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Rice KJ, Chen J, Kemps E, Roberts RM, Edwards S, Johnstone K. Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT. J Behav Ther Exp Psychiatry 2024; 85:101985. [PMID: 39142096 DOI: 10.1016/j.jbtep.2024.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/05/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Transdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience. METHODS This follow-up study captured data from 162 of 316 initial students (aged 8-13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator. RESULTS At 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found. LIMITATIONS Although self-report measures are common in universal, school-based research, this represents a study limitation. CONCLUSIONS Both interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research.
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Affiliation(s)
- Karlie J Rice
- Faculty of Health & Medical Sciences, University of Adelaide, Australia
| | - Junwen Chen
- Research School of Psychology, Australian National University, Australia
| | - Eva Kemps
- College of Education, Psychology & Social Work, Flinders University, Australia
| | - Rachel M Roberts
- Faculty of Health & Medical Sciences, University of Adelaide, Australia.
| | - Suzanne Edwards
- Faculty of Health & Medical Sciences, University of Adelaide, Australia
| | - Kristy Johnstone
- College of Education, Psychology & Social Work, Flinders University, Australia
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Wiehn J, Kurth T, Ravens-Sieberer U, Prugger C, Piccininni M, Reiss F. Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements. Front Pediatr 2024; 12:1252964. [PMID: 39055620 PMCID: PMC11269264 DOI: 10.3389/fped.2024.1252964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life. Design We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis. Participants The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression. Variables The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems. Statistical methods We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping. Results After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up. Conclusion Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.
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Affiliation(s)
- Jascha Wiehn
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christof Prugger
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Reiss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li J, Hesketh T. A school-based intervention programme to prevent anxiety and depression among Chinese children during the COVID-19 pandemic. Child Adolesc Psychiatry Ment Health 2024; 18:71. [PMID: 38886799 PMCID: PMC11184792 DOI: 10.1186/s13034-024-00758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Child and adolescent mental health is a major public health concern worldwide. The development of children's social and emotional skills helps to improve mental health and wellbeing, and prevent anxiety and depression. The school-based social emotional learning (SEL) programmes have proved effective in a number of countries. But in Mainland China, there has been no empirical research of the effectiveness on children's mental health. The study conducted a SEL programme in China during the COVID-19 pandemic and aimed to determine whether: (1) a SEL programme can reduce anxiety and depression, (2) the intervention effect is influenced by sociodemographic characteristics, (3) the programme effects change children's emotion management and communication. METHODS Participants were 230 children aged 8-12 years in the intervention school and 325 in the control school in two poor villages in central China. The study was a quasi-experimental trial, comprising 16 weekly 90-minute sessions. It used a mixed-methods design, with a quantitative survey administered at baseline, post-intervention, and 5-month follow-up, and qualitative interviews. Linear mixed effects regression modeling was used to analyse the intervention effectiveness, linear models were conducted to examine the moderation effect of sociodemographic variables, and the inductive thematic analysis approach was used for interview data. RESULTS The intervention had no significant effect on anxiety or depression, except that intervention school children who lived with neither parent (left behind children) reported lower depression scores than control school at post-intervention and 5-month follow-up. Qualitative interviews showed after intervention children were more able to control tempers and better communicated their thoughts and feelings, improving their relationships with family and friends. CONCLUSIONS The programme was cheap, easy to implement, and warmly welcomed by children, schools and caregivers, suggesting it was feasible and potentially sustainable. More research is needed on the adaptation of the SEL programme in the Chinese context.
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Affiliation(s)
- Jiameng Li
- Centre for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Therese Hesketh
- Centre for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province, People's Republic of China.
- The Institute for Global Health, UCL, 30 Guilford St, WC1NEH, London, UK.
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Vivas-Fernandez M, Garcia-Lopez LJ, Piqueras JA, Espinosa-Fernandez L, Muela-Martinez JA, Jimenez-Vazquez D, Diaz-Castela MDM, Ehrenreich-May J. A 12-Month Follow-Up of PROCARE+, a Transdiagnostic, Selective, Preventive Intervention for Adolescents At-Risk for Emotional Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01638-2. [PMID: 38127203 DOI: 10.1007/s10578-023-01638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Few studies have reported long-term follow-up data on selective preventive interventions for adolescents. No follow-up selective preventive transdiagnostic studies for adolescents at-risk for emotional disorders, such as anxiety and depression, have been reported. To fill this gap, this study aims to provide the first follow-up assessment of a randomized controlled trial (RCT) studying selective transdiagnostic prevention in at-risk adolescents. A 12-month follow-up assessment was conducted with subjects who originally received either PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), PROCARE+, which includes the PROCARE protocol along with personalized add-on modules or an active control condition (ACC) based on emotional psychoeducation, and their respective booster session for each experimental condition. 80 subjects (47.5% girls) aged between 12 and 18 years (M = 14.62; SD 1.43) who completed these treatment conditions were available for the 12-month follow-up. The results demonstrate the superior long-term efficacy of the PROCARE+ intervention in mitigating emotional symptoms and obsessive-compulsive symptomatology compared to the PROCARE and ACC conditions, with effect sizes notably exceeding those commonly observed in preventive programs. While the three treatments demonstrated beneficial impacts, the pronounced results associated with PROCARE+ at the 12-month follow-up emphasized the importance of personalized treatment modules and the sustained benefits of booster sessions in the realm of preventive psychological interventions. The findings also highlight the potential role of add-on modules in enhancing the effects of the PROCARE+ condition.
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Affiliation(s)
- Manuel Vivas-Fernandez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain
| | - Luis-Joaquin Garcia-Lopez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain.
| | - Jose A Piqueras
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Lourdes Espinosa-Fernandez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain
| | - Jose-Antonio Muela-Martinez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain
| | - David Jimenez-Vazquez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain
| | - Maria Del Mar Diaz-Castela
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5, Jaen, Spain
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Filges T, Smedslund G, Eriksen T, Birkefoss K. PROTOCOL: The FRIENDS preventive programme for reducing anxiety symptoms in children and adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1374. [PMID: 38107252 PMCID: PMC10723782 DOI: 10.1002/cl2.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows. The main objective of this review is to answer the following research question: What are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Further, the review will attempt to answer if the effects differ between participant age groups, participant socio-economic status, type of prevention (universal, selective or indicated), type of provider (lay or mental health provider), country of implementation (Australia or other countries) and implementation issues in relation to the booster sessions and parent sessions (implemented, partly implemented or not at all).
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Affiliation(s)
- Trine Filges
- VIVE – The Danish Center for Social Science ResearchCopenhagenDenmark
| | | | - Tine Eriksen
- VIVE – The Danish Center for Social Science ResearchAarhusDenmark
| | - Kirsten Birkefoss
- VIVE – The Danish Center for Social Science ResearchCopenhagenDenmark
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Harvey LJ, White FA, Hunt C, Abbott M. Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes. Behav Res Ther 2023; 169:104408. [PMID: 37804543 DOI: 10.1016/j.brat.2023.104408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
There is increasing research interest as to whether Dialectical Behaviour Therapy (DBT), specifically the group skills training component, is an effective early intervention approach when delivered universally in schools. The current study aimed to provide the first large-scale examination of a universal DBT-based intervention and to also determine the extent to which home practice of DBT skills predicted changes in social and emotional outcomes over time. A non-randomised controlled trial design was employed whereby 1071 participants (51.30% Male; M age = 13.48 years) completed either an adapted eight-session DBT skills-training intervention ('WISE Teens) (n = 563) or class-as-per-usual (n = 508). On average, the 'WISE Teens' intervention did not improve outcomes with significant deteriorations or null effects observed across outcomes relative to class-as-per-usual immediately post-intervention. The largest deteriorations were observed for depressive (d = -0.22; 95% CI = -0.35, -0.08) and anxiety symptoms (d = -0.28; 95%CI - = -0.41, -0.14). Applying Bonferroni corrections, most group differences in outcomes had dissipated at follow-up, however, 'WISE Teens' participants continued to report significantly poorer quality of parent-child relationships relative to control (d = .16 for mother (95% CI = 0.01, 0.31); d = 0.17 for father (95% CI = 0.02, 0.33). While home practice was modest on average, further exploratory analyses nevertheless revealed that greater home practice was generally associated with more positive outcomes both immediately post-intervention and at follow-up. Based on these findings, the DBT-based 'WISE Teens' intervention is not recommended in its current format for universal dissemination amongst early adolescents in schools. Further research is needed to determine how to improve engagement and feasibility of delivery of DBT-based interventions universally in this context.
