Cited by 345Child and Adolescent Psychosocial and Emotional DevelopmentAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

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Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention

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Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., Patton, G.·2016·Psychological Medicine

DOI 10.1017/s0033291715001725

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Abstract

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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“According to recent reviews, the durability of universal prevention programs for anxiety and depression has not been investigated beyond 4 years post intervention and into the young adult years [28-30].”
Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders
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Implementing a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark
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Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial
Kawakami, N., Imamura, K., Watanabe, K., Sekiya, Y., Sasaki, N., Sato, N., & SMART-CBT Project Team (2021) · JMIR Research Protocols · doi:10.2196/30305 · Cited by 12
“Universal interventions also have an advantage in possessing a less stigmatizing nature than other interventions in the field of mental health [16].”
A Transactional, Whole-School Approach to Resilience
Cefai, C. (2021) · doi:10.1093/oso/9780190095888.003.0013 · Cited by 12
“Various reviews of studies provide evidence for the effectiveness of school- based, universal interventions like FRIENDS in improving self- confidence and social skills and reducing anxiety and depression among school children (Brunwasser, Gillham, & Kim 2009; Dray et al., 2017; Stockings et al., 2016; Werner- Seidler…”
Background
Prävention psychischer Störungen bei Kindern und Jugendlichen
Schulte‐Körne, G. (2022) · Monatsschrift Kinderheilkunde · doi:10.1007/s00112-022-01508-6 · Cited by 12
“Selektive präventive Maßnahmen adressieren Risikogruppen für psychische Erkrankungen, zu denen Kinder psychisch erkrankter Eltern gehören.”
BackgroundInfluential
The Effectiveness of Mental Health First Aid Training among Undergraduate Students in Switzerland: A Randomized Control Trial
Dzemaili, S., Pasquier, J., Bachmann, A. O., & Mohler‐Kuo, M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021303 · Cited by 12
“Another reason for lack of seeking help includes mental illness stigma and lack of knowledge regarding mental health problems [21].”
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Health and Disease in Adolescence
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“Preventive measures start before the onset of the disease and can effectively reduce the symptoms of mental disorders (Horowitz and Garber, 2006; Stockings et al., 2016).”
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Effectiveness of Internet-based cognitive behavioural therapy for employees with depression: a systematic review and meta-analysis
Xiong, J., Wen, J. L., Pei, G., Han, X., & He, D. Q. (2022) · International Journal of Occupational Safety and Ergonomics · doi:10.1080/10803548.2022.2043647 · Cited by 12
“[21], pharmacological interventions [22], music interventions [23], active control [24] and Internet-based interventions [25].”
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A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators
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“However, it is worth noting that within the field of youth depression prevention, even the most powerful interventions only reach “small” effects [56].”
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Using effective community coalitions to prevent mental and behavioral disorders on a national scale
Toumbourou, J. W., Westrupp, E. M., Benstead, M., Klettke, B., Clancy, E. M., Kelly, A. B., Reavley, N. J., & Rowland, B. (2024) · Mental Health & Prevention · doi:10.1016/j.mhp.2024.200322 · Cited by 11
Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial
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“While prevention interventions for anxiety and depression already exist for adolescents and young people, systematic reviews suggest that effect sizes are relatively small [13-15].”
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Garaigordobil, M., Jaureguizar, J., & Bernarás, E. (2018) · The Journal of Psychology · doi:10.1080/00223980.2018.1502741 · Cited by 11
