Prevention of Childhood Emotional Disorders: Reducing the Burden of Suffering Associated with Anxiety and Depression

Examining the role of maternal religiosity in offspring mental health using latent class analysis in a UK prospective cohort study

BACKGROUND

Previous research has examined the role of parental religious belief in offspring mental health, but has revealed inconsistent results, and suffered from a number of limitations. The aim of this study is to examine the prospective relationship between maternal religiosity and offspring mental health and psychosocial outcomes.

METHODS

We used latent classes of religious belief (Highly religious, Moderately religious, Agnostic, Atheist) in mothers from the Avon Longitudinal Study of Parents and Children from 1990, and examined their association with parent-reported mental health outcomes and self-reported psychosocial outcomes in their children at age 7-8 (n = 6079 for mental health outcomes and n = 5235 for psychosocial outcomes). We used inverse probability weighted multivariable logistic regression analysis adjusted for maternal mental health, adverse childhood experience, and socioeconomic variables.

RESULTS

There was evidence for a greater risk of internalising problems among the offspring of the Highly religious and Moderately religious classes [e.g. for depression; OR 1.40. 95% CI (1.07-1.85), OR 1.48, 95% CI (1.17-1.87)], and greater risk of externalising problems in the offspring of the Atheist class [e.g. for ADHD; OR 1.41, 95% CI (1.08-1.85)], compared to the offspring of the Agnostic class.

CONCLUSIONS

These novel findings provide evidence associations between maternal religiosity and offspring mental health differ when examined using a person-centred approach, compared to the previously used variable-centred approaches. Our findings also suggest that differences may exist in the relationship between religious (non)belief and mental health variables when comparing the UK and US.

Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention

Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.

Exercise intervention and improvement of negative emotions in children: a meta-analysis

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.

Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan-a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development, and treatment of depression.

The role of youth mental health services in the treatment of young people with serious mental illness: 2-year outcomes and economic implications

AIM

This study aims to evaluate the outcomes and economic case for a UK innovative youth-specific mental health service for 16-25 year olds.

METHODS

A pre-, during- and post-treatment comparative design for 20 young people at high risk of developing psychosis who received 2 years' treatment with the service, using outcomes that concurred with the service aims: changes in mental health, employment rates and service use.

RESULTS

Forty-five percent of those at risk and with symptoms of serious mental illness commencing treatment were not receiving mental health services at baseline. Compared with service use prior to treatment at the youth-specific service, hospital admissions, Accident and Emergency, and criminal justice system use appear to decrease over the 2 years of treatment and the year after treatment, with potential cost differences of £473 000. Mental health improved or stayed the same, compared with baseline. Employment rates improved, although the sample size for this is very small. Potential cost differences associated with service users moving into employment over the 2 years are £148 000. The estimated cost over 2 years of providing the youth-specific mental health service to these young people was £106 000.

CONCLUSIONS

Given the extensive long-term negative consequences and high costs of untreated mental illness in the 16-25 age group and the documented problems young people have in receiving appropriate services, this youth-specific, age-appropriate service model appears to be successful, with improved outcomes and cost differences in the short-term, and with encouraging implications for the longer term.

Equine-Assisted Psychotherapy for adolescents experiencing depression and/or anxiety: A therapist's perspective

Animal-Assisted Interventions (AAIs) are thought to overcome some of the limitations of traditional therapies as they do not rely exclusively on language as a medium for change. One such Animal-Assisted Therapy (AAT) approach involves horses as a therapeutic medium. Equine-Assisted Psychotherapy (EAP) comprises a collaborative effort between a licensed therapist and a horse professional working with clients to address treatment goals. The purpose of the present Australian-based qualitative study was to examine EAP facilitators' perspectives on the biospychosocial benefits and therapeutic outcomes of EAP for adolescents experiencing depression and/or anxiety. The findings suggest a range of improvements within adolescent clients, including increases in confidence, self-esteem and assertiveness, as well as a decrease in undesirable behaviours. The effectiveness of the therapy was thought to be due to the experiential nature of involving horses in therapy. The lack of understanding in the wider community about EAP was seen as a barrier to recognition and acceptance of EAP as a valid therapeutic intervention.