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Affiliation(s)
- Lauren J Harvey
- School of Psychology, University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Fiona A White
- School of Psychology, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Maree Abbott
- School of Psychology, University of Sydney, Camperdown, NSW, 2050, Australia
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Li J, Jiang X, Huang Z, Shao T. Exercise intervention and improvement of negative emotions in children: a meta-analysis. BMC Pediatr 2023; 23:411. [PMID: 37608261 PMCID: PMC10464442 DOI: 10.1186/s12887-023-04247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Anxiety, depression, and stress are the most common mental health problems in childhood. Exercise interventions in childhood help to promote mental health. OBJECTIVE To investigate the relationship between exercise interventions and improvement of negative emotions such as anxiety, depression, and stress in children (5-12 years). METHODS Articles were searched in five electronic databases from their inception to January 2023. The meta-analysis was performed using Stata 16.0. RESULTS Twenty-three intervention studies included 6830 children. 1) The exercise intervention group was significantly better than the control group in improving negative emotions (Standard Mean Difference SMD=-0.25, 95% Confidence Intervals CI: -0.34 to -0.15, P < 0.01). Exercise intervention improved different kinds of negative emotions: anxiety (SMD=-0.19, 95% CI: -0.33 to -0.06, P < 0.01), depression (SMD=-0.22, 95% CI: -0.43 to -0.01, P < 0.01), and stress (SMD=-0.33, 95% CI: -0.53 to -0.14, P < 0.01); it was most effective at relieving problematic stress. Exercise interventions lasting 20-45 min were most effective in improving children's negative emotions (SMD=-0.38, 95% CI: -0.56 to -0.20, P < 0.01). An exercise intervention period of 10 weeks was more effective in improving children's negative mood (SMD=-0.26, 95% CI: -0.34 to -0.17, P = 0.274). CONCLUSION Exercise interventions may improve negative emotions such as anxiety, depression, and stress in children. These findings may have clinical implications for children with negative affect. However, these studies showed a large heterogeneity, and the results should be interpreted with caution. Future studies should report the variability of exercise interventions by gender, age group, and type, intensity, and place of exercise.
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Affiliation(s)
- Jiayu Li
- College of Physical Education and Health Sciences, Zhejiang Normal University, 321004, Jinhua, Zhejiang, China
| | - Xiaoping Jiang
- College of Physical Education and Health Sciences, Zhejiang Normal University, 321004, Jinhua, Zhejiang, China
| | - Zan Huang
- College of Physical Education and Health Sciences, Zhejiang Normal University, 321004, Jinhua, Zhejiang, China
| | - Tianyi Shao
- College of Physical Education and Health Sciences, Zhejiang Normal University, 321004, Jinhua, Zhejiang, China.
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Arthur A, McDevitt M, Rooney RM, MacLeod A, Kane RT, Tonta K, McMillan K, Peckover J, Baughman N. Short-term effects of the "I Spy Feelings" program on emotion regulation in 5- to 6-year-old children. Front Psychol 2023; 14:1016521. [PMID: 37599750 PMCID: PMC10434767 DOI: 10.3389/fpsyg.2023.1016521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 05/02/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Mental health difficulties in early childhood can have a debilitating and ongoing impact throughout an individual's life; emotion regulation can serve as a protective factor. Therefore, evidence-based prevention programs that teach children effective skills and strategies for emotion regulation are needed. Methods As part of the Aussie Optimism pilot study evaluating the "I Spy Feelings" program, this study aims to assess the short-term effects of the program on emotion regulation in pre-primary aged children after 2 months via a longitudinal cluster randomized controlled trial. Participants included parents (N = 73) of 5- to 6-year-old children attending four different Catholic primary schools. Children from two of the schools were allocated to the intervention group where they participated in the program (N = 33), while children from the other two schools were allocated to the control group where they did not (N = 40). At each time point, all parents completed abridged Children's Emotional Management Scales measuring how well parents believe their child is able to cope with anger, sadness and worry. Results A significant intervention effect 2 months after intervention was found for the outcome of anger coping such that parents whose children were in the intervention group reported significantly greater improvement in their children's ability to cope with anger compared to parents whose children were in the control group. No significant effect was found for the outcome of sadness, and results for the worry subscale were inconclusive due to unacceptable internal consistency. Discussion The present study provides insight into the benefit of programs designed to enhance the emotion regulation skills of very young children. Further follow-up is needed to assess whether the "I Spy Feelings" program has lasting effects.
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Affiliation(s)
- Annaliese Arthur
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Maryanne McDevitt
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Rosanna M. Rooney
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Amber MacLeod
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Robert T. Kane
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Kate Tonta
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
- Curtin enAble Institute, Curtin University, Bentley, WA, Australia
| | - Kaitlin McMillan
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Jacob Peckover
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Natalie Baughman
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
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García-Rubio C, Herrero M, Luna-Jarillo T, Albert J, Rodríguez-Carvajal R. Effectiveness and mechanisms of change of a mindfulness-based intervention on elementary school children: A cluster-randomized control trial. J Sch Psychol 2023; 99:101211. [PMID: 37507179 DOI: 10.1016/j.jsp.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/03/2022] [Accepted: 04/10/2023] [Indexed: 07/30/2023]
Abstract
Mindfulness-based interventions (MBIs) in the school context are increasingly widespread worldwide. The present study evaluates the effectiveness of a school-MBI (GrowingUp Breathing program) on children's socio-emotional and academic development. Three hundred thirteen elementary students from 7 to 12 years old from two schools in Madrid (Spain) participated. A cluster-randomized control trial was designed, assigning eight classrooms to the MBI-group (N = 155) and eight classrooms to the waiting-list control group (N = 158). Measures were evaluated at pre- and post-intervention in both groups and a 3-month follow-up was collected in the MBI-group. Children self-reported their mindfulness skills (i.e., dispositional mindfulness and psychological inflexibility) and well-being (i.e., anxiety and life satisfaction) and teachers evaluated children's social-emotional competence (i.e., emotion regulation, peer-relationship problems, and prosociality), well-being (i.e., emotional symptoms), and academic competence (i.e., student engagement and academic achievement). Mindfulness skills and emotional regulation were examined as potential mediators. Results revealed that children who received the MBI, compared to children in the WLC-group, improved their mindfulness skills, emotion regulation, prosociality, and emotional and behavioral engagement and decreased anxiety and peer-relationship problems. Positive changes in dispositional mindfulness led to reductions in children's anxiety and psychological inflexibility. Positive changes in emotional regulation led to improvements in prosociality and student engagement and decreased peer-relationships problems and emotional symptoms. Therefore, the results showed that a brief-MBI integrated in the Spanish regular school curriculum enhanced children's socio-emotional and academic development. Dispositional mindfulness and emotion regulation work as processes of change that underlie the intervention's impact.
