Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs

Siobhan Hugh-Jones,Pavan Mallikarjun,Sophie Beckett,Ella Tumelty

doi:10.1007/s00787-020-01564-x

Abstract

Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based interventions exist but it is unclear how effective targeted approaches are for reducing symptoms of anxiety. This review and meta-analysis aimed to determine the effectiveness of school-based indicated interventions for symptomatic children and adolescents. The study was registered with PROSPERO [CRD42018087628]. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library for randomised-controlled trials comparing indicated programs for child and adolescent (5–18 years) anxiety to active or inactive control groups. Data were extracted from papers up to December 2019. The primary outcome was efficacy (mean change in anxiety symptom scores). Sub-group and sensitivity analyses explored intervention intensity and control type. We identified 20 studies with 2076 participants. Eighteen studies were suitable for meta-analysis. A small positive effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = − 0.28, CI = − 0.50, − 0.05, k = 18). This benefit was maintained at 6 (g = − 0.35, CI = − 0.58, − 0.13, k = 9) and 12 months (g = − 0.24, CI = − 0.48, 0.00, k = 4). Based on two studies, > 12 month effects were very small (g = − 0.01, CI = − 0.38, 0.36). No differences were found based on intervention intensity or control type. Risk of bias and variability between studies was high (I2 = 78%). Findings show that school-based indicated programs for child and adolescent anxiety can produce small beneficial effects, enduring for up to 12 months. Future studies should include long-term diagnostic assessments.

Highlights

Approximately 117 million children and young people are affected by anxiety disorders [1]
Four studies (20%) used diagnostic screening interviews that led to the inclusion of children who met both clinical and sub-clinical thresholds for anxiety disorder [33,34,35,36]
We found an overall small post-test effect sizes (ES) for anxiety symptom reduction of − 0.28 for intervention groups compared to controls

Summary

Introduction

Approximately 117 million children and young people are affected by anxiety disorders [1]. Fewer than 20% of young people with anxiety disorder access support [2], and of those that do, a significant minority end treatment prematurely or do not benefit [3, 4]. Cost-effectiveness analyses indicate that treatment alone is insufficient to eliminate the disease burden of these disorders and that investment in prevention and early intervention are needed [5]. Elevated anxiety symptoms affect quality of life and are a risk factor for anxiety disorders. The reduction of elevated symptoms is important to improve functioning and well-being, and to potentially prevent new cases of disorder.

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Discussion

Conclusion