Practitioner Review: School-based interventions in child mental health

BACKGROUND

School-based interventions (SBIs) are well-established and effective treatments for improving child mental health. Specific school-based topics include prevention (Tier I-III) and interventions (e.g. cognitive-behavioural programmes and daily report cards).

METHODS

We performed a systematic literature search in five commonly used online databases (ERIC, MEDLINE, PsycARTICLES, PsycINFO and PSYNDEX) for English-language articles published between 1993 and 2015. Additional sources included reference lists of relevant articles and book chapters.

RESULTS

We identified a number of successful behavioural or cognitive-behavioural programmes yielding moderate to strong effects for a range of emotional and behavioural problems. The implementation of these programmes and the collaboration of the involved settings (school and home) and persons are important factors for their effectiveness under real-life conditions.

CONCLUSIONS

Effective SBIs are valuable tools for students with mental health problems if evidence-based cognitive-behavioural interventions are applied and rules of translational algorithms and implementation science are respected.

Short-term effects of the "Together at School" intervention program on children's socio-emotional skills: a cluster randomized controlled trial

BACKGROUND

Together at School is a universal intervention program designed to promote socio-emotional skills among primary-school children. It is based on a whole school approach, and implemented in school classes by teachers. The aim of the present study is to examine the short-term effects of the intervention program in improving socio-emotional skills and reducing psychological problems among boys and girls. We also examine whether these effects depend on grade level (Grades 1 to 3) and intervention dosage.

METHODS

This cluster randomized controlled trial design included 79 Finnish primary schools (40 intervention and 39 control) with 3 704 children. The outcome measures were the Strengths and Difficulties Questionnaire (SDQ) and the Multisource Assessment of Social Competence Scale (MASCS) with teachers as raters. The intervention dosage was indicated by the frequencies six central tools were used by the teachers. The data was collected at baseline and 6 months later. Intervention effects were analyzed using multilevel modeling.

RESULTS

When analyzed across all grades no intervention effect was observed in improving children's socio-emotional skills or in reducing their psychological problems at 6-month follow-up. Among third (compared to first) graders the intervention decreased psychological problems. Stratified analyses by gender showed that this effect was significant only among boys and that among them the intervention also improved third graders' cooperation skills. Among girls the intervention effects were not moderated by grade. Implementing the intervention with intended intensity (i.e. a high enough dosage) had a significant positive effect on cooperation skills. When analyzed separately among genders, this effect was significant only in girls.

CONCLUSIONS

These first, short-term results of the Together at School intervention program did not show any main effects on children's socio-emotional skills or psychological problems. This lack of effects may be due to the relatively short follow-up period given the universal, whole school-based approach of the program. The results suggest that the grade level where the intervention is started might be a factor in the program's effectiveness. Moreover, the results also suggest that for this type of intervention program to be effective, it needs to be delivered with a high enough dosage.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02178332 ; Date of registration: 03-April-2014.

Child, Teacher and Parent Perceptions of the FRIENDS Classroom-Based Universal Anxiety Prevention Programme: A Qualitative Study

School-based mental health prevention programmes can be effective but their adoption within schools will depend on their social acceptability. We report a qualitative evaluation summarising the views of children (115), parents (20) and school staff (47) about a universal school-based anxiety prevention programme FRIENDS. This study was conducted as part of a large scale randomised controlled trial (n = 1362) involving 40 schools in the UK providing primary education to children aged 7-11. Reported overall experience of the programme was very positive, with all three major components of the cognitive behaviour therapy programme (emotional, cognitive, and behavioural) being accepted well and understood by children. The programme was considered to be enjoyable and valuable in teaching children important skills, particularly emotional regulation and coping. Children provided examples of using the skills learned during FRIENDS to manage their emotions and solve problems. However, teachers were concerned that the programme overlapped with the current school curriculum, required additional time and almost half were unable to identify any tangible changes in the children's behaviour. Whilst this paper provides evidence to support the social validity of the FRIENDS anxiety prevention programme, the concerns raised by teachers question the longer-term sustainability of the programme.