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Affiliation(s)
- Carlos García-Rubio
- Faculty of Psychology, Universidad Autónoma de Madrid, Calle Iván Pavlov, 6, 28049, Madrid, Spain; Nirakara Lab, Mindfulness and Cognitive Science Chair, Complutense University of Madrid, Madrid, Spain.
| | - Marta Herrero
- Department of Social and Developmental Psychology, University of Deusto, Unibertsitate Etorb, 24, Bilbao 48007, Spain
| | | | - Jacobo Albert
- Faculty of Psychology, Universidad Autónoma de Madrid, Calle Iván Pavlov, 6, 28049, Madrid, Spain
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Valente J, Pietrobom T, Mihic J, Caetano S, Mari J, Sanchez ZM. Externalizing and internalizing problems as predictors of alcohol-related harm and binge drinking in early adolescence: The role of gender. J Affect Disord 2023; 327:167-174. [PMID: 36623566 DOI: 10.1016/j.jad.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting adolescent alcohol-related harm and binge drinking, taking into account the gender differences. We also evaluated if externalizing problems could moderate the association between internalizing problems and alcohol outcomes. METHOD We used longitudinal data from 2368 8th grade students across 37 public schools in three Brazilian cities. Linear and logistic regressions were performed to analyze the association between alcohol outcomes and the independent variables (externalization and internalization scores, and sociodemographic variables) according to gender. We also tested the same model with an interaction term between externalizing*internalizing. RESULTS Our results suggest that externalizing problems predict adolescents' binge drinking in both genders; it also may predict adolescents' alcohol-related harms, but only in boys. Internalizing problems seem to be a gender-specific risk factor for binge drinking among girls. All findings are independent of comorbid problems and sociodemographic variables. LIMITATION The findings should be considered taking into account the short follow-up period from risk factors to the outcomes. CONCLUSION Our results highlight the contribution of internalizing and externalizing problems to the development of alcohol-related harm and binge drinking in early adolescence and the need for interventions to prevent early behavioral problems that consider the role played by gender.
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Affiliation(s)
- Juliana Valente
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Tania Pietrobom
- Department of Preventive Medicine, Section of Epidemiology and Biostatistics, Universidade Federal de São Paulo, Brazil
| | - Josipa Mihic
- Department of Behavioural Disorders, University of Zagreb, Croatia
| | - Sheila Caetano
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Jair Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Section of Epidemiology and Biostatistics, Universidade Federal de São Paulo, Brazil.
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11
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School-based Mental Health Interventions Targeting Depression or Anxiety: A Meta-analysis of Rigorous Randomized Controlled Trials for School-aged Children and Adolescents. J Youth Adolesc 2023; 52:195-217. [PMID: 36229755 PMCID: PMC9560730 DOI: 10.1007/s10964-022-01684-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023]
Abstract
Past meta-analyses in mental health interventions failed to use stringent inclusion criteria and diverse moderators, therefore, there is a need to employ more rigorous methods to provide evidence-based and updated results on this topic. This study presents an updated meta-analysis of interventions targeting anxiety or depression using more stringent inclusion criteria (e.g., baseline equivalence, no significant differential attrition) and additional moderators (e.g., sample size and program duration) than previous reviews. This meta-analysis includes 29 studies of 32 programs and 22,420 students (52% female, 79% White). Among these studies, 22 include anxiety outcomes and 24 include depression outcomes. Overall, school-based mental health interventions in grades K-12 are effective at reducing depression and anxiety (ES = 0.24, p = 0.002). Moderator analysis shows that improved outcomes for studies with anxiety outcomes, cognitive behavioral therapy, interventions delivered by clinicians, and secondary school populations. Selection modeling reveals significant publication and outcome selection bias. This meta-analysis suggests school-based mental health programs should strive to adopt cognitive behavioral therapy and deliver through clinicians at the secondary school level where possible.
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12
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Osenk I, Johnson C, Wade TD. A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents. SCHOOL MENTAL HEALTH 2023; 15:151-164. [PMID: 36092281 PMCID: PMC9446653 DOI: 10.1007/s12310-022-09540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021). Supplementary Information The online version contains supplementary material available at 10.1007/s12310-022-09540-3.
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Affiliation(s)
- Ivana Osenk
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia Australia
| | - Catherine Johnson
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia Australia
| | - Tracey D Wade
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia Australia
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13
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Badawi E, Coursaris CK, Sénécal S, Léger PM. Facilitating engagement of universal school-based digital mental health solutions through user experience: A qualitative exploration. Front Digit Health 2023; 5:1040739. [PMID: 37035481 PMCID: PMC10075357 DOI: 10.3389/fdgth.2023.1040739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Digital mental health intervention (DMHI) programs offered in schools present a readily-accessible and flexible means for educating, empowering, and supporting adolescents in maintaining a balanced mental health, especially during uncertain and stressful times such as the COVID-19 pandemic. Recent studies indicate that the effectiveness of DMHI programs in improving students' mental well-being and in preventing from their mental health complications depends on the users' engagement. This study focuses on identifying the user experience factors that can facilitate user engagement with universal school-based DMHI programs (i.e., the DMHI programs delivered to the students regardless of their mental health risks or conditions). To identify said factors, we sought to gain a deeper understanding of perceptions, opinions, and preferences of actual end-users (i.e., the adolescents) regarding their experiences with both digital and non-digital mental health resources. Specifically, interviews were conducted with two participant groups to uncover the reasons that could lead the adolescents to better engage with school-based DMHI programs, as well as the shortcomings that could prevent that from happening: (a) adolescent users who had either a high or a low level of engagement with universal DMHI programs of a specific school-based digital mental health solution; and (b) adolescents who had voluntarily used non-digital or non-school-based digital mental health resources for purposes other than treatment. Through a thematic analysis of interview data, the most important (or primary) and the additionally desirable (or secondary) factors that could lead to a higher engagement level for school-based DMHI programs were identified. Lastly, using the evidence gathered from our interviews, specific recommendations are proposed that could help in targeting each identified engagement factor and in increasing the likelihood that school-based DMHI programs achieve their desired outcome for high school students.
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Affiliation(s)
- Erfan Badawi
- Department of Information Technologies, HEC Montréal, Montréal, QC, Canada
- Correspondence: Erfan Badawi
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14
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Developing a Brief Parent Training Intervention to Prevent Anxiety in Offspring. Scand J Child Adolesc Psychiatr Psychol 2022; 10:123-133. [PMID: 36514489 PMCID: PMC9716892 DOI: 10.2478/sjcapp-2022-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Offspring of parents with anxiety disorders have an increased risk of developing anxiety themselves. Very few studies have evaluated interventions aiming to prevent anxiety in offspring of anxious parents. This study was a small (N=40) randomized pilot study with three arms evaluating the feasibility of a novel parent support group for anxious parents, the Supporting Anxious Parents Program (SAPP). The primary objective was to evaluate the acceptability of the SAPP. In addition, we also evaluated preliminary effects on child anxiety, parent risk factors, and quality of life, and feasibility of the study design. Excessive parental worry and anxiety and having a child not meeting criteria for an anxiety disorder (6-12 years old), served as inclusion criteria. Thirteen parents were randomly allocated to a group-based intervention, 14 to an individual Internet-based version of the intervention, and 13 to a waitlist control condition. The intervention was developed to target three risk factors involved in the parent-child transmission of anxiety; criticism/low warmth, overprotective behaviors, and modeling of anxiety. The results showed that parents were generally very satisfied with the intervention. We did not find any significant decreases in child anxiety in the intervention conditions. However, for the parents, we found preliminary support for reduced overprotective behaviors, reduced worry, and increased quality of life. The study design was found to be feasible. According to the results, a revision of the intervention is recommended before a full randomized controlled trial could be conducted.
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15
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Morgado TMM, Loureiro LMDJ, Rebelo Botelho MA. Acceptability and Feasibility of the ProLiSMental Psychoeducational Intervention to Promote Adolescents' Mental Health Literacy on Anxiety in a School Context. Issues Ment Health Nurs 2022; 43:532-542. [PMID: 34913800 DOI: 10.1080/01612840.2021.1999541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The ProLiSMental psychoeducational intervention intends to promote adolescents' mental health literacy on anxiety, facilitating their access, understanding, evaluation, and use of effective mental health information. This study aimed to assess the acceptability and feasibility of that intervention in a school context and improve its content, structure, and procedure. A convenience sample of seventeen participants has been recruited: eleven students (mean age = 14.09 years, SD = 0,30) and six education and health professionals (mean age = 53.00 years, SD = 4,05). High levels of acceptability and feasibility of the ProLiSMental psychoeducational intervention were observed and important improvements were made.
