Abstract
SummaryBackgroundRates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.MethodsWe did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4–18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.Findings1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD −0·65, 95% credible interval −1·14 to −0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.InterpretationConsidering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.FundingUK National Institute for Health Research.
Highlights
Common mental disorders are a key cause of morbidity in children and young people younger than 18 years
Evidence suggests that lifetime trajectories of common mental disorders are established by mid-adolescence[2] with half of all mental disorders starting by age 14 years, and three-quarters by age 25 years.[3]
We report a systematic review and network meta-analysis to assess the comparative effectiveness of educational setting-based interventions for preventing depression and anxiety in children and young people
Summary
Common mental disorders are a key cause of morbidity in children and young people younger than 18 years. Depressive disorders are the third most frequent cause of adolescent disability-adjusted life-years lost, and anxiety disorders are the fifth most frequent cause of disability-adjusted life-years lost for adolescent girls.[1] Evidence suggests that lifetime trajectories of common mental disorders are established by mid-adolescence[2] with half of all mental disorders starting by age 14 years, and three-quarters by age 25 years.[3] Even in the context of under-reporting and detection, rates of anxiety and depression are high and increasing among children and young people.[4,5,6]. Against this background there is a growing imperative for primary prevention of common mental disorders in children and young people
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