Risiko- und Schutzfaktoren generalisierter Ängstlichkeit im Kindes- und Jugendalter

Zusammenfassung. Die generalisierte Angststörung bei Kindern und Jugendlichen weist eine Prävalenz von 2 % und ein Erstmanifestationsalter von 8.5 Jahren auf. Anhand der Daten der BELLA-Kohortenstudie wurden Einflüsse ausgewählter Risiko- und Schutzfaktoren auf das Auftreten und die Entwicklung von Symptomen generalisierter Angststörung (generalisierte Ängstlichkeit) untersucht. Mit latenten Wachstumsmodellen und linearen Regressionen wurden die Angaben von n = 1 469 Teilnehmern (11 bis 17 Jahre) zu drei Messzeitpunkten analysiert. Zu Studienbeginn wirkte die elterliche Ängstlichkeit als Risikofaktor und das Selbstwertgefühl der Kinder und Jugendlichen als Schutzfaktor auf die generalisierte Ängstlichkeit. Initiale elterliche Ängstlichkeit wirkte auch nachhaltig auf die Veränderung generalisierter Ängstlichkeit über den Studienverlauf. Weiterhin ging eine Verbesserung des Selbstwertgefühls über den Studienverlauf mit einem Abfall generalisierter Ängstlichkeit einher. Einflüsse der potentiellen Schutzfaktoren elterliche Fürsorge und soziale Unterstützung lagen nicht vor. Obwohl nur geringe Effekte gefunden wurden, ist das Selbstwertgefühl für die klinische Arbeit mit Kindern und Jugendlichen mit generalisierter Angststörung interessant.

Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

BACKGROUND

Childhood anxiety presents a serious mental health problem, and it is one of the most common forms of psychological distress reported by youth worldwide. The prevalence of anxiety symptoms amongst South African youth is reported to be significantly higher than in other parts of the world. These high prevalence rates become even more significant when viewed in terms of children with visual impairments, as it is suggested that children with physical disabilities may be more prone, than their non-disabled peers, for the development of psychological difficulties.

OBJECTIVES

The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments.

METHOD

A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9-13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- post- and follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants' symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale.

CONCLUSION

If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African) anxiety intervention programmes can be built.

The risk and protective factors associated with depression and anxiety in a national sample of Irish adolescents

OBJECTIVES

The aim of this study is to examine the risk and protective factors associated with anxiety and depression in a representative sample of Irish adolescents.

METHODS

Data used in this study were drawn from a subset of the My World Survey (MWS). The MWS-Second Level (MWS-SL) subset consists of a randomised sample of 72 schools, with a final sample of 6085 students. Outcome measures were depression and anxiety. Risk and protective factors included measures within the socio-demographic, psychosocial and risk-taking domains.

RESULTS

One in three adolescents experienced elevated levels of depression and anxiety. Age, gender, maternal education, family composition, parental mental health as well as the experience of racism and bereavement were associated with elevated distress. Psychosocial factors associated with depression and anxiety included optimism, personal competence, life-satisfaction, self-esteem, anger, body dissatisfaction, family competence, maternal and paternal criticism, experiencing the break-up of a romantic relationship, school and peer connectedness as well as the availability of one good adult. Finally, engaging in substance misuse was found to increase the likelihood of anxiety and depression.

CONCLUSION

Since factors protecting and putting adolescents at risk of anxiety and depression exist at every level of the adolescent's ecological system, the study supports a community-based approach to youth mental health.

Targeted group-based interventions in schools to promote emotional well-being: a systematic review

The school environment offers significant opportunities to deliver psychological interventions to groups of young people in the UK. However, the nature and effectiveness of programmes are not consistently documented. This systematic review aimed to identify and examine group-based interventions delivered in UK schools. Sixteen papers describing eight interventions were included. It was found that nurture groups have an immediate positive impact on the social and emotional well-being of young people. Results from follow-up studies are less clear, and limited by a high level of sample attrition. The findings reported in relation to social and emotional aspects of learning, cognitive, behavioural and social skills based interventions were limited as each intervention is only evaluated by one paper. The review highlighted a need to implement well-designed, longitudinal studies with larger samples in order to evaluate which interventions are effective in UK schools.