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Affiliation(s)
- Tânia Manuel Moço Morgado
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Nursing, Health Sciences Research Unit, Coimbra, Portugal.,Center for Health Technology and Services Research, NursID: Innovation & Development in Nursing, Porto, Portugal
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16
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 297] [Impact Index Per Article: 148.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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17
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Grazzani I, Agliati A, Cavioni V, Conte E, Gandellini S, Lupica Spagnolo M, Ornaghi V, Rossi FM, Cefai C, Bartolo P, Camilleri L, Oriordan MR. Adolescents' Resilience During COVID-19 Pandemic and Its Mediating Role in the Association Between SEL Skills and Mental Health. Front Psychol 2022; 13:801761. [PMID: 35197901 PMCID: PMC8860228 DOI: 10.3389/fpsyg.2022.801761] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
The main purpose of this paper is to investigate the role of social and emotional learning (SEL) skills and resilience in explaining mental health in male and female adolescents, during the COVID-19 pandemic. Three self-report questionnaires were administered to 778 participants aged between 11 and 16 years (mean age = 12.73 years; SD = 1.73) and recruited from 18 schools in Northern Italy. The SSIS-SELb-S and the CD-RISC 10 assessed SEL and resilience skills respectively, while the Strengths and Difficulties Questionnaire (SDQ) was used to measure mental health in terms of internalizing problems, externalizing problems, and prosocial behavior. We found that SEL and resilience skills were positively and significantly associated with each other, negatively associated with internalizing and externalizing problems, and positively related to prosocial behavior. Three linear regression analyses showed the significant role of resilience, age, and gender in explaining the variance of internalizing problems; the significant role of SEL skills, resilience, age, and gender in explaining the variance of externalizing problems; and the role of SEL skills, age, and gender in explaining prosocial behavior. Importantly, we found that resilience fully mediated the relationship between SEL skills and internalizing problems, partially mediated the relationship between SEL skills and externalizing problems and didn't mediate the relationship between SEL skills and prosocial behavior. The paper concludes with a discussion of the limitations of the study as well as its practical implications.
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Affiliation(s)
- Ilaria Grazzani
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Alessia Agliati
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Valeria Cavioni
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Elisabetta Conte
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Sabina Gandellini
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Mara Lupica Spagnolo
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Veronica Ornaghi
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Francesca Micol Rossi
- "R. Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
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18
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A randomised controlled trial evaluating two universal prevention programs for children: Building resilience to manage worry. J Affect Disord 2022; 297:437-446. [PMID: 34715158 DOI: 10.1016/j.jad.2021.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Childhood anxiety and depression lead to great distress and impairment. Preventing them simultaneously in early life is critically important. We evaluated the long-term efficacy of an emotion regulation-based (ER) and a behavioural activation-based (BA) program. Both aimed to build resilience to prevent worry, a transdiagnostic feature across anxiety and depression. METHODS Participants were 316 students (52.2% female; 8-13 years) from six South Australian primary schools. Schools were randomised to the ER, BA or a control condition. Measures of resilience, worry, anxiety, and depression were taken at pre- and post- program, and at 6- and 12-month follow-up. In addition, levels of emotion regulation, behavioural activation and resilience were measured as potential mediators of changes in anxiety and depression. RESULTS No significant condition × time interactions were observed. However, the percentage of children who met the clinical cut-offs for generalised anxiety disorder and major depressive disorder decreased significantly in the BA condition at 12-month follow-up, as well as the percentage of children who met the clinical cut-off for obsessive compulsive disorder in the ER condition. Furthermore, emotion regulation mediated the relationship between condition and worry at post-program in the ER condition. LIMITATIONS The sample size is relatively small. Reliance on child self-report may have resulted in inaccurate responses. CONCLUSION The ER and BA transdiagnostic prevention programs for childhood anxiety and depression showed promising results for certain anxiety disorders not otherwise observed in universal school-based studies. Future research should consider evaluating the programs with a larger sample using alternative outcome measures.
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19
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Primary prevention of depression: An umbrella review of controlled interventions. J Affect Disord 2021; 294:957-970. [PMID: 34375224 DOI: 10.1016/j.jad.2021.07.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Primary prevention has the potential to modify the course of depression, but the consistency and magnitude of this effect are currently undetermined. METHODS PRISMA and RIGHT compliant (PROSPERO:CRD42020179659) systematic meta-review, PubMed/Web of Science, up to June 2020. Meta-analyses of controlled interventions for the primary prevention of depressive symptoms [effect measures: standardized mean difference (SMD)] or depressive disorders [effect measure: relative risk (RR)] were carried out. Results were stratified by: (i) age range; (ii) target population (general and/or at-risk); (iii) intervention type. Quality (assessed with AMSTAR/AMSTAR-PLUS content) and credibility (graded as high/moderate/low) were assessed. USPSTF grading system was used for recommendations. RESULTS Forty-six meta-analyses (k=928 individual studies, n=286,429 individuals, mean age=22.4 years, 81.1% female) were included. Effect sizes were: SMD=0.08-0.53; for depressive symptoms; RR=0.90-0.28 for depressive disorders. Sensitivity analyses including only RCTs did not impact the findings. AMSTAR median=9 (IQR=8-9); AMSTAR-PLUS content median=4.25 (IQR=4-5). Credibility of the evidence was insufficient/low in 43 (93.5%) meta-analyses, moderate in two (4.3%), and high in one (2.2%): reduction of depressive symptoms using psychosocial interventions for young adults only, and a combination of psychological and educational interventions in primary care had moderate credibility; preventive administration of selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in individuals with a stroke had high credibility. LIMITATIONS Intervention heterogeneity and lack of long-term efficacy evaluation. CONCLUSIONS Primary preventive interventions for depression might be effective. Among them, clinicians may offer SSRIs post-stroke to prevent depressive disorders, and psychosocial interventions for children/adolescents/young adults with risk factors or during the prenatal/perinatal period.
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20
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Oorloff S, Rooney R, Baughman N, Kane R, McDevitt M, Bryant A. The Impact of the Aussie Optimism Program on the Emotional Coping of 5- to 6-Year-Old Children. Front Psychol 2021; 12:570518. [PMID: 34456775 PMCID: PMC8385210 DOI: 10.3389/fpsyg.2021.570518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Research indicates that mental health disorders can occur in children as young as 4 years of age, prompting the need for prevention programs for young children. The ability to use healthy strategies to cope with emotions is a protective factor against mental health disorders that can be effectively taught to children from an early age. The current study used a pre-test post-test cluster randomized controlled trial to test the efficacy of the new Aussie Optimism: I Spy Feelings Program. The aim of the study was to investigate the effects of the program on children’s emotional coping. The program included content on emotion regulation strategies, focusing on the emotions of happiness, sadness, anger, fear, and worry. The participants were 73 children (intervention = 33; control = 40) from pre-primary classes. Four schools were cluster randomized to the intervention or control group, resulting in two schools in each condition. Parents completed measures of their children’s emotional coping with sadness, anger and worry. Children in the intervention group participated in ten sessions of the I Spy Feelings Program, spread over 5 weeks. The results indicated a significant, small to moderate intervention effect for coping with anger. Children in the control group decreased in their ability to cope with anger, while children in the intervention group remained stable. No intervention effects were found for coping with sadness or worry, with results for these emotions staying stable across time for both groups. This pilot study will inform the further development of the program. The effects of the program on coping with anger provide support for the use of emotion regulation strategies in intervention programs to maintain healthy emotional coping, which is a protective factor against internalizing and externalizing disorders in childhood.
