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Universal Prevention for Anxiety and Depressive Symptoms in Children: A Meta-analysis of Randomized and Cluster-Randomized Trials
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden.
Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden.
2015 (English)In: Journal of Primary Prevention, ISSN 0278-095X, E-ISSN 1573-6547, Vol. 36, no 6, 387-403 p.Article, review/survey (Refereed) Published
Abstract [en]

Although under-diagnosed, anxiety and depression are among the most prevalent psychiatric disorders in children and adolescents, leading to severe impairment, increased risk of future psychiatric problems, and a high economic burden to society. Universal prevention may be a potent way to address these widespread problems. There are several benefits to universal relative to targeted interventions because there is limited knowledge as to how to screen for anxiety and depression in the general population. Earlier meta-analyses of the prevention of depression and anxiety symptoms among children suffer from methodological inadequacies such as combining universal, selective, and indicated interventions in the same analyses, and comparing cluster-randomized trials with randomized trials without any correction for clustering effects. The present meta-analysis attempted to determine the effectiveness of universal interventions to prevent anxiety and depressive symptoms after correcting for clustering effects. A systematic search of randomized studies in PsychINFO, Cochrane Library, and Google Scholar resulted in 30 eligible studies meeting inclusion criteria, namely peer-reviewed, randomized or cluster-randomized trials of universal interventions for anxiety and depressive symptoms in school-aged children. Sixty-three percent of the studies reported outcome data regarding anxiety and 87 % reported outcome data regarding depression. Seventy percent of the studies used randomization at the cluster level. There were small but significant effects regarding anxiety (.13) and depressive (.11) symptoms as measured at immediate posttest. At follow-up, which ranged from 3 to 48 months, effects were significantly larger than zero regarding depressive (.07) but not anxiety (.11) symptoms. There was no significant moderation effect of the following pre-selected variables: the primary aim of the intervention (anxiety or depression), deliverer of the intervention, gender distribution, children's age, and length of the intervention. Despite small effects, we argue for the possible clinical and practical significance of these programs. Future evaluations should carefully investigate the moderators and mediators of program effects to identify active program components.

Place, publisher, year, edition, pages
2015. Vol. 36, no 6, 387-403 p.
Keyword [en]
Meta-analysis; Universal prevention; Anxiety; Depression; Children
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-271258DOI: 10.1007/s10935-015-0405-4ISI: 000365220900002OAI: oai:DiVA.org:uu-271258DiVA: diva2:891498
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2017-12-01Bibliographically approved
In thesis
1. Universal prevention of anxiety and depression in school children
Open this publication in new window or tab >>Universal prevention of anxiety and depression in school children
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anxiety and depression are common in children and adolescents, and involve individual suffering, risk of future psychiatric problems, and high costs to society. However, only a limited number of children experiencing debilitating anxiety and depression are identified and receive professional help. One approach that could possibly reduce the prevalence of these conditions is universal school-based prevention aimed at reducing the impact of risk factors and strengthening protective factors involved in the development of anxiety and depression. The current thesis aimed to contribute to the literature on universal prevention of anxiety and depression in children. Study I involved a meta-analysis of earlier randomized, and cluster-randomized trials of universal prevention of anxiety and depression. Overall, the meta-analysis showed small but significant effects of universal preventive interventions, meaning that lower levels of anxiety and depression were evident after intervention completion and partially evident at follow-up assessments. No variables were found to significantly enhance the effects, however, there was a tendency for larger effects to be associated with mental health professionals delivering the interventions. In Study II, a widely adopted prevention program called Friends for Life was evaluated in a large school-based cluster-randomized effectiveness trial. The results showed no evidence of an intervention effect for the whole sample. However, children with elevated depressive symptoms at baseline and children with teachers who highly participated in supervision, seemed to benefit from the intervention in the short term. Study III involved a 3-year follow-up of Study II and an examination of the effects of sample attrition. The results showed no long-term effects for the whole sample and no maintenance of the short-term subgroup effects observed in Study II. Finally, to increase our understanding of the development of anxiety in children and to assist future improvements of universal prevention, Study IV evaluated different trajectories of overall anxiety together with related patterns of disorder-specific symptoms in a school-based sample over 39 months. Evidence favored a model of three different developmental trajectories across age. One trajectory was characterized by increasing levels of overall anxiety, but fluctuating disorder-specific symptoms arguably related to the normal challenges of children’s developmental level, which warrants an increased focus on age-relevant challenges in universal prevention. The four studies provide further understanding of the overall effectiveness of universal prevention of anxiety and depression in children, the short- and long-term effects of universal prevention in a Swedish context, and ideas for further development of preventive interventions.    

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 148
Keyword
universal prevention; anxiety; depression; school children; cluster-randomization; long-term effects; developmental trajectories
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-333033 (URN)978-91-513-0153-2 (ISBN)
Public defence
2018-01-19, Betty Pettersson-salen (14:031), Blåsenhus, von Kraemers allé 1, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2017-12-15 Created: 2017-11-17 Last updated: 2017-12-15

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