Universal Prevention for Anxiety and Depressive Symptoms in Children: A Meta-analysis of Randomized and Cluster-Randomized Trials

Abstract

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.

School‐based prevention of anxiety using the “My FRIENDS” emotional resilience program: Six‐month follow‐up

“…The effect sizes we obtained (e.g., .12 for component worries and .09 for internalising difficulties ) are comparable to those reported for other similar interventions in a recent meta‐analysis of universal preventive interventions (e.g., Cohen's d of .13 in Ahlen, Lenhard, & Ghaderi, ) and the effects persisted at the 6‐month follow‐up (e.g., Cohen's d of .11 in Ahlen et al, ). Effect sizes should be interpreted in the light of prevention science, for example, in educational research, an effect size of .20 is regarded as sufficient to warrant a change in policy (Hedges & Hedberg, ).…”

“…Greenberg, Domitrovich, and Bumbarger () noted that as well as reducing anxiety, there is a strong probability that cognitive behavioural programs also have a beneficial impact on related difficulties (e.g., externalisation difficulties), and we would also like to test this probability. In a study similar to ours, Ahlen et al () found that the effects of an intervention were not moderated by any of the following preselected variables: the primary target of the intervention (anxiety or depression), the deliverer of the intervention, sex distribution of the group, age of participants or length of the intervention. In future research, we hope to include analyses of potential moderator variables (e.g., personality traits, group size) and to compare the online delivery of the program with conventional, group‐based face‐to‐face delivery.…”

Preventing Adolescent Social Anxiety and Depression and Reducing Peer Victimization: Intervention Development and Open Trial

“…To date, the bulk of prevention research has universally targeted a broad array of anxiety symptoms in children and early adolescents (e.g., the FRIENDS Program; Barrett, Farrell, Ollendick, & Dadds, 2006; Essau, Conradt, Sasagawa, & Ollendick, 2012), with meta-analytic findings supporting only modest improvements in anxiety-specific symptoms following universal prevention at post-test and follow-up (Ahlen, Lenhard, & Ghaderi, 2015). In contrast, social anxiety-specific research has focused almost exclusively on treating clinical levels of SAD using behavioral and cognitive-behavioral treatment models (e.g., Beidel, Turner, & Morris, 2000; Masia Warner et al, 2005), including treatment studies conducted within school settings (Masia Warner, Colognori, Brice, & Sanchez, 2015).…”

Long-term Results from the Empowering a Multimodal Pathway Toward Healthy Youth Program, a Multimodal School-Based Approach, Show Marked Reductions in Suicidality, Depression, and Anxiety in 6,227 Students in Grades 6–12 (Aged 11–18)

“…Nonetheless, the research evidence to date has not clarified if it is more effective to target entire populations (so-called “universal” interventions) (14–17), or whether it is more effective to identify and then intervene in a smaller “high-risk” group (18–21). Overall, research findings and reviews have been supportive of a variety of both high-risk and universal interventions potentially reducing suicide rates in those aged 11–18, without definitively determining if one approach has better outcomes (22–27).…”