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Moreno-Peral P, Conejo-Cerón S, Wijnen B, Lokkerbol J, Fernández A, Smit F, Bellón JÁ. Health-Economic Evaluation of Psychological Interventions for Anxiety Prevention: A Systematic Review. Psychiatr Serv 2024; 75:667-677. [PMID: 38410039 DOI: 10.1176/appi.ps.20230101] [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] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Although evidence supports the effectiveness of psychological interventions for prevention of anxiety, little is known about their cost-effectiveness. The aim of this study was to conduct a systematic review of health-economic evaluations of psychological interventions for anxiety prevention. METHODS PubMed, PsycInfo, Web of Science, Embase, Cochrane Central Register of Controlled Trials, EconLit, National Health Service (NHS) Economic Evaluations Database, NHS Health Technology Assessment, and OpenGrey databases were searched electronically on December 23, 2022. Included studies focused on economic evaluations based on randomized controlled trials of psychological interventions to prevent anxiety. Study data were extracted, and the quality of the selected studies was assessed by using the Consensus on Health Economic Criteria and the Cochrane risk-of-bias tool. RESULTS All included studies (N=5) had economic evaluations that were considered to be of good quality. In two studies, the interventions showed favorable cost-effectiveness compared with usual care groups. In one study, the intervention was not cost-effective. Findings from another study cast doubt on the cost-effectiveness of the intervention, and the cost-effectiveness of the intervention in the remaining study could not be established. CONCLUSIONS Although the findings suggest some preliminary evidence of cost-effectiveness of psychological interventions for preventing anxiety, they were limited by the small number of included studies. Additional research on the cost-effectiveness of psychological interventions for anxiety in different countries and populations is required.
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Affiliation(s)
- Patricia Moreno-Peral
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Sonia Conejo-Cerón
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Ben Wijnen
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Joran Lokkerbol
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Anna Fernández
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Filip Smit
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Juan Ángel Bellón
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
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Fitzgerald HE, Hoyt DL, Kredlow MA, Smits JAJ, Schmidt NB, Edmondson D, Otto MW. Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021; 28:323-337. [PMID: 35300171 PMCID: PMC8923531 DOI: 10.1037/cps0000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.
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Affiliation(s)
- Hayley E Fitzgerald
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - Danielle L Hoyt
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02140
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23 St., Austin, TX 78712
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | | | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
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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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Urao Y, Ohira I, Koshiba T, Ishikawa SI, Sato Y, Shimizu E. Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the 'Journey of the Brave'. Child Adolesc Psychiatry Ment Health 2021; 15:21. [PMID: 33894787 PMCID: PMC8070271 DOI: 10.1186/s13034-021-00374-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/15/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In Japan, 'Journey of the Brave', a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers. METHODS Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children's Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up). RESULTS Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were - 4.91 (95% CI - 5.91, - 3.90) in the intervention group and - 2.53 (95% CI - 3.52, - 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group. CONCLUSIONS The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme's effectiveness. Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018-Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083.
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Affiliation(s)
- Yuko Urao
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan.
| | - Ikuyo Ohira
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takako Koshiba
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Shimizu
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
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A Rumination-Focused Cognitive-Behavioral Therapy Self-Help Program to Reduce Depressive Rumination in High-Ruminating Japanese Female University Students: A Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial. Br J Gen Pract 2021; 71:e95-e104. [PMID: 33495203 PMCID: PMC7846354 DOI: 10.3399/bjgp20x714041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. Aim To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Design and setting Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. Method In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. Results A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = −2.7% [95% CI = −5.1% to −0.3%]; P = 0.029). Conclusion A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.
