Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention
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Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5–18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d ) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies ( n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37–0.60], selective (RR 0.61, 95% CI 0.43–0.85) or indicated (RR 0.48, 95% CI 0.29–0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.)
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The booster session contributed to maintaining long-term effects.
“Indeed, the booster session contributed to maintaining longterm effects, highlighting the relevant role of the booster session for the transdiagnostic treatment in the maintenance of effects over time, which is consistent with reports from other studies (Loevaas et al., 2020;Rasing et al., 2017;Stockings et al., 2016).”
From Effectiveness of a transdiagnostic indicated preventive intervention for adolescents at high risk for anxiety and depressive disorders (2024) · cites this paper as Stockings et al., 2016
The Discussion (page unavailable) suggests that repeated exposure to a psychological intervention may be necessary to maintain benefits over time. It does not establish that a booster session contributed to maintained long-term effects, or evaluate a booster session in the cited transdiagnostic treatment. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMost studies of indicated prevention have found relatively small or modest short-term effects, with many findings dissipating over the long term, suggesting a need for booster sessions.
“However, most of the studies have found relatively small or modest effects in the short term, with many findings dissipating over the long term, which suggests the need for booster sessions to maintain the effects of such indicated programs over time (Rasing et al., 2017;Stockings et al., 2016).”
From Effectiveness of a transdiagnostic indicated preventive intervention for adolescents at high risk for anxiety and depressive disorders (2024) · cites this paper as Stockings et al., 2016
Booster sessions may have reduced the likelihood of the onset of clinical disorders in both conditions.
“Another explanation is that booster sessions may have reduced the likelihood of the onset of clinical disorders in both conditions, as authors have argued that booster sessions could maintain the effects of interventions over time (Rasing et al., 2017;Stockings et al., 2016).”
From Effectiveness of a transdiagnostic indicated preventive intervention for adolescents at high risk for anxiety and depressive disorders (2024) · cites this paper as Stockings et al., 2016
Universal prevention for mental health has an advantage in its less stigmatizing nature.
“The universal prevention for mental health also has an advantage in its less stigmatizing nature28.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [28]
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“However, most of the studies have found relatively small or modest effects in the short term, with many findings dissipating over the long term, which suggests the need for booster sessions to maintain the effects of such indicated programs over time (Rasing et al., 2017; Stockings et al., 2016).”
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- Authors
- Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., & Patton, G.
- Affiliations
- UNSW Sydney (AU)
- University of Washington (US)
- Australian National University (AU)
- The University of Queensland (AU)
- Royal Children's Hospital (AU)
- Corresponding author
- Stockings, E. A.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-08-28
- Volume
- 46
- Issue
- 1
- Pages
- 11-26
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W1864246873
- Cited by
- 345
- References
- 27
- Citations by year
- 2026: 17 · 2025: 27 · 2024: 50 · 2023: 40 · 2022: 25 · 2021: 53 · 2020: 36 · 2019: 29 · 2018: 29 · 2017: 24 · 2016: 13 · 2014: 1
- FWCI
- 27.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Deakin Research Online (Deakin University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Australian Government (APP1041472)
- University of New South Wales
- Medical Research Council
- National Health and Medical Research Council (1041131, APP1041472, 1019887)
- National Drug and Alcohol Research Centre (APP1041472)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression prevention, anxiety prevention, internalizing disorders, universal prevention, selective prevention, indicated prevention, children and adolescents, comorbidities, psychological intervention, school-based intervention
- MeSH terms
- Adolescent, Anxiety Disorders, Child, Child, Preschool, Depressive Disorder, Humans, Outcome Assessment, Health Care, Early Medical Intervention
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