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Affiliation(s)
- Selina Oorloff
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Rosanna Rooney
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Natalie Baughman
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Robert Kane
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Maryanne McDevitt
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Aidan Bryant
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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21
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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22
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Who benefits most from an evidence-based program to reduce anxiety and depression in children? A latent profile analysis. Dev Psychopathol 2021; 34:1636-1644. [PMID: 34099077 DOI: 10.1017/s0954579421000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Comorbidity between anxiety and depression symptoms is often high in children. Person-oriented statistical approaches are useful to detect heterogeneity of individuals and diverse patterns of response to treatment. This study aimed to explore the different profiles in a sample of Spanish children who received the Super Skills for Life (SSL) transdiagnostic program, to identify which profile of individuals benefited most from the intervention and the likelihood of transition of symptom patterns over time. Participants were 119 children (42.9% were female) aged 8-12 years old (M = 9.39; SD = 1.26). Children completed anxiety and depression measures at the baseline, postintervention, and 12-months follow-up. Results from latent transition analysis (LTA) revealed two groups depending on the severity of the anxiety and depression symptoms: low symptoms (LS) and high symptoms (HS). LS group remained stable and HS decreased by 25%, switching to the LS group. Children with greater social anxiety benefited most from the program over time. Furthermore, older children were more likely to improve rapidly one year after the intervention compared to younger children. This study provides information to consider when implementing preventive interventions for schoolchildren and to tailor them according to the target population characteristics to increase their effectiveness.
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Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis. Harv Rev Psychiatry 2021; 29:196-215. [PMID: 33979106 DOI: 10.1097/hrp.0000000000000294] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). METHODS We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. RESULTS 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. CONCLUSION Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
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Hugh-Jones S, Beckett S, Tumelty E, Mallikarjun P. Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs. Eur Child Adolesc Psychiatry 2021; 30:849-860. [PMID: 32535656 PMCID: PMC8140963 DOI: 10.1007/s00787-020-01564-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
Abstract
Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based interventions exist but it is unclear how effective targeted approaches are for reducing symptoms of anxiety. This review and meta-analysis aimed to determine the effectiveness of school-based indicated interventions for symptomatic children and adolescents. The study was registered with PROSPERO [CRD42018087628]. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library for randomised-controlled trials comparing indicated programs for child and adolescent (5-18 years) anxiety to active or inactive control groups. Data were extracted from papers up to December 2019. The primary outcome was efficacy (mean change in anxiety symptom scores). Sub-group and sensitivity analyses explored intervention intensity and control type. We identified 20 studies with 2076 participants. Eighteen studies were suitable for meta-analysis. A small positive effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = - 0.28, CI = - 0.50, - 0.05, k = 18). This benefit was maintained at 6 (g = - 0.35, CI = - 0.58, - 0.13, k = 9) and 12 months (g = - 0.24, CI = - 0.48, 0.00, k = 4). Based on two studies, > 12 month effects were very small (g = - 0.01, CI = - 0.38, 0.36). No differences were found based on intervention intensity or control type. Risk of bias and variability between studies was high (I2 = 78%). Findings show that school-based indicated programs for child and adolescent anxiety can produce small beneficial effects, enduring for up to 12 months. Future studies should include long-term diagnostic assessments.
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Affiliation(s)
| | - Sophie Beckett
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
| | - Ella Tumelty
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
| | - Pavan Mallikarjun
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
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Project Chill: Program Description and Session Feedback Data From a Proof-of-Concept Study of a School-Based Psychoeducational Program Using Creative Media. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A tailored online intervention to improve parenting risk and protective factors for child anxiety and depression: Medium-term findings from a randomized controlled trial. J Affect Disord 2020; 277:814-824. [PMID: 33065822 DOI: 10.1016/j.jad.2020.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite considerable evidence on parenting risk and protective factors for child anxiety and depressive disorders, the development of interventions based on this evidence is still lagging behind. To address this gap, the web-based Parenting Resilient Kids (PaRK) program was developed to target these risk and protective factors. This study evaluated the effects of the program at 12-month follow-up. METHODS A randomized controlled trial was conducted with a community sample of 355 parents and 342 children (Mchild age = 9.79). Parents randomized into the web-based PaRK intervention condition received a personalized feedback report about their parenting and were recommended a tailored course of up to 12 interactive modules. Parents in the control condition received a standard set of web-based educational factsheets. RESULTS Parents in the intervention group demonstrated significantly greater improvement in self-reported parenting compared to control group parents from baseline to 12-month follow-up, d = 0.24, 95% CI [0.03, 0.45]. Both groups showed reductions in child anxiety and depressive symptoms, parental psychological control and unhealthy family functioning; and improvements in parental acceptance, child- and parent- health-related quality of life. LIMITATIONS The PaRK intervention was tailored based on the parents' own report of their parenting behaviors. There was an over-representation of highly-educated mothers and only one parent-child dyad was included per family. CONCLUSIONS PaRK improved parenting for up to 12 months, but had no superior effect on children's mental health outcomes compared with an educational-factsheet intervention. Further follow-up is needed to assess longer-term effects.
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Long-term outcomes of psychological interventions on children and young people's mental health: A systematic review and meta-analysis. PLoS One 2020; 15:e0236525. [PMID: 33196654 PMCID: PMC7668611 DOI: 10.1371/journal.pone.0236525] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over 600 RCTs have demonstrated the effectiveness of psychosocial interventions for children and young people's mental health, but little is known about the long-term outcomes. This systematic review sought to establish whether the effects of selective and indicated interventions were sustained at 12 months. METHOD We conducted a systematic review and meta-analysis focusing on studies reporting medium term outcomes (12 months after end of intervention). FINDINGS We identified 138 trials with 12-month follow-up data, yielding 165 comparisons, 99 of which also reported outcomes at end of intervention, yielding 117 comparisons. We found evidence of effect relative to control at end of intervention (K = 115, g = 0.39; 95% CI: 0.30-0.47 I2 = 84.19%, N = 13,982) which was maintained at 12 months (K = 165, g = 0.31, CI: 0.25-0.37, I2 = 77.35%, N = 25,652) across a range of diagnostic groups. We explored the impact of potential moderators on outcome, including modality, format and intensity of intervention, selective or indicated intervention, site of delivery, professional/para-professional and fidelity of delivery. We assessed both risk of study bias and publication bias. CONCLUSIONS Psychosocial interventions provided in a range of settings by professionals and paraprofessionals can deliver lasting benefits. High levels of heterogeneity, moderate to high risk of bias for most studies and evidence of publication bias require caution in interpreting the results. Lack of studies in diagnostic groups such as ADHD and self-harm limit the conclusions that can be drawn. Programmes that increase such interventions' availability are justified by the benefits to children and young people and the decreased likelihood of disorder in adulthood.
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Clinical Utility of an Internet-Delivered Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (iUP-A): A Pilot Open Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228306. [PMID: 33182711 PMCID: PMC7697415 DOI: 10.3390/ijerph17228306] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) has been shown to be effective for reducing symptoms of anxiety and depression in adolescents with emotional disorders. Internet-delivered psychological treatments have great potential to improve access to evidence-based psychological therapy since they are associated with reduced human and economic costs and less social stigma. Recently, our group developed an online version of the UP-A (the iUP-A) for the treatment of emotional disorders in adolescents. The aim of this pilot trial was to test the clinical utility of the iUP-A in a small sample (n = 12) of adolescents with elevated anxiety and/or depressive symptoms. Intention-to-treat and completer analyses revealed pre- to post-intervention self-reported decreases of anxiety and depressive symptoms, anxiety sensitivity, emotional avoidance, panic disorder symptoms, panic disorder severity, generalized anxiety disorder symptoms, pathological worry, and major depressive disorder symptoms. We found high feasibility and acceptability of the program with all participants and responsible parents reporting an improvement in the adolescents’ ability to cope with emotions. Results suggest that the iUP-A may provide a new approach to improve access to treatment for anxious and depressive adolescents in Spain; however, further research must be conducted before firm conclusions can be drawn.
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Šouláková B, Kasal A, Butzer B, Winkler P. Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness. J Prim Prev 2020; 40:255-278. [PMID: 31140100 DOI: 10.1007/s10935-019-00552-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This meta-review summarizes existing evidence from systematic reviews and meta-analyses on the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness. Systematic reviews and meta-analyses were identified via the electronic databases PsycINFO, Web of Knowledge, Medline, Embase, and HMIC (Health Management Information Consortium). Ten systematic reviews and meta-analysis were eligible for inclusion in the final analyses. These systematic reviews and meta-analyses evaluated the effects of five types of school-based psychological interventions: Mindfulness, Social Emotional Learning, Cognitive Behavioral Therapy, Yoga, and Body-Image. Overall effectiveness reported in the included studies was significant for the most part, and ranging from small to large with respect to the effect size. The authors of all of the studies emphasized the need for additional high-quality trials to further examine the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness.
