Comparative Effectiveness of Mental Health Simulation Techniques in Nursing Education: A Systematic Review and Meta-Analysis

Simulation-based training in mental health is increasingly recognised as an effective tool within nursing education. This systematic review and meta-analysis aimed to evaluate the effectiveness of various simulation modalities, including standardised participants (SPs), role-plays, virtual reality (VR), mannequins and voice simulations, in improving educational outcomes for nursing students. A comprehensive literature search was conducted to identify studies evaluating the impact of mental health simulation on nursing education. Data from 62 studies were extracted and analysed. The primary outcomes included knowledge, confidence, self-efficacy, competence and anxiety. Meta-analyses assessed both pretest/posttest changes and comparisons between simulation and control groups. Pretest/posttest analyses revealed significant improvements across multiple modalities: SPs enhanced knowledge (SMD = 1.26), confidence (SMD = 1.20), self-efficacy (SMD = 0.94), attitude (SMD = 0.22), competence (SMD = 2.30) and anxiety reduction (SMD = -0.88). Role-plays demonstrated gains in knowledge (SMD = 0.87), confidence (SMD = 1.24), self-efficacy (SMD = 0.74), attitude (SMD = 0.53), competence (SMD = 0.82) and reduced anxiety (SMD = -0.73). VR improved knowledge (SMD = 0.86), self-efficacy (SMD = 0.75) and competence (SMD = 0.69). Mannequins showed no significant changes in knowledge or competence. Voice simulations improved knowledge (SMD = 0.96). Comparisons with control groups indicated that SPs significantly increased knowledge (SMD = 1.31), competence (SMD = 1.51) and reduced anxiety (SMD = -2.01). Role-plays enhanced knowledge (SMD = 1.03) compared with inactive controls; VR increased knowledge (SMD = 0.86) compared with controls. Mannequins showed no significant differences, and voice simulations lacked sufficient data for comprehensive analysis. This meta-analysis underscores the value of simulation-based training in mental health nursing education, with SPs proving particularly effective in enhancing clinical preparedness. Role-plays, VR and voice simulations offer supplementary benefits but may require integration with more interactive methods for optimal impact. Future research should prioritise high-quality randomised controlled trials, standardised simulation protocols and long-term follow-up to clarify the sustained effects of simulation training on clinical practice.