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Moreno-Peral P, Bellón JÁ, Motrico E, Campos-Paíno H, Martín-Gómez C, Ebert DD, Buntrock C, Roca M, Conejo-Cerón S. Moderators of psychological and psychoeducational interventions for the prevention of anxiety: A systematic review. J Anxiety Disord 2020; 76:102317. [PMID: 33096463 DOI: 10.1016/j.janxdis.2020.102317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to assess the available evidence on potential moderators of psychological and psychoeducational interventions for the prevention of anxiety. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and CENTRAL was performed up to October 2019. Two independent researchers assessed the fulfillment of eligibility criteria, extracted the data and performed a quality assessment of the included studies. Outcomes were moderators of the reduction of anxious symptoms or the incidence of anxiety disorders. Fourteen studies reporting results on moderator analyses performed in 13 randomized controlled trials were included. Twenty-seven potential moderators were organized into six categories: sociodemographic, clinical characteristics, cognitive variables, life events, interpersonal functioning and intervention characteristics. The most frequently examined variables were gender, age and baseline anxiety. We found insufficient evidence for all moderator categories studied. In children and adolescents, we found some studies with significant results for the low family support variable and higher levels of anxiety symptoms at baseline, which were both associated with higher effectiveness. Limited conclusions can be drawn about for whom and under what conditions interventions work in the prevention of anxiety. A strong need to improve the methodological quality and the number of moderator studies was identified.
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Affiliation(s)
- Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009, Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Juan Ángel Bellón
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009, Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain; 'El Palo' Health Centre, Health District of Primary Care Málaga-Guadalhorce, SAS, Av. Salvador Allende, 159, 29018, Málaga, Spain; Department of Public Health and Psychiatry, University of Málaga, Bulevar Louis Pasteur, 32, 29010, Málaga, Spain
| | - Emma Motrico
- Department of Psychology, University Loyola Andalucia, Seville, Spain
| | - Henar Campos-Paíno
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009, Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | | | - David D Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Miquel Roca
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain; Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Carretera de Valldemossa, 07122, Palma, Illes Balears, Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009, Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
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Besharov DJ, Call DM, Scott JM. PROTOCOL: Early childhood education programs for improving the development and achievement of low-income children: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1100. [PMID: 37131912 PMCID: PMC8356309 DOI: 10.1002/cl2.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - Douglas M. Call
- School of Public PolicyUniversity of MarylandCollege ParkMarylandUSA
| | - Jason M. Scott
- School of Public PolicyUniversity of MarylandCollege ParkMarylandUSA
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Risk Factors and Prevention Strategies for Anxiety Disorders in Childhood and Adolescence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:543-559. [PMID: 32002945 DOI: 10.1007/978-981-32-9705-0_27] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anxiety is prevalent in childhood and adolescence. Youth with maladaptive responses to common situations and stressors are at risk of having anxiety disorders. Persistent anxiety symptoms and anxiety disorders can be debilitating with long-term adverse outcomes in adulthood. Hence, decreasing the burden of anxiety disorders is an important public health priority. Development of anxiety disorders has a multifactorial etiology. There is a considerable complex interaction of genetics, temperament, parenting behavior, environmental triggers, and physiologic factors. Identification of these risk factors is key to early detection, prevention, and development of applicable management approaches. Despite several evidence-based treatments published, there are limited prevention strategies available. Effective implementation of prevention strategies is essential and can be achieved by either elimination or reduction of the negative risk factors or strengthening the protective factors on anxiety symptoms and anxiety disorders. This chapter reviews the common risk and protective factors and provides current literature on prevention strategies for pediatric and adolescent anxiety disorders.
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Lyssenko L, Müller G, Kleindienst N, Schmahl C, Berger M, Eifert G, Kölle A, Nesch S, Ommer-Hohl J, Wenner M, Bohus M. Long-term outcome of a mental health promotion program in Germany. Health Promot Int 2019; 34:532-540. [PMID: 29509890 DOI: 10.1093/heapro/day008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mental health promotion programs (MHP) seek to reduce sub-syndromal symptoms of mental distress and enhance positive mental health. This study evaluates the long-term effects of a mindfulness-based MHP program ('Life Balance') provided by health coaches in a multi-site field setting on mental distress, satisfaction with life and resilience. Using a controlled design, propensity score matching was used to select a control group for participants of the MHP. The total study sample (N = 3624) comprised 83% women, with a mean age of 50 years. Data was collected via mailings 1 year after study entry. Results suggest participants experience reduced emotional distress at 12-month follow-up, with a medium between-group effect size (d = 0.40) for those participants who showed clinically relevant symptoms of mental distress at study entry. The effects of the program were more pronounced in participants with higher initial distress scores. New cases of psychopathological symptoms were prevented in 1 of 16 participants. Satisfaction with life and resilience were enhanced significantly. Our data suggest 'Life Balance' shows long-term effectiveness and indicate it is possible to design MHP programs that serve as both primary and indicated prevention, and that these programs can be applied on a population basis.