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Affiliation(s)
- Barbora Šouláková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
| | - Alexandr Kasal
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Social Sciences, Charles University in Prague, Prague, Czech Republic
| | - Bethany Butzer
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,School of Psychology, University of New York in Prague, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kozina A. Can FRIENDS for Life social-emotional learning programme be used for preventing anxiety and aggression in a school environment: 6 months, 1-year and 1-and-a-half-year follow-up. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2020. [DOI: 10.1080/17405629.2020.1776103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ana Kozina
- Center for Evaluation Studies, Educational Research Institute, Ljubljana, Slovenia
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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: An Initial Cluster Randomized Wait-List-Controlled Trial. Behav Ther 2020; 51:461-473. [PMID: 32402261 DOI: 10.1016/j.beth.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 11/21/2022]
Abstract
Anxiety and depression are common debilitating conditions that show high comorbidity rates in adolescence. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al., 2018) is one of the few existing resources aimed at applying transdiagnostic treatment principles across the core dysfunctions implicated in the development of both anxiety and depression using a single protocol. This is the first known controlled study to examine the efficacy of the UP-A adapted as a nine-session universal preventive intervention program delivered in a school setting. A total of 151 students (mean age: 15.05) participated in this randomized wait-list-controlled trial conducted in Madrid, Spain. An unexpected decline in anxiety and depression levels from pre- to posttreatment and follow-up was found in both groups (p = .009, d = -0.22), and overall differences between conditions did not reach significance. Exploratory analyses of baseline emotional symptom severity as a potential predictor trended toward a significantly greater decrease in symptoms of depression for those with greater baseline emotional symptoms in the UP-A group compared to the wait-list-control group. Future trials with larger samples are justified to estimate the effect of the UP-A adapted as a selective prevention program for anxiety and depression.
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Johnstone KM, Middleton T, Kemps E, Chen J. A pilot investigation of universal school‐based prevention programs for anxiety and depression symptomology in children: A randomized controlled trial. J Clin Psychol 2020; 76:1193-1216. [DOI: 10.1002/jclp.22926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tracey Middleton
- School of Psychology Flinders University Adelaide South Australia Australia
| | - Eva Kemps
- School of Psychology Flinders University Adelaide South Australia Australia
| | - Junwen Chen
- Research School of Psychology Australian National University Canberra Australian Capital Territory Australia
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Ab Ghaffar SF, Mohd Sidik S, Ibrahim N, Awang H, Gyanchand Rampal LR. Effect of a School-Based Anxiety Prevention Program among Primary School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244913. [PMID: 31817328 PMCID: PMC6950005 DOI: 10.3390/ijerph16244913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Anxiety is one of the most common mental health disorders in childhood, and children with anxiety have an increased risk of psychiatric disorders during adulthood. This study aimed to evaluate the effectiveness of a school-based anxiety prevention program for reducing anxiety among primary school students relative to a school-as-usual control group. Secondary to this, the current study aimed to examine the effect of a school-based prevention program on worry coping skills and self-esteem. A two-group parallel cluster randomized controlled trial of a single-blinded study was conducted to evaluate the effectiveness of the program, with schools as the unit of allocation and individual participants as the unit of analysis. The intervention program was conducted between May 2016 and December 2017. The primary outcome was anxiety, whereas the secondary outcomes were worry coping skills and self-esteem measured at three months post-intervention. Data were analyzed by using a generalized linear mixed model, accounting for the clustering effect. Subgroup analyses were performed for children with anxiety. A total of 461 students participated in this study. At baseline, there was no significant difference between groups for anxiety score, worry coping skills score, and self-esteem score (p > 0.05). The intervention was effective in reducing anxiety for the whole sample (p = 0.001) and the anxiety subgroup (p = 0.001). However, it was not effective in improving worry coping skills and self-esteem. These findings suggest that the program could be effective for reducing symptoms of anxiety when delivered in schools and provide some support for delivering this type of program in primary school settings.
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Affiliation(s)
- Siti Fatimah Ab Ghaffar
- Faculty of Hospitality, Tourism and Wellness, City Campus, Pengkalan Chepa, Locked Bag 36, Kota Bharu 16100, Kelantan, Malaysia;
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
| | - Sherina Mohd Sidik
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
- Cancer Resource & Education Center, Faculty of Medicine and Health Sciences Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia
- Correspondence: ; Tel.: +60-3-8947-1011
| | - Normala Ibrahim
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Hamidin Awang
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Lekhraj Rampal Gyanchand Rampal
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
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Girio-Herrera E, Ehrlich CJ, Danzi BA, La Greca AM. Lessons Learned About Barriers to Implementing School-Based Interventions for Adolescents: Ideas for Enhancing Future Research and Clinical Projects. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 26:466-477. [PMID: 32855590 PMCID: PMC7448397 DOI: 10.1016/j.cbpra.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The majority of youth with mental health problems do not receive treatment, highlighting the critical need to transport evidence-based interventions into community settings, such as schools. Despite being able to reach a large number of adolescents and minority youth, the process of implementing evidence-based interventions to schools is challenging. This paper discusses some expected and unexpected challenges experienced during the implementation of an open trial and a pilot randomized controlled trial examining the acceptability and effectiveness of a school-based preventive intervention for adolescents at risk for internalizing disorders. First, we highlight key programs and findings on preventive interventions for adolescents at risk for depression and anxiety. Next, we provide a brief overview of the preventive intervention we implemented in schools. This provides a context for the section that describes implementation issues and highlights specific challenges and potential solutions for intervention implementation. Finally, the paper offers recommendations for researchers and clinicians interested in implementing school-based mental health services for adolescents.
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Orgilés M, Fernández-Martínez I, Espada JP, Morales A. Spanish version ofSuper Skills for Life: short- and long-term impact of a transdiagnostic prevention protocol targeting childhood anxiety and depression. ANXIETY STRESS AND COPING 2019; 32:694-710. [DOI: 10.1080/10615806.2019.1645836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, Alicante, Spain
| | | | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, Alicante, Spain
| | - Alexandra Morales
- Department of Health Psychology, Miguel Hernández University, Alicante, Spain
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Prevention of Anxiety and Depression in Swedish School Children: a Cluster-Randomized Effectiveness Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:147-158. [PMID: 28730396 PMCID: PMC5801374 DOI: 10.1007/s11121-017-0821-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our study aimed at evaluating FRIENDS for Life, an intervention to prevent anxiety and depression in Swedish school children. A total of 695 children between the ages of 8 and 11 were recruited from 17 schools in Stockholm, Sweden, and cluster-randomized to either the intervention or control group. Teachers in the intervention group received a full day of training and administered FRIENDS for Life in their classrooms. We assessed the children’s anxiety and depressive symptoms, general mental health, and academic performance at pre- and post-intervention as well as at the 12-month follow-up. A multi-informant approach was used with data collected from children, parents, and teachers. Assessment was done with the Spence Children’s Anxiety Scale, Children’s Depression Inventory, and the Strengths and Difficulties Questionnaire. Children’s baseline symptoms, gender, and age as well as their teacher’s use of supervision were examined as moderators of effect. Our study found no short- or long-term effects of the intervention for any outcome with regard to the entire sample. We found an enhanced effect of the intervention regarding children with elevated depressive symptoms at baseline. We found a decrease in anxiety symptoms among children whose teachers attended a larger number of supervision sessions, compared to children whose teachers attended fewer supervised sessions or the control group. Mediation analyses showed that this effect was driven by change in the last phase of the intervention, suggesting that supervision might play an important role in enhancing teachers’ ability to administer the intervention effectively.
