School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis
Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the...
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| Vydané v: | The Lancet. Psychiatry Ročník 6; číslo 12; s. 1011 |
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| Hlavní autori: | , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
01.12.2019
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| ISSN: | 2215-0374, 2215-0374 |
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| Abstract | Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.
We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.
1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.
Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.
UK National Institute for Health Research. |
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| AbstractList | Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.
We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.
1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.
Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.
UK National Institute for Health Research. Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.BACKGROUNDRates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.METHODSWe did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.FINDINGS1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.INTERPRETATIONConsidering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.UK National Institute for Health Research.FUNDINGUK National Institute for Health Research. |
| Author | French, Clare López-López, José A Gunnell, David Welton, Nicky J Caro, Paola Hetrick, Sarah E Stockings, Emily Thomas, James Campbell, Rona Davies, Sarah R Kidger, Judi Caldwell, Deborah M Palmer, Jennifer C |
| Author_xml | – sequence: 1 givenname: Deborah M surname: Caldwell fullname: Caldwell, Deborah M email: d.m.caldwell@bristol.ac.uk organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: d.m.caldwell@bristol.ac.uk – sequence: 2 givenname: Sarah R surname: Davies fullname: Davies, Sarah R organization: School for Policy Studies, University of Bristol, Bristol, UK – sequence: 3 givenname: Sarah E surname: Hetrick fullname: Hetrick, Sarah E organization: Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand – sequence: 4 givenname: Jennifer C surname: Palmer fullname: Palmer, Jennifer C organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK – sequence: 5 givenname: Paola surname: Caro fullname: Caro, Paola organization: School for Policy Studies, University of Bristol, Bristol, UK – sequence: 6 givenname: José A surname: López-López fullname: López-López, José A organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Spain – sequence: 7 givenname: David surname: Gunnell fullname: Gunnell, David organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust, Bristol, UK – sequence: 8 givenname: Judi surname: Kidger fullname: Kidger, Judi organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK – sequence: 9 givenname: James surname: Thomas fullname: Thomas, James organization: EPPI-Centre, University College, London, UK – sequence: 10 givenname: Clare surname: French fullname: French, Clare organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK – sequence: 11 givenname: Emily surname: Stockings fullname: Stockings, Emily organization: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia – sequence: 12 givenname: Rona surname: Campbell fullname: Campbell, Rona organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK – sequence: 13 givenname: Nicky J surname: Welton fullname: Welton, Nicky J organization: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31734106$$D View this record in MEDLINE/PubMed |
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| References | 32828170 - Lancet Psychiatry. 2020 Sep;7(9):e59. doi: 10.1016/S2215-0366(20)30352-7. 31734107 - Lancet Psychiatry. 2019 Dec;6(12):969-971. doi: 10.1016/S2215-0366(19)30440-7. |
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| Snippet | Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in... |
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| SubjectTerms | Adolescent Anxiety - prevention & control Anxiety - therapy Child Child, Preschool Cognitive Behavioral Therapy Depression - prevention & control Depression - therapy Humans School Health Services Suicidal Ideation |
| Title | School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis |
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