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Affiliation(s)
- Lisa Lyssenko
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Germany
| | | | - Nikolaus Kleindienst
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Germany
| | - Christian Schmahl
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Germany
| | - Mathias Berger
- Deptartment of Psychiatry and Psychotherapy, University of Freiburg, Germany
| | - Georg Eifert
- College of Health & Behavioral Sciences, Chapman University, Orange, USA
| | | | | | | | | | - Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Germany.,Department of Health, Antwerp University, Belgium
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Weisel KK, Zarski AC, Berger T, Krieger T, Schaub MP, Moser CT, Berking M, Dey M, Botella C, Baños R, Herrero R, Etchemendy E, Riper H, Cuijpers P, Bolinski F, Kleiboer A, Görlich D, Beecham J, Jacobi C, Ebert DD. Efficacy and cost-effectiveness of guided and unguided internet- and mobile-based indicated transdiagnostic prevention of depression and anxiety (ICare Prevent): A three-armed randomized controlled trial in four European countries. Internet Interv 2019; 16:52-64. [PMID: 30775265 PMCID: PMC6364519 DOI: 10.1016/j.invent.2018.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent and often co-occur. Several studies indicate the potential of disorder-specific psychological interventions for the prevention of each of these disorders. To treat comorbidity, transdiagnostic treatment concepts seem to be a promising approach, however, evidence for transdiagnostic concepts of prevention remains inconclusive. Internet- and mobile-based interventions (IMIs) may be an effective means to deliver psychological interventions on a large scale for the prevention of common mental disorders (CMDs) such as depression and anxiety. IMIs have been shown to be effective in treating CMDs, e.g. in reducing symptoms of depression and anxiety. However, there is a lack of studies examining the efficacy of interventions reducing the incidence of CMDs. Moreover, the comparative cost-effectiveness of guided versus unguided IMIs for the prevention of depression and anxiety has not been studied yet. Hence, this study aims at investigating the (cost-) effectiveness of guided and unguided internet- and mobile-based transdiagnostic individually tailored indicated prevention of depression and anxiety. METHODS A multi-country three-armed randomized controlled trial will be conducted to compare a guided and unguided intervention to treatment as usual (TAU). Both active conditions are based on the same intervention, ICare Prevent, and differ only with regard to guidance format. Altogether, 954 individuals with subclinical symptoms of depression (CES-D ≥ 16) and anxiety (GAD-7 ≥ 5) who do not have a full-blown disorder will be recruited in Germany, Switzerland, Spain and the Netherlands, and randomized to one of three conditions (guided intervention, unguided intervention, or TAU). The TAU arm will receive access to the training after a 12-month waiting period. The primary outcome will be time to CMD onset (any depression/anxiety disorder) within a follow-up period of 12 months after baseline. Secondary outcomes will include disorder-specific symptom severity (depression/anxiety) assessed by diagnostic raters blinded to intervention condition at post-intervention, self-reports, acceptability, health related quality of life, and psychosocial variables associated with developing a CMD. Assessments will take place at baseline, mid-intervention (5 weeks into the intervention), post-intervention (8 weeks after randomization) and follow-up (6 and 12 months after randomization). Data will be analyzed on an intention-to-treat basis and per protocol. Cost-effectiveness will be evaluated from a public health and a societal perspective, including both direct and indirect costs. DISCUSSION The present study will further enhance the evidence-base for transdiagnostic preventive interventions and provide valuable information about optimal trade-off between treatment outcome and costs. TRIAL REGISTRATION German Clinical Trial Registration (DRKS - http://www.drks.de/drks_web/): DRKS00011099.
