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Universal Prevention for Anxiety and Depressive Symptoms in Children: A Meta-analysis of Randomized and Cluster-Randomized Trials

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Abstract

Although under-diagnosed, anxiety and depression are among the most prevalent psychiatric disorders in children and adolescents, leading to severe impairment, increased risk of future psychiatric problems, and a high economic burden to society. Universal prevention may be a potent way to address these widespread problems. There are several benefits to universal relative to targeted interventions because there is limited knowledge as to how to screen for anxiety and depression in the general population. Earlier meta-analyses of the prevention of depression and anxiety symptoms among children suffer from methodological inadequacies such as combining universal, selective, and indicated interventions in the same analyses, and comparing cluster-randomized trials with randomized trials without any correction for clustering effects. The present meta-analysis attempted to determine the effectiveness of universal interventions to prevent anxiety and depressive symptoms after correcting for clustering effects. A systematic search of randomized studies in PsychINFO, Cochrane Library, and Google Scholar resulted in 30 eligible studies meeting inclusion criteria, namely peer-reviewed, randomized or cluster-randomized trials of universal interventions for anxiety and depressive symptoms in school-aged children. Sixty-three percent of the studies reported outcome data regarding anxiety and 87 % reported outcome data regarding depression. Seventy percent of the studies used randomization at the cluster level. There were small but significant effects regarding anxiety (.13) and depressive (.11) symptoms as measured at immediate posttest. At follow-up, which ranged from 3 to 48 months, effects were significantly larger than zero regarding depressive (.07) but not anxiety (.11) symptoms. There was no significant moderation effect of the following pre-selected variables: the primary aim of the intervention (anxiety or depression), deliverer of the intervention, gender distribution, children’s age, and length of the intervention. Despite small effects, we argue for the possible clinical and practical significance of these programs. Future evaluations should carefully investigate the moderators and mediators of program effects to identify active program components.

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  1. Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden

    Johan Ahlen

  2. Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden

    Fabian Lenhard & Ata Ghaderi

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Appendix: Measures

Appendix: Measures

Several different measures were used in the studies. Measures of anxiety were in descending order, the Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds, 1980); State-Trait Anxiety Inventory for Adults (STAI; Spielberger, Gorsuch, & Lushene, 1970); Spence Children’s Anxiety Scale (SCAS; Spence, 1997); the Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan, & Stallings, 1997); the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher et al., 1997); State-Trait Anxiety Inventory for Children (STAI-C; Spielberger, Edwards, Montouri, & Lushene, 1973); in one study the Social Phobia and Anxiety Inventory for Children (SPAI-C; Beidel, Turner, & Morris