“depressive symptomatology at early ages (Stockings et al., 2016), this work provides a program to prevent childhood depression that has been proven effective to reduce clinical variables.”
BackgroundInfluential
Follow‐up of the Cool Little Kids translational trial into middle childhood
Bayer, J. K., Brown, A. M., Prendergast, L. A., Bretherton, L., Hiscock, H., Mihalopoulos, C., Nelson‐Lowe, M., Gilbertson, T., Noone, K., Bischof, N., et al. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13464 · Cited by 12
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Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression
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Examining Caretaker Attitudes Towards Primary Prevention of Pediatric Behavioral Health Problems in Integrated Care
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“School-based interventions and mental health prevention programs are recognized as cost-effective alternatives [40,47,49].”
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Outcomes of a Randomized Controlled Trial on the Effectiveness of Depression and Anxiety Prevention for Adolescents with a High Familial Risk
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“Recent review studies found that there is less evidence for the effectiveness of universally delivered depression prevention in adolescence [22,23].”
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Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial
Piña, A., Gonzales, N. A., Mazza, G. L., Gunn, H., Holly, L. E., Stoll, R. D., Parker, J. H., Chiapa, A., Wynne, H., & Tein, J. (2020) · Prevention Science · doi:10.1007/s11121-019-01066-6 · Cited by 11
“…segment of the population (~ 31.9%; Merikangas et al. 2010) and schools being staffed to respond as the primary source of care (80% of schools staff mental health and/or wellness personnel and anxiety is covered under the Individuals with Disabilities Education Act [2004]; Stockings et al. 2016).”
BackgroundInfluential
Does virtual reality increase the efficacy of psychotherapy for young adults with mild-to-moderate depression? A study protocol for a multicenter randomized clinical trial
Montesano, A., Medina, J. C., Paz, C., García‐Mieres, H., Niño‐Robles, N., García‐Grau, E., Cañete, J., Garcia-Gutierrez, A., Alabèrnia-Segura, M., & Feixas, G. (2021) · Trials · doi:10.1186/s13063-021-05809-1 · Cited by 11
The school-led Preventure study: Protocol of a cluster-randomised controlled trial of effectiveness to prevent adolescent alcohol misuse, internalising problems, and externalising problems through a personality-targeted intervention delivered by school staff
Kelly, E. V., Grummitt, L. R., Birrell, L., Stapinski, L. A., Barrett, E. L., Boyle, J., Teesson, M., & Newton, N. C. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101286 · Cited by 10
Lessons from Iceland: Developing scalable and sustainable community approaches for the prevention of mental disorders in young Australians
Hoare, E., Thorisdóttir, I. E., Kristjansson, A. L., Sigfusdóttir, I. D., Hayward, J., Allender, S., Strugnell, C., Reavley, N., Patton, G., Berk, M., et al. (2019) · Mental Health & Prevention · doi:10.1016/j.mhp.2019.200166 · Cited by 9
Self-citation
Identifying Adolescents at Risk for Emotional Disorders with Latent Profile Analysis: A Personalized, Transdiagnostic Preventive Intervention
Piqueras, J. A., Falcó, R., Rico‐Bordera, P., Canals, J., Fernández, L. E., Vivas-Fernández, M., López, L. J. G., on behalf of PROCARE team, Díaz-Castela, M. D. M., Jiménez-Vázquez, D., et al. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-024-01689-z · Cited by 9
“Thus, in the meta-analysis by Stockings et al. [61], regarding selective prevention interventions, the type of risk used ranged from teenage pregnancy to above-average standard deviation on a personality risk scale, having a close relative with major depression, being a child of divorced parents,…”
Barriers and facilitators to targeted anxiety prevention programmes in families at risk: a qualitative interview study
Lawrence, P. J., Harvey, K., Williams, C., & Creswell, C. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01703-4 · Cited by 9
Project ASPIRE: A feasibility randomized controlled trial of a brief intervention for reducing risk of depression and alcohol-related harms among South African adolescents
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“…the effectiveness of early interventions for reducing risk of mental health and substance use problems among adolescents globally (González-Valero et al., 2019; Huang et al., 2018; Stockings et al., 2016; Tindall et al., 2017; Weersing et al., 2017), most studies come from high income countries.”