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Affiliation(s)
- Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, Germany
- Leuphana University, Innovation Incubator, Division Health Trainings Online, Lüneburg, Germany
| | - Thomas Berger
- University of Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - Tobias Krieger
- University of Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Christian T. Moser
- University of Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, Germany
| | - Michelle Dey
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Cristina Botella
- Jaume I University, Castellón, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- University of Valencia, Valencia, Spain
| | - Rocio Herrero
- Jaume I University, Castellón, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- University of Zaragoza, Teruel, Spain
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Felix Bolinski
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Münster, Germany
| | - Jennifer Beecham
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, United Kingdom
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, Germany
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12
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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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Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JDD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón JÁ. Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2017; 74:1021-1029. [PMID: 28877316 PMCID: PMC5710546 DOI: 10.1001/jamapsychiatry.2017.2509] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Importance To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (β = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
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Affiliation(s)
- Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Sonia Conejo-Cerón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Maria Rubio-Valera
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anna Fernández
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- Service of Community Health, Public Health Agency of Barcelona, Barcelona, Spain
| | - Desirée Navas-Campaña
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Málaga, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Alina Rigabert
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Juan de Dios Luna
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Biostatistics, University of Granada, Granada, Spain
| | - Carlos Martín-Pérez
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of Marquesado, Área Nordeste de Granada, Granada, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of San José, Linares, Jaén, Spain
| | | | - Juan Vicente Luciano
- Prevention and Health Promotion Research Network, Málaga, Spain
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain
| | - Juan Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Primary Care Center of El Palo, Málaga, Spain
- Department of Preventive Medicine, Public Health and Psychiatry, University of Málaga, Málaga, Spain
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Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. Behav Res Ther 2017; 90:123-136. [DOI: 10.1016/j.brat.2016.12.015] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 09/16/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
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15
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Ebert DD, Cuijpers P, Muñoz RF, Baumeister H. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research. Front Psychiatry 2017; 8:116. [PMID: 28848454 PMCID: PMC5554359 DOI: 10.3389/fpsyt.2017.00116] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/15/2017] [Indexed: 01/08/2023] Open
Abstract
Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs). This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs), effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include substance use disorders, bipolar disorders, stress-related disorders, phobic disorders and panic disorder, obsessive-compulsive disorder, impulse-control disorders, somatic symptom disorder, and insomnia. In summary, there is a need for more rigorously conducted large scale randomized controlled trials using standard clinical diagnostic instruments for the selection of participants without MHD at baseline and the assessment of MHD onset. Subsequently, we discuss future directions for the field in order to fully exploit the potential of IMI for the prevention of MHD.
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Affiliation(s)
- David Daniel Ebert
- Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ricardo F Muñoz
- Palo Alto University, Palo Alto, CA, United States.,University of California, San Francisco, San Francisco, CA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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16
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Smith BA, Georgiopoulos AM, Quittner AL. Maintaining mental health and function for the long run in cystic fibrosis. Pediatr Pulmonol 2016; 51:S71-S78. [PMID: 27662107 DOI: 10.1002/ppul.23522] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 12/11/2022]
Abstract
Research shows that individuals with cystic fibrosis (CF) and their families experience significant emotional morbidity. In addition to distress, worry, and grief, high rates of clinically significant symptoms of depression and anxiety have been found in both individuals with CF and parents. These disorders have a major impact on the person's functioning, and that of their family, and adversely impact the capacity to cope with the burden of CF and adhere to prescribed treatments. Despite growing recognition that mental health care is an essential component of comprehensive CF care, evidence suggests many patients and their families do not receive needed support and mental health interventions. Clinical practice guidelines for screening and treating depression and anxiety in individuals with CF have been developed by The Cystic Fibrosis Foundation and the European Cystic Fibrosis Society in response to this need. This review highlights that the optimum care for individuals with CF and their families incorporates mental health in routine CF care. Addressing mental health could substantially improve physical and mental health outcomes and the functioning of individuals with CF and their families. Pediatr Pulmonol. 2016;51:S71-S78. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Beth A Smith
- Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, Buffalo, New York.