A qualitative process evaluation of classroom-based cognitive behaviour therapy to reduce adolescent depression

Small scale trials indicate that classroom-based Cognitive Behaviour Therapy (CBT) for adolescents has good reach and can help prevent depression. However, under more diverse everyday conditions, such programmes tend not to show such positive effects. This study examined the process of implementing a classroom-based CBT depression prevention programme as part of a large (n = 5,030) randomised controlled trial across eight UK secondary schools which was not found to be effective (PROMISE, ISRCTN19083628). The views of young people (n = 42), teachers (n = 12) and facilitators (n = 16) involved in the Resourceful Adolescent Programme (RAP) were obtained via focus groups and interviews which were thematically analysed. The programme was considered to be well structured and contain useful content, particularly for younger pupils. However, challenges associated with implementation were its age appropriateness for all year groups, its perceived lack of flexibility, the consistency of quality of delivery, the competing demands for teacher time and a culture where academic targets were prioritised over personal, social and health education. Whilst schools are convenient locations for introducing such programmes and allow good reach, the culture around improving well-being of young people in schools, increasing engagement with teachers and young people and sustaining such programmes are issues that need addressing.

A qualitative investigation of adolescents' perceived mechanisms of change from a universal school-based depression prevention program

A recent meta-analysis provides evidence supporting the universal application of school-based prevention programs for adolescent depression. The mechanisms underlying such successful interventions, however, are largely unknown. We report on a qualitative analysis of 109 Grade 9 students' beliefs about what they gained from an evidence-based depression prevention intervention, the Resourceful Adolescent Program (RAP-A). Fifty-four percent of interviewees articulated at least one specific example of program benefit. A thematic analysis of responses revealed two major themes, improved interpersonal relationships and improved self-regulation, both stronger than originally assumed. A more minor theme also emerged-more helpful cognitions. It is postulated that both improved interpersonal relationships and improved self-regulation are likely to enhance one another, and more helpful cognitions may express its contribution through enhanced self-regulation. These findings broaden our understanding of the impact of depression prevention programs, beginning to illuminate how such programs benefit participants.

Parenting and problem behaviors in children of substance abusing parents

BACKGROUND

This study examined parenting practices, parental stress, and problem behaviors among urban Children of Substance Abusing Parents.

METHOD

One hundred and seven children completed the Child Rating Scale and the Children's Depression Inventory. Parents completed the Parenting Practices Scale-Parent Version, Parenting Stress Index, and internalizing and externalizing scales on the Parent Observation of Classroom Adaptation.

RESULTS

Structural Equation Modeling findings support an indirect effects pathway in which unfavorable parenting practices predict parental stress and parental stress predicts internalizing and externalizing behaviors.

CONCLUSION

The results argue for assessing parental stress and including activities to improve the parent-child bond in family intervention programs.

Psychometric properties of the Persian version of the screen for child anxiety-related emotional disorders (SCARED)

The present study examined the psychometric properties of the Persian translation of the Screen for Child Anxiety-Related Emotional Disorders-child version (SCARED-C) in a community sample of 557 children, aged 9-13 years, in the city of Isfahan, Iran. In addition to the SCARED-C, all the participants completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). The SCARED-C demonstrated moderate to high internal consistency (alpha=0.59-0.80) and good convergent and divergent validity. The one-factor and the five-factor model of the SCARED-C fitted the data moderately. However, the five-factor model had a significantly better fit than the one-factor model (Δχ(2)=287.346, df=10, P<.001). These findings showed that SCARED-C can be used as a reliable and valid measure of anxiety symptoms among children in Iran.

