADS´ begrepsvaliditet. Middelverdier var rapportert i 10 publikasjoner, men vi fant ingen skandinaviske normer. Ingen publikasjoner rapporterte kriterievaliditet, test-retest reliabilitet eller mål på endringssensitivitet. Konklusjon: Måleegenskaper for skandinaviske full- og kort barneversjoner av RCADS var gode, og samsvarte med funn fra internasjonale studier. Men klinikere bør benytte den norske versjonen med forsiktighet ettersom skandinaviske normer ikke foreligger. Kunnskapsgrunnlaget for måleegenskapene ved den norske foreldreversjonen av RCADS-47 og RCADS-25 er foreløpig mangelfullt og det er et behov for studier som undersøker disse.

Abstract Background International studies show increasing prevalence of anxiety and depression among children. Parents are vital for children in all aspects of life, also in supporting their offspring in promoting better mental health, life skills and reducing emotional difficulties. Therefore, involving parents in interventions aimed at preventing development of anxiety and depression is natural. In treatment studies, targeted parental involvement has been difficult to prove effective. However, few existing studies investigate the effect of parental involvement in preventive interventions. Objective We aimed to explore whether attendance influenced the change in child’s emotional symptoms post intervention and one-year later reported by parents. Method Parents of children attending an indicated preventive intervention named EMOTION, who took part in a high parental involvement condition were included in this study (n = 385). High involvement entailed 5 parent group sessions. Using linear mixed models, we investigated whether attendance in the parent groups influenced the parent-reported levels of children’s emotional symptoms post-intervention and at one-year follow-up. Results Parents who did not attend parent sessions reported significantly larger reductions in child anxiety symptoms over time than attending parents. There was no such effect on child depression. However, parents who attended sessions reported significantly higher depression symptoms than non-attendees at baseline. Further, attending more parent sessions did not significantly impact either symptom measure. Discussion Given the non-significant differences of parental attendance in this study, future studies could examine less resource demanding interventions for children with emotional difficulties. When the child is struggling with anxiety and depression, the parent’s role in child’s life could be vital for symptom amelioration. The challenge is finding effective, evidence-based methods to involve parents, to reduce child emotional difficulties and improve their quality of life. Conclusions In this preventive study, attendance in parent sessions has limited effect on parent-reported symptoms of child emotional difficulties.

[This corrects the article DOI: 10.3389/fpsyg.2023.1290358.].

Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children’s satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.

IntroductionThe COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life.MethodsOur study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations.ResultsLevels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness.DiscussionOur study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.

Mind My Mind (MMM) cognitive behavioral therapy (CBT) manualized treatment is effective in the management of common emotional and behavioral mental health problems in youth, yet not all individuals respond satisfactorily to treatment. This study explored potential effect modifiers, i.e., baseline factors associated with a differential treatment effect. We conducted secondary effect modifier analyses with MMM trial data, which involved randomization of 396 youths aged 6-16 years to either MMM CBT treatment (9-13 sessions) or management as usual in local community settings. We examined sociodemographic- (sex, age, family composition, ethnicity, parental education, and income) and clinical variables (mental disorders and duration of mental health problems) as potential effect modifiers of the a) change in parent-rated impact of mental health problems measured by the Strengths and Difficulties Questionnaire (SDQ) or b) response (reduction of ≥1 on SDQ-impact). In intention-to-treat analyses, superior treatment (net) benefits from the MMM intervention were found among youths who met criteria for any mental disorder at baseline (-1.25 [95%CI: -1.67;-0.82]) compared to youths that did not meet diagnostic criteria (-0.22 [95%CI:-1.09;0.65]). Comorbidity vs no comorbidity (-1.84 [95%CI:-2.58;-1.10] vs -0.72 [95%CI:-1.15;-0.29]) and longer duration of untreated mental health problems, i.e., more vs less than 6 months (-1.16 [95%CI:-1.55;-0.78] vs 0.43 [95%CI:-1.01;1.86]) were also associated with superior treatment benefits. The sociodemographic factors were not associated with differential treatment effects in the intention-to-treat analyses. These findings suggest that community-based programs like the MMM are well-suited for youths with substantial mental health problems. Clinical Trials Identifier: NCT03535805.

Bakgrunn: VIP Snakk om det (tidligere VIP-programmet) er et psykoedukativt program som retter seg mot elever i videregående skoler i alderen 16 og 17 år. Programmet gir informasjon om psykisk helse og psykiske lidelser samt veiledning i hvordan man håndterer slike vansker. Lærere og helsepersonell får opplæring i programmet og hvordan man oppdager problemer hos elevene tidlig for å kunne sette i verk hjelpetiltak gjennom helsesystemet. Metode: Denne kunnskapsoppsummeringen bygger på et systematisk litteratursøk i databasene Embase, Medline og Psykinfo, NORART, Cochrane, Cristin, NORA, SCOPUS og SweMed. Det er også søkt i internasjonale kunnskapsdatabaser samt innhentet informasjon om tiltaket fra tiltakseier. Litteratursøk og annen innhentet informasjon ble gjennomgått for å identifisere nordiske effektstudier, internasjonale oppsummeringsstudier og eventuelt andre norske studier om tiltaket. Resultater: VIP Snakk om det er evaluert i et kvasieksperimentelt design med test og kontrollgruppe, der data ble innhentet før intervensjonen, rett etter og 6, 12 og 24 måneder etter. Effektene som gjelder kunnskap om psykiske lidelser er moderate, både rett etter deltakelse i programmet og i etterundersøkelsen. Det er en svakhet at effektene ikke er konsistent rapportert for alle måletidspunkter. Psykiske problemer er bare rapportert for tidsrommet rett etter intervensjonen til ett år etter. På grunn av valgt design og spørreskjema er det vanskelig å sammenlikne effektene med andre resultater i feltet. I tillegg måles angstsymptomer med en skala som har fem spørsmål og uavklart validitet. Konklusjon: VIP Snakk om det klassifiseres på evidensnivå 3 – Tiltak med noe dokumentasjon på effekt.