| | - Anna M Georgiopoulos
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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17
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Patterns of anxiety symptoms during adolescence: Gender differences and sociomotivational factors. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2016. [DOI: 10.1016/j.appdev.2016.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Watson HJ, Joyce T, French E, Willan V, Kane RT, Tanner-Smith EE, McCormack J, Dawkins H, Hoiles KJ, Egan SJ. Prevention of eating disorders: A systematic review of randomized, controlled trials. Int J Eat Disord 2016; 49:833-62. [PMID: 27425572 DOI: 10.1002/eat.22577] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia. .,Department of Health in Western Australia, Centre for Clinical Interventions, Perth, Australia. .,Faculty of Medicine, Dentistry, and Health Sciences, School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. .,Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
| | - Tara Joyce
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Elizabeth French
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Vivienne Willan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Robert T Kane
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Emily E Tanner-Smith
- Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Nashville
| | - Julie McCormack
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Hayley Dawkins
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Kimberley J Hoiles
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Sarah J Egan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Kendall PC, Makover H, Swan A, Carper MM, Mercado R, Kagan E, Crawford E. What steps to take? How to approach concerning anxiety in youth. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Zalta AK, Shankman SA. Conducting Psychopathology Prevention Research in the RDoC Era. ACTA ACUST UNITED AC 2016; 23:94-104. [PMID: 27065571 DOI: 10.1111/cpsp.12144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Research Domain Criteria (RDoC) initiative promoted by the National Institute of Mental Health emphasizes a dimensional approach to psychopathology that is agnostic to DSM diagnosis. The RDoC project offers exciting possibilities for advancing research aimed at preventing psychopathology. However, prevention has historically been defined using diagnostic status, requiring the field to redefine what constitutes prevention using an RDoC approach. This article outlines new criteria for prevention in the RDoC context and provides guidance for implementing these criteria. We also describe the role of prevention-mechanism trials that examine whether preventive interventions change proximal etiological mechanisms known to be associated with psychopathology. We hope that these modified criteria and recommendations will stimulate new possibilities for prevention research that will advance the field.
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Affiliation(s)
- Alyson K Zalta
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL; Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Stewart A Shankman
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
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21
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Zabaleta-del-Olmo E, Bolibar B, García-Ortíz L, García-Campayo J, Llobera J, Bellón JÁ, Ramos R. Building interventions in primary health care for long-term effectiveness in health promotion and disease prevention. A focus on complex and multi-risk interventions. Prev Med 2015; 76 Suppl:S1-4. [PMID: 25778858 DOI: 10.1016/j.ypmed.2015.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Nursing, Universitat de Girona, c/Emili Grahit 77, 17071 Girona, Spain.
| | - Bonaventura Bolibar
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Luis García-Ortíz
- Primary Care Research Unit, The Alamedilla Health Center, Salamanca Institute for Biomedical Research (IBSAL), Av. Comuneros 27-31, 37003 Salamanca, Spain; Department of Biomedical Sciences and Diagnostics, University of Salamanca, Miguel de Unamuno Campus, Calle Alfonso X El Sabio s/n, 37007 Salamanca, Spain
| | - Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, redIAPP, Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Joan Llobera
- Research Unit, Primary Care Department of Mallorca, Ib-Salut Balears, IdISPa, Govern de les Illes Balear, C/Reina Esclaramunda 9, 07003 Palma, Spain
| | - Juan Ángel Bellón
- El Palo Health Centre, Avenida Salvador Allende 159, 20018 Málaga, Spain; Research Unit of Málaga Primary Care District, c/Sevilla 23, 3ª planta, 29009 Málaga, Spain; Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Campus de Teatinos, 29071 Málaga, Spain; Málaga Biomedical Research Institute (IBIMA), Av. Jorge Luis Borges 15, Bl.3 Pl.3, 29010 Málaga, Spain
| | - Rafel Ramos
- Girona Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/Maluquer Salvador 11, 17002 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, c/Emili Grahit, 77, 17071 Girona, Spain
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22
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García-Campayo J, del Hoyo YL, Valero MS, Yus MCP, Esteban EA, Guedea MP, Botaya RM. Primary prevention of anxiety disorders in primary care: A systematic review. Prev Med 2015; 76 Suppl:S12-5. [PMID: 25456801 DOI: 10.1016/j.ypmed.2014.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/27/2014] [Accepted: 10/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care. METHODS A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire. RESULTS No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention. CONCLUSION This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.