Background
Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood—a six-year cohort study with repeated exposure measurements
Wiehn, J., Kurth, T., Ravens‐Sieberer, U., Prugger, C., Piccininni, M., & Reiß, F. (2024) · Frontiers in Pediatrics · doi:10.3389/fped.2024.1252964 · Cited by 8
Interventions Targeting Anxiety in Individuals with Learning Disabilities: A Scoping Review
Beaudoin, E., Blackburn, S., Hove, I. E., & Sladeczek, I. E. (2024) · Learning Disabilities Research and Practice · doi:10.1177/09388982241295772 · Cited by 8
“Some researchers have found anxiety interventions for students without LD to demonstrate effectiveness in reducing anxiety symptoms (Carpenter et al., 2018; Fisak et al., 2023, 2011; Neil & Christensen, 2009; Newby et al., 2015; Stockings et al., 2016; Werner-Seidler et al., 2017).”
The effectiveness of targeted preventive interventions for depression symptoms in children and adolescents: Systematic review and meta-analyses
Luttinen, J., Watroba, A., Niemelä, M., Miettunen, J., & Ruotsalainen, H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.002 · Cited by 13
Internalized Stigma Is a Predictor of Mental Health Secrecy and Loneliness in Young People With Clinical Depression Symptoms: A Longitudinal Study
Prizeman, K., McCabe, C., & Weinstein, N. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23789 · Cited by 11
Exploring the Role of Resilience as a Mediator in Selective Preventive Transdiagnostic Intervention (PROCARE+) for Adolescents at Risk of Emotional Disorders
Vivas-Fernández, M., López, L. J. G., Muela-Martínez, J. A., Piqueras, J. A., Fernández, L. E., Jiménez-Vázquez, D., & Díaz-Castela, M. D. M. (2024) · European Journal of Psychology Open · doi:10.1024/2673-8627/a000054 · Cited by 11
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Vivas-Fernández, M., López, L. J. G., & David, J.-V. (2024) · Revista de Psicología Clínica con Niños y Adolescentes · doi:10.21134/rpcna.2024.11.2.1 · Cited by 11
“This observation aligns with the insights of Ghandour et al. (2019) and Stockings et al. (2016), who emphasized the impact and need for targeted interventions in this population.”
BackgroundResult
Does School-Based Recruitment for Anxiety Interventions Reach Youth Not Otherwise Identified? A Comparison Between a School-Based Sample and a Clinical Sample
Husabø, E. B., Haugland, B. S. M., McLeod, B. D., Ogden, T., Rapee, R. M., & Wergeland, G. J. (2020) · School Mental Health · doi:10.1007/s12310-019-09357-7 · Cited by 8
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“Additionally, other meta-analyses (Fisak, 2014; Stockings et al., 2016; Werner-Seidler et al., 2017) addressing prevention often include data from children and adolescents and do not assess at a particular age period, as our analyses have done.”
Results of a brief online group application of the unified protocol for the preventionof emotional disorders in university students: a pilot study with multiple baseline experimental design
Socias-Soler, J., Martínez‐García, L., Péris-Baquero, Ó., & Osma, J. (2024) · Anales de Psicología · doi:10.6018/analesps.554261 · Cited by 9
Prevention Approaches for Compulsive Buying-Shopping Disorder
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Evaluation of a CBT‐Based Program for Mental Health in the General Population During the COVID‐19 Pandemic: A Stepped‐Care Approach Using a Chatbot and Digitized Group Intervention
Langhammer, T., Hilbert, K., Wasenmueller, R., Praxl, B., Ertle, A., Asbrand, J., & Lueken, U. (2024) · Depression and Anxiety · doi:10.1155/2024/8950388 · Cited by 7
“Numerous studies investigating indicated prevention for depression and anxiety disorders have demonstrated the bene ﬁ ts of both online and in-person interventions [9, 10].”

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.
ORCID: Stockings, E. A.
Degenhardt, L.
Dobbins, T.
Lee, Y. Y.
Erskine, H. E.
Whiteford, H. A.
Patton, G.
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
DOI: 10.1017/s0033291715001725
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
FWCI: 27.28
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
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
Health Sciences › Medicine › Psychiatry and Mental health › 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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Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention

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