Annual Research Review: Universal and targeted strategies for assigning interventions to achieve population impact
Abstract
This article proposes that universal and targeted preventive interventions should be compared and evaluated in terms of their benefit–cost ratio in achieving population‐wide impact on mental disorders and related outcomes. Universal approaches attempt to affect every individual in a population, whereas targeted approaches select candidates for intervention based on screening of demographic or behavioral characteristics. Unique assets and challenges of each approach in achieving population impact in a cost‐efficient way are discussed, along with spillover effects, sensitivity and specificity, developmental processes, timing of intervention, and the relation between severity of risk and plasticity. A general targeted‐efficiency framework is proposed as a heuristic to evaluate the collective merits of universal and targeted approaches in specific cases. A tiered approach that combines universal and targeted identification strategies is proposed, and examples are described. Issues for high‐priority research are identified.
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Help-seeking is known to be associated with a self-selection bias.
“As help-seeking is known to be associated with a self-selection bias, there is an urgent need to offer help at very early stages even before individuals actively seek help while keeping the advantages of targeted prevention [26, 32].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [26]
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“It has also been argued that indicated prevention programs may have the potential to be effective, given the greater potential scope of the change in symptoms (Dodge, 2020; Jiménez-Vázquez et al., in press).”
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“Our results align with recent efforts to utilize targeted intervention to identify and deliver services to subgroups of individuals who are at relatively high-risk based characteristics of the group (Dodge, 2020).”
ResultHirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2 · see citing works
“While universal and targeted prevention should be conceptualized as complementary approaches [22, 26], indicated prevention targeting individuals with minimal signs or symptoms of a mental disorder below the diagnostic threshold [22, 27] seems especially beneficial.”
Background
- Authors
- Dodge, K. A.
- Affiliations
- Duke University (US)
- Corresponding author
- Dodge, Kenneth A.
- ORCID
- Dodge, Kenneth A.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-10-23
- Volume
- 61
- Issue
- 3
- Pages
- 255-267
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2982241607
- Cited by
- 95
- References
- 58
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 12 · 2023: 12 · 2022: 25 · 2021: 10 · 2020: 9 · 2014: 1
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- universal prevention, targeted prevention, mental illness, benefit-cost ratio, spillover effects, screening, sensitivity and specificity, developmental processes, intervention timing, risk severity, neuroplasticity, cost efficiency, population effects
- MeSH terms
- Mental Disorders, Cost-Benefit Analysis, Humans, Outcome and Process Assessment, Health Care, Preventive Health Services, Patient Selection
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