BACKGROUND:Tracking clinical outcomes during therapy can be useful for improving both clinical practice and research. For repeated data collection, short, reliable, and valid measures of central aspects of psychopathology are necessary. The current paper investigates the psychometric properties of two short surveys for measuring central dimensions of psychopathology in youth.METHODS:We investigated the factor structure and validity of the Norwegian translations of the Behavior and Feelings Survey (BFS) and the Brief Problem Monitor (BPM). The BFS has previously shown a two-factor structure and indications of validity as a measure of internalizing and externalizing problems in youth. The BPM has support for a three-factor structure of internalizing, externalizing, and attention problems. In our sample of 503 patients (56% female, age 6 to 18) in a Norwegian outpatient clinic, we conducted confirmatory factor analyses to test the assumed measurement models and further considered the concurrent validity of the measures.RESULTS:Internal reliability of both measures were good. The results suggest that the assumed measurement models for both questionnaires only partly fit our data but that subscales of the BFS and BPM still indicate convergent validity. Scores on subscales (internalizing and externalizing problems) on both measures converged with relevant subscales as well as with relevant groups of diagnoses.CONCLUSIONS:Alternative measurement models, and the usefulness and limitations of these short-form questionnaires for internalizing and externalizing problems, are discussed.

Objectives Our objective was to evaluate the cost-effectiveness of the transdiagnostic psychotherapy program Mind My Mind (MMM) for youth with common mental health problems using a cost-utility analysis (CUA) framework and data from a randomized controlled trial. Furthermore, we analyzed the impact of the choice of informant for both quality-of-life reporting and preference weights on the Incremental Cost-Effectiveness Ratio (ICER). Methods A total of 396 school-aged (6–16 years) youth took part in the 6-month trial carried out in Denmark. CUAs were carried out for the trial period and four one-year extrapolation scenarios. Costs were based on a combination of budget and self-reported costs. Youths and parents were asked to report on the youth’s quality-of-life three times during the trial using the Child Health Utility 9D (CHU9D). Parental-reported CHU9D was used in the base case together with preference weights of a youth population. Analyses using self-reported CHU9D and preference weights of an adult population were also carried out. Results The analysis of the trial period resulted in an ICER of €170,465. The analyses of the one-year scenarios resulted in ICERs between €23,653 and €50,480. The ICER increased by 24% and 71% compared to the base case when using self-reported CHU9D and adult preference weights, respectively. Conclusion The MMM intervention has the potential to be cost-effective, but the ICER is dependent on the duration of the treatment effects. Results varied significantly with the choice of informant and the choice of preference weights indicating that both factors should be considered when assessing CUA involving youth.

Abstract Objectives Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient‐reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self‐report measures, RCADS‐47 and RCADS‐25, generalize to a Norwegian setting. Methods We examined gender and age differences in symptomatology among 592 children (mean age 10.7 years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS‐47 and RCADS‐25 youth versions. Results Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS‐47 and RCADS‐25 scales indicated good internal consistency. Structural validity for RCADS‐47 and RCADS‐25 was supported by confirmatory factor analyses results. For both measures, strong gender‐based measurement invariance was present. Convergent validity of the RCADS‐47 and RCADS‐25 with other well‐established self‐report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported. Conclusion The RCADS‐47 and RCADS‐25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross‐cultural validity.

To investigate the effects of measurement feedback systems (MFSs) in therapy on mental health outcomes through a literature review and meta-analysis. Using a three-level modeling approach, we conducted a meta-analysis of all effect sizes from randomized controlled studies of MFSs used in the treatment of common mental health disorders. Eighty-two effect sizes were extracted from the thirty-one included studies. Analyses were performed to consider the post-treatment effects of the MFS-assisted treatment compared to treatment as usual. A separate analysis was done for the subgroup “not-on-track” patients as it is theorized that MFSs will be clinically useful because they make therapists aware of patients who fail to progress. MFSs had a significant effect on mental health outcomes ( d = 0.14, 95% CI [0.082–0.206], p < .001). Further analysis found a larger effect in patients identified as less respondent to therapy, the “not-on-track” group ( d = 0.29, 95% CI [0.114, 0.464], p = .003). Moderation analyses indicated that the type of outcome measurement and type of feedback system used, and whether it was used for a child and youth or adult population, influenced effect sizes. MFSs seem to have a small positive effect on treatment outcomes. The effects seem to be larger for “not-on-track” patients, the group of patients that would usually not benefit much from treatment.