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Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention
Open accessAbstract
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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“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
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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).”
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
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“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
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“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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Self-citationWhiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61611-6 · Cited by 6,006
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Cited by
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Our future: a Lancet commission on adolescent health and wellbeing
Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00579-1 · Cited by 3,785
Self-citationThe social determinants of mental health and disorder: evidence, prevention and recommendations
Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J. L., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., et al. (2024) · World Psychiatry · doi:10.1002/wps.21160 · Cited by 1,619
“Relevantly, a 2016 review estimated that universal prevention programs of depression and anxiety delivered in schools (mostly CBTbased) prevented 50% of cases of a diagnosable internalizing disorder in the following 6 to 9 months 345 .”
BackgroundThe impact of COVID-19 lockdown on child and adolescent mental health: systematic review
Panchal, U., Salazar de Pablo, G., Franco, M., Moreno, C., Parellada, M., Arango, C., & Fusar-Poli, P. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01856-w · Cited by 1,028
Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.10.005 · Cited by 773
“…conducted on diagnostic outcomes following prevention programs consistently support this assertion, with a recent review showing that preventive programs are associated with a 53% decrease in risk of internalising disorder onset in the 6-9 months following program delivery (Stockings et al., 2016).”
BackgroundResultInfluentialPreventive strategies for mental health
Arango, C., Díaz-Caneja, C. M., McGorry, P. D., Rapoport, J., Sommer, I. E., Vorstman, J. A., McDaid, D., Marín, O., Serrano-Drozdowskyj, E., Freedman, R., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30057-9 · Cited by 1,271
“60 Examples of effective indicated interventions supported by meta-analyses include parent management training to prevent externalizing disorders in children with high antisocial behaviour scores, 77 and to prevent depression and anxiety disorders in children showing early manifestations of…”
Metadata
- 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
- 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
- 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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