Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention

Abstract

Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5-18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37-0.60], selective (RR 0.61, 95% CI 0.43-0.85) or indicated (RR 0.48, 95% CI 0.29-0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.).

Depression and Anxiety Prevention Based on Cognitive Behavioral Therapy for At-Risk Adolescents: A Meta-Analytic Review

“…Further, depression is known for its recurrent course and its fluctuations in level of depression symptoms (Judd et al, 1998; Kennedy and Paykel, 2004; Van Rijsbergen, 2014). This implies that in some adolescents depression symptoms might recur after some time, despite the preventive intervention they received, which is also advocated in different meta-analyses (Stockings et al, 2016). Especially when there is no change in the risk factors, the risk for depression remains high.…”

Our future: a Lancet commission on adolescent health and wellbeing

“…The dominant approach has been to take effective clinical treatments, such as cognitive-behavioural therapies (CBT), and apply these to the general population of adolescents or to at-risk subgroups to test if they prevent disorders developing. A systematic review and meta-analysis of RCTs 287 of prevention interventions for depression or anxiety in children and adolescents had mixed findings on the effectiveness of this strategy. The investigators concluded that these interventions produced minimal to moderate reduction in symptoms in the shortterm but no effect beyond 12 months of follow-up.…”

“…Although digital and social media have been implicated as risk factors, online and mobile-phone interventions could play a positive part in prevention and promotion of access to clinical services. 287 …”

What’s wrong with John? a randomised controlled trial of Mental Health First Aid (MHFA) training with nursing students

“…It is acknowledged that young people are less likely to seek help for mental health problems if they have negative attitudes towards seeking help, if they feel they should be able to resolve the issue themselves and if they are experiencing suicidal ideation [18]. Accessing help for mental health problems is recognised as a protective factor [18] with indicated and early intervention programs likely to be most beneficial to adolescents and young adults [18, 19]. …”