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Guo Y, Rousseau J, Hsu AS, Kehoe P, Daviss M, Flores S, Renno P, Saunders K, Phillips S, Evangelista LS. Emotional and Behavioral Health Needs in Elementary School Students in an Underserved Hispanic Community. J Sch Nurs 2019; 35:128-136. [PMID: 28893118 DOI: 10.1177/1059840517726857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High rates of mental health problems in adolescents have been well documented; less is known about elementary school children in disadvantaged communities. We examined emotional and behavioral health needs in 202 third and fourth graders enrolled in a charter school in a largely Hispanic community. The child-reported Revised Child Anxiety and Depression Scale-25 and Teacher's Report Form were used to evaluate mental health needs as perceived by these children and their teachers. The prevalence of teacher-reported depression and child self-reported anxiety was 7.0% and 6.67%, respectively. Living in a single parent household was found to be a specific risk factor in that those children had higher rates of emotional and behavioral problems than children living with both parents. Evidence of higher depression and anxiety identified in this sample compared to national representative data suggests the need for development of culturally sensitive early prevention and intervention in this underserved community.
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Affiliation(s)
- Yuqing Guo
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Julie Rousseau
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Anna S Hsu
- 2 Department of Psychology and Social Behavior, University of California, Irvine, CA, USA
| | - Priscilla Kehoe
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Monique Daviss
- 3 El Sol Science and Arts Academy of Santa Ana, Santa Ana, CA, USA
| | - Sara Flores
- 3 El Sol Science and Arts Academy of Santa Ana, Santa Ana, CA, USA
| | - Patricia Renno
- 4 Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Kathleen Saunders
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Susanne Phillips
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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Dimension-specific symptom patterns in trajectories of broad anxiety: A longitudinal prospective study in school-aged children. Dev Psychopathol 2019; 32:31-41. [DOI: 10.1017/s0954579418001384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractTheories of maladaptive anxiety in children have suggested different developmental trajectories across age. Weems (2008) suggested that one subgroup of children demonstrates high and stable levels of broad anxiety, but shifting levels of dimension-specific symptoms in part due to related normative challenges. In a prospective longitudinal design, the current study examined patterns of dimension-specific anxiety symptoms in subgroups of children following different developmental trajectories of broad anxiety. A total of 300 children (150 girls, 150 boys) ages 8–11 at baseline, completed the Spence Children's Anxiety Scale four times over 3 years. Using latent class growth mixture modeling, we found evidence of three subgroups of children following different trajectories of broad anxiety across age: low-stable, moderate-increasing, and high-decreasing. Compared with other children, the subgroup with moderate and increasing levels of broad anxiety demonstrated an initially higher level of separation anxiety with larger improvement across time but, initially, similar levels of generalized and social anxiety with a larger increase across age. High broad anxiety was partly carried by different sets of dimension-specific symptoms at different ages, which suggests that children with high levels of broad anxiety across time may be more sensitive to normative challenges that happen in typical child development.
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Long-Term Outcome of a Cluster-Randomized Universal Prevention Trial Targeting Anxiety and Depression in School Children. Behav Ther 2019; 50:200-213. [PMID: 30661560 DOI: 10.1016/j.beth.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8-11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child's anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.
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Kozina A. School-based prevention of anxiety using the "My FRIENDS" emotional resilience program: Six-month follow-up. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2018; 55 Suppl 1:70-77. [PMID: 30511384 DOI: 10.1002/ijop.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/25/2018] [Indexed: 11/06/2022]
Abstract
Anxiety-related problems are common in childhood and adolescence and, if left untreated, may hold short-term and long-term negative consequences for psychosocial functioning and other domains. In addition to having negative individual-level consequences, anxiety-related problems may have a negative impact at the school level. Because almost all children and adolescents attend school, school plays a significant role in development as a socialisation agent and provides an ideal venue for the delivery of prevention and intervention programs. Here, we present the first evidence regarding the effectiveness of the My FRIENDS emotional resilience program as a method of reducing anxiety among students in Slovenia and the feasibility of implementing the program at the national level. Grade 8 students (N = 78) were assigned either the intervention condition, the My FRIENDS program, or a no-treatment control condition. We measured general anxiety and its components using the AN-UD (Lestvica anksioznosti za učence in dijake) anxiety scale and internalising difficulties using the Strengths and Difficulties Questionnaire at preintervention, postintervention, and 6-month follow-up assessments. Students in the intervention condition reported lower amounts of general anxiety and its cognitive component of worrying, and fewer internalising difficulties at the postintervention and follow-up assessments.
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Affiliation(s)
- Ana Kozina
- Educational Research Institute, Ljubljana, Slovenia
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Breedvelt JJF, Kandola A, Kousoulis AA, Brouwer ME, Karyotaki E, Bockting CLH, Cuijpers P. What are the effects of preventative interventions on major depressive disorder (MDD) in young adults? A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2018; 239:18-29. [PMID: 29990660 DOI: 10.1016/j.jad.2018.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/23/2018] [Accepted: 05/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Depression is a prevalent disorder with a peak rate of onset in young adulthood from 18 to 25 years. To date, no review has systematically assessed the effectiveness of programs that aim to reduce depressive symptoms or diagnosis of depression in young adults. METHOD A systematic search was performed in Cochrane, PubMed, PsycINFO and EMBASE. We performed a random-effects meta-analysis of the randomized controlled studies that compared an intervention for young adults (aged 18-25) without a diagnosis or history of depression and a control condition. Comparisons between intervention and control group outcomes were carried out at the post-intervention time point. We also compared intervention and control group outcomes at later follow-up time points where data were available. RESULTS Twenty-six randomized controlled trials among 2865 young adults were included in the analysis. The pooled effect size of the interventions versus control at post-intervention was g = 0.37 (95% CI: 0.28-0.47, NNT = 9) and heterogeneity was moderate I2 = 36 (95% CI: 11-64). There were no significant effects in terms of the type of delivery, focus of study, type of control, or type of support within the interventions. LIMITATIONS The authors were unable to assess the effects of interventions on the onset of depression as none of the included studies measured incidence. The risk of bias was high in most studies (81%). Only one study included a follow-up of more than a year. Demographic factors were inconsistently reported in the included articles. CONCLUSION While it was not possible to investigate the effects of interventions on depression incidence, some evidence was found for the effectiveness of preventative interventions in reducing depressive symptoms in young adults. Future research should address limitations of the current evidence base to allow stronger conclusions to be drawn.
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Affiliation(s)
- J J F Breedvelt
- Research Department, Mental Health Foundation, London, United Kingdom; Department of Psychiatry, Program Mood Disorders, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - A Kandola
- Research Department, Mental Health Foundation, London, United Kingdom.
| | - A A Kousoulis
- Research Department, Mental Health Foundation, London, United Kingdom.
| | - M E Brouwer
- Department of Psychiatry, Program Mood Disorders, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - E Karyotaki
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Netherlands.
| | - C L H Bockting
- Department of Psychiatry, Program Mood Disorders, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - P Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Netherlands.