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Affiliation(s)
- Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, REDIAPP, Isabel la Catolica, 1-3, 50009 Zaragoza, Spain.
| | - Yolanda López del Hoyo
- Department of Psychology & Sociology, University of Zaragoza, REDIAPP, Violante de Hungría, 23, 50009 Zaragoza, Spain
| | | | - Maria Cruz Pérez Yus
- Aragon Health Sciences Institute, REDIAPP, CS. Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
| | - Eva Andrés Esteban
- 12 de Octubre Research Institute, Avda. de Córdoba, s/n, 28041 Madrid, Spain
| | | | - Rosa Magallón Botaya
- Health Aragon, REDIAPP, CS, Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
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Sockol LE, Epperson CN, Barber JP. Preventing postpartum depression: a meta-analytic review. Clin Psychol Rev 2013; 33:1205-17. [PMID: 24211712 PMCID: PMC4104584 DOI: 10.1016/j.cpr.2013.10.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 11/16/2022]
Abstract
This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g=0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.
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Affiliation(s)
- Laura E Sockol
- Williams College, Department of Psychology, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; University of Pennsylvania, Department of Psychology, United States.
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Jacka FN, Reavley NJ, Jorm AF, Toumbourou JW, Lewis AJ, Berk M. Prevention of common mental disorders: what can we learn from those who have gone before and where do we go next? Aust N Z J Psychiatry 2013; 47:920-9. [PMID: 23798717 DOI: 10.1177/0004867413493523] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Prevention strategies have made a major contribution to the considerable successes in reductions in cardiovascular disease and cancer mortality seen in recent decades. However, in the field of psychiatry, similar population-level initiatives in the prevention of common mental disorders, depression and anxiety, are noticeably lacking. This paper aims to provide a brief overview of the existing literature on the topic of the prevention of common mental disorders and a commentary regarding the way forward for prevention research and implementation. METHODS This commentary considers what we currently know, what we might learn from the successes and failures of those working in prevention of other high prevalence health conditions, and where we might go from here. Taking cognisance of previous preventive models, this commentary additionally explores new opportunities for preventive approaches to the common mental disorders. RESULTS The consensus from a large body of evidence supports the contention that interventions to prevent mental disorders across the lifespan can be both effective and cost-effective. However, funding for research in the area of prevention of common mental disorders is considerably lower than that for research in the areas of treatment, epidemiology and neurobiology. Thus, there is a clear imperative to direct funding towards prevention research to redress this imbalance. Future prevention interventions need to be methodologically rigorous, scalable to the population level and include economic evaluation. Evidence-based knowledge translation strategies should be developed to ensure that all stakeholders recognise preventing mental disorders as an imperative, with appropriate resources directed to this objective. CONCLUSION There has been a recent expansion of research into potentially modifiable risk factors for depression, and it is now timely to make a concerted effort to advance the field of prevention of common mental disorders.
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Affiliation(s)
- Felice N Jacka
- 1IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Australia and Department of Psychiatry, The University of Melbourne, Parkville, Australia
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Improving prevention of depression and anxiety disorders: Repetitive negative thinking as a promising target. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2012.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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