Universal Prevention of Anxiety and Depression in a Recreational Camp Setting: An Initial Open Trial

BACKGROUND: Anxiety and depressive disorders may pose a long-term, deleterious impact on youth, prompting a need for early and effective prevention of such concerns. A growing body of research has examined universal prevention programs targeting these emotional disorders in childhood. While most universal prevention programs are offered within the school setting, there is also a rationale for developing and investigating prevention programs within novel settings, including a recreational context. OBJECTIVE: This initial investigation utilized the Emotion Detectives Prevention Program (EDPP), a universal prevention protocol focusing on anxiety and depression symptoms within a recreational summer camp. The aims of this pilot study were to assess the EDPP's feasibility and participant satisfaction following its initial administration in a camp setting. METHOD: Forty children (ages 7-10 years, 70.7% male) were recruited from an existent recreational sports camp and participated in a non-randomized, open trial of the EDPP. The EDPP, a 15-session program, presents cognitive-behavioral strategies in a manner that emphasizes strategy applicability across a range of emotional experiences. RESULTS: Participating children reported a significant decrease in anxiety symptoms at post-prevention. No significant change in depression symptoms or other emotion regulation indices were reported. Moderate to high participant satisfaction was indicated. CONCLUSIONS: The EDPP appears to be a feasible program for the prevention of child-reported anxiety symptoms in a camp setting. Given the novelty of the prevention context, issues inherent in the conduct of research in a recreational camp setting and future directions for research in this setting are discussed.

Prevention of anxiety disorders

Research into the prevention of anxiety has increased dramatically in the past few years. Prevention programs have been directed at broad, nonspecific anxiety and at more specific anxiety types, such as panic disorder and post-traumatic stress disorder. Prevention of anxiety is still a relatively new field, but there has been a recent surge of literature reporting on different prevention programs. Universal prevention trials have shown modest but promising results, and school-based programs offered to all students also help to reduce stigmatization and common barriers to accessing treatment (eg, time, location, and cost). In contrast, targeted programs tend to show somewhat larger effects but rely on identification of relevant populations. Specific programs for the prevention of panic disorder and post-traumatic stress disorder have also demonstrated some preliminary success. This paper reviews the recent studies of prevention of anxiety and discusses several key issues, specifically (1) identification of at-risk participants for prevention programs, (2) motivation for participation, (3) optimal age for intervention, and (4) who should deliver the program.

A meta-analysis of anxiety symptom prevention with cognitive-behavioral interventions

This meta-analysis assessed efficacy of cognitive-behavioral interventions in preventing anxiety symptoms. A systematic review identified 15 independent pretest-posttest randomized or quasi-randomized efficacy trials for analysis. At posttest, intervention groups demonstrated significantly greater symptom reduction compared to control groups resulting in weighted mean effect sizes (Hedges' g) of 0.25 for general anxiety, 0.24 for disorder-specific symptoms, and 0.22 for depression after the removal of outliers. These effects appeared to diminish over 6- and 12-month follow-up. Exploratory moderator analyses indicated that individually administered media interventions were more effective than human-administered group interventions at preventing general anxiety and depression symptoms. Implications of current findings are discussed with attention to existing gaps in the literature.

Assessment and treatment of anxiety disorders in children and adolescents

This article reviews the current screening and assessment tools for anxiety disorders in children and adolescents, as well as evidence-based treatment interventions for these disorders. The following anxiety disorders are discussed: separation anxiety disorder, generalized anxiety disorder, specific phobia, panic disorder, social anxiety disorder (social phobia), and selective mutism. There are several well-studied screening and assessment tools to identify childhood anxiety disorders early and differentiate the various anxiety disorders. Evaluations of baseline somatic symptoms, severity, and impairment ratings of the anxiety disorders, and collecting ratings from several sources is clinically helpful in assessment and treatment follow-up. Cognitive-behavioral therapy (CBT) has been extensively studied and has shown good efficacy in treatment of childhood anxiety disorders. A combination of CBT and medication may be required for moderate to severely impairing anxiety disorders and may improve functioning better than either intervention alone. Selective serotonin reuptake inhibitors are currently the only medications that have consistently shown efficacy in treatment of anxiety disorders in children and adolescents. Despite proven efficacy, the availability of CBT in the community is limited. Current research is focusing on early identification of anxiety disorders in community settings, increasing the availability of evidence-based interventions, and modification of interventions for specific populations.