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An Open Trial Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Prevention Program. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9471-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Waldron SM, Stallard P, Grist R, Hamilton-Giachritsis C. The ‘long-term’ effects of universal school-based anxiety prevention trials: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mhp.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johnstone KM, Kemps E, Chen J. A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children. Clin Child Fam Psychol Rev 2018; 21:466-481. [DOI: 10.1007/s10567-018-0266-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Keles S, Idsoe T. A meta-analysis of group Cognitive Behavioral Therapy (CBT) interventions for adolescents with depression. J Adolesc 2018; 67:129-139. [DOI: 10.1016/j.adolescence.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 01/09/2023]
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Cheng M, Rooney RM, Kane RT, Hassan S, Baughman N. Do Parent Mental Illness and Family Living Arrangement Moderate the Effects of the Aussie Optimism Program on Depression and Anxiety in Children? Front Psychiatry 2018; 9:183. [PMID: 29946269 PMCID: PMC6005872 DOI: 10.3389/fpsyt.2018.00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Abstract
Parent mental illness and family living arrangement are associated with depression and anxiety in children, and may influence the effects of programs that aim to prevent these disorders. This study investigated whether these family context factors moderated the intervention effects of the enhanced Aussie Optimism Positive Thinking Skills program on depression and anxiety in primary school children. The intervention was a universal, cognitive-behavioral program, with a one hour session each week for 10 weeks, delivered by trained teachers. The participants were 502 children from 13 private schools, aged 9-11, with 347 in the intervention group and 155 in the control group. There were 267 females and 235 males. Data from 502 parents was also included. A cluster randomized controlled trial design was used, including eight intervention schools and five control schools. Depression and anxiety were assessed at pre-test, post-test, and 6-months follow-up. Information on parent mental illness and family living arrangement was collected through a parent questionnaire. The data was analyzed using covariance analysis with Generalized Linear Mixed Methods. At baseline, depressive and anxiety symptoms did not differ significantly based on parent mental illness. Symptoms of depression at baseline were significantly higher for children from a higher-risk family living arrangement, but anxiety symptoms were not. Parent mental illness and family living arrangement did not moderate the effects of the program on depression and anxiety at post-test or 6-months follow-up. Parent mental illness moderated the intervention effects on negative self-esteem, an aspect of depression, at post-test, with improvements seen only for children who did not have a parent with a mental illness. The findings indicate an association between family living arrangement and depressive symptoms in children. The findings suggest that the program is effective for children regardless of parent mental illness or family living arrangement, although parent mental illness has the capacity to influence the program's outcomes.
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Affiliation(s)
- Maryanne Cheng
- Faculty of Health Sciences, School of Psychology, Curtin University, Perth, WA, Australia
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Recent advances in the prevention of mental disorders. Soc Psychiatry Psychiatr Epidemiol 2018; 53:325-339. [PMID: 29546492 DOI: 10.1007/s00127-018-1501-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Prevention of mental disorders is a rapidly growing area of research with substantial potential benefits for population health. This paper reviews the evidence base for prevention of depression, anxiety, and schizophrenia. METHODS We synthesized evidence from recent systematic reviews and meta-analyses published between 2013 and 2018 on prevention of depression, anxiety, and first-episode psychosis. We included reviews of randomized controlled trials testing psychological, psychosocial, and pharmacological preventive interventions. RESULTS There is good evidence that depression and anxiety can be prevented, although effect sizes are generally small. Indicated prevention of first-episode psychosis appears promising. Economic evaluations provide support for prevention of depression, anxiety, and first-episode psychosis, but more studies evaluating costs and benefits are needed to strengthen the knowledge base, particularly regarding long-term outcomes, which include chronicity of the prevented disorder, as well as later occurence of important comorbid mental and physical health problems. Promising areas for further development include internet- or computer-based prevention strategies, mindfulness-based interventions, and integration of prevention programs within occupational settings. CONCLUSIONS A number of interventions to prevent mental disorders are efficacious. While intervention effect sizes are generally small for prevention of depression and anxiety, they may nonetheless be of significant population benefit. Using the growing evidence base to inform policy and dissemination of evidence-based prevention programs is critical for moving prevention science into real-world settings.
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Roberts CM, Kane RT, Rooney RM, Pintabona Y, Baughman N, Hassan S, Cross D, Zubrick SR, Silburn SR. Efficacy of the Aussie Optimism Program: Promoting Pro-social Behavior and Preventing Suicidality in Primary School Students. A Randomised-Controlled Trial. Front Psychol 2018; 8:1392. [PMID: 29599729 PMCID: PMC5863632 DOI: 10.3389/fpsyg.2017.01392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
The efficacy of an enhanced version of the Aussie Optimism Program (AOP) was investigated in a cluster randomized controlled trial. Grade 6 students aged 10-11 years of age (N = 2288) from 63 government primary schools in Perth, Western Australia, participated in the pre, post, and follow-up study. Schools were randomly assigned to one of three conditions: Aussie Optimism with teacher training, Aussie Optimism with teacher training plus coaching, or a usual care condition that received the regular Western Australian Health Education Curriculum. Students in the Aussie Optimism conditions received 20, 1-h lessons relating to social and interpersonal skills and optimistic thinking skills over the last 2 years of primary school. Parents in the active conditions received a parent information booklet each year, plus a self-directed program in Grade 7. Students and parents completed the Extended Strengths and Difficulties Questionnaire. Students who scored in the clinical range on the Emotional Symptoms Scale were given The Diagnostic Interview for Children and Adolescents IV, to assess suicidal ideation and behavior, and depressive and anxiety disorders. Results indicated that Aussie Optimism with teacher training plus coaching was associated with the best outcomes: a significant increase in student-reported pro-social behavior from pre-test to post-test 1 (maintained at post-test 2) and significantly lower incidence rates from suicidal ideation at post-test 2 and follow-up. No significant intervention effects on anxiety and depressive disorders, and total difficulties were reported. These findings suggest that the AOP with teacher training along with coaching may have the potential to positively impact on suicidality and pro-social behavior in the pre-adolescent years.
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Affiliation(s)
- Clare M. Roberts
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Robert T. Kane
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Rosanna M. Rooney
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Yolanda Pintabona
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Natalie Baughman
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Sharinaz Hassan
- School of Psychology and Speech Pathology, Curtin University of Technology, Perth, WA, Australia
| | - Donna Cross
- Child Health Promotion Research Centre, Edith Cowan University, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Stephen R. Zubrick
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Sven R. Silburn
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Exploring Students’ Participation in Universal, Depression and Anxiety, Prevention Programmes at School: A Meta-aggregation. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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García-Escalera J, Valiente RM, Chorot P, Ehrenreich-May J, Kennedy SM, Sandín B. The Spanish Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: Study Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e149. [PMID: 28827212 PMCID: PMC5583506 DOI: 10.2196/resprot.7934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/07/2023] Open
Abstract
Background Anxiety and depression are common, impairing conditions that evidence high comorbidity rates in adolescence. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is one of the few existing resources aimed at applying transdiagnostic treatment principles to target core dysfunctions associated with both anxiety and depression within a single protocol. To our knowledge, this is the first study examining the efficacy of the UP-A adapted as a universal preventive intervention program. Objective The primary aim of this study is to examine whether the Spanish version of the UP-A is more effective than a waitlist (WL) control group in reducing and preventing symptoms of anxiety and depression when employed as a universal, classroom-based preventive intervention. The secondary aim is to investigate changes in a broad range of secondary outcome measures, including negative and positive affect, anxiety sensitivity, emotional avoidance, top problems ratings, school grades, depression and anxiety-related interference, self-esteem, life satisfaction, quality of life, conduct problems, hyperactivity/inattention symptoms, peer problems, prosocial behavior, school adjustment, and discipline problems. Other aims are to assess a range of possible predictors of intervention effects and to examine the feasibility and the acceptability of implementing UP-A in a prevention group format and in a school setting. Methods A cluster, randomized, WL, controlled trial design with classroom as the unit of randomization was used in this study. Five classes including a total of 152 adolescents were randomized to the experimental or WL control groups. Participants in the experimental group received 9 55-minute sessions delivered by advanced doctoral and masters students in clinical psychology. The WL control group will receive the intervention once the 3-month follow-up assessment is completed. Results We have recruited participants to the cluster randomized controlled trial (RCT) and have conducted the intervention with the experimental group. We expect the WL control group to complete the intervention in July 2017. Data analysis will take place during the second semester of 2017. Conclusions We expect the experimental group to outperform the WL control group at post-intervention and 3-month follow-up. We also expect the WL control group to show improvements in primary and secondary outcome measures after receiving the intervention. Results will have implications for researchers, families, and education providers. Trial Registration Clinicaltrials.gov NCT03123991; https://clinicaltrials.gov/ct2/show/NCT03123991 (Archived by WebCite at http://www.webcitation.org/6qp7GIzcR)
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Affiliation(s)
| | - Rosa M Valiente
- Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Paloma Chorot
- Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Sarah M Kennedy
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Bonifacio Sandín
- Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
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