Community-based prevention programs for anxiety and depression in youth: a systematic review

Little is known about the effectiveness of prevention and early intervention programs for young people and adolescents once they leave or dropout from school. The effectiveness of 18 anxiety and 26 depression studies addressing prevention in community programs were identified using systematic review methodology. Anxiety and depression symptoms were reduced in ~60% of the programs. Cognitive behavioral therapy programs were more common than other interventions and were consistently found to lower symptoms or prevent depression or anxiety. Automated or computerized interventions showed promise, with 60% of anxiety programs and 83% of depression programs yielding successful outcomes on at least one measure. Further research is needed to determine the active components of successful programs, to explore cost-effectiveness and scalability factors, to investigate individual predictors of successful outcome, and to design best practice prevention programs.

Profiles of Personal Resiliency in Child and Adolescent Psychiatric Inpatients

To ascertain whether children and adolescents whose ages ranged from 9 to 17 years described distinct profiles of personal resiliency, the Resiliency Scales for Children and Adolescents (RSCA) were administered to 100 youth who were admitted to an inpatient psychiatric unit and were diagnosed with various DSM-IV-TR disorders along with the Beck Youth Inventories of Emotional and Social Impairment (BYI-II). Four profiles based on the RSCA Sense of Self-Mastery, Sense of Relatedness, and Emotional Reactivity scales were identified by a k-means nonhierarchical cluster analysis. The profiles were not differentiated with respect to sex, age, being Caucasian, or diagnoses, but were discriminated with respect to different levels of self-reported symptoms as measured by the BYI-II scales. The results were discussed as suggesting that different profiles of personal resiliency should be considered when treating psychiatric inpatients.

Immediate and short-term outcomes of the 'COPEing with Toddler Behaviour' parent group

BACKGROUND

Controlling, uninvolved, and rejecting parenting in early childhood are strong predictors of later disruptive behavior disorders. However, there have been no evaluations of non-targeted groups for parents of very young children, despite their potential advantages.

METHODS

We randomly assigned 79 mothers of 12- to 36-month-olds to an 8-session parent training program (called 'COPEing with Toddler Behaviour') or to a waiting list control condition. We investigated the immediate and short-term impact on parent-reported child behavior problems, observed parent-child interaction, and self-reported parenting behavior and parent functioning.

RESULTS

In an intent-to-treat design, the program yielded significant effects on child behavior problems, positive parent-child interaction, and parental overreactivity and depression but not observed negative child behavior or parental laxness. Most effects were significant at both post-test and 1-month follow-up and effects sizes were small to medium for the intervention group and inverse to small for the control group.

CONCLUSIONS

The potential of the program to prevent later behavior problems is supported by improvements in six of the eight outcomes. As part of a community strategy, groups such as COPEing with Toddler Behaviour may promote positive parent-child interaction and children's mental health.

Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety

A systematic review was conducted of school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%). Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher delivery.

Evidence-based psychosocial treatments for child and adolescent depression

The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines, the cognitive-behavioral therapy (CBT) based specific programs of Penn Prevention Program, Self-Control Therapy, and Coping with Depression-Adolescent are probably efficacious. Interpersonal Therapy-Adolescent, which falls under the theoretical category of interpersonal therapy (IPT), also is a probably efficacious treatment. CBT provided through the modalities of child group only and child group plus parent components are well-established intervention approaches for depressed children. For adolescents, two modalities are well-established (CBT adolescent only group, IPT individual), and three are probably efficacious (CBT adolescent group plus parent component, CBT individual, CBT individual plus parent/family component). From the broad theoretical level, CBT has well-established efficacy and behavior therapy meets criteria for a probably efficacious intervention for childhood depression. For adolescent depression, both CBT and IPT have well-established efficacy. Future research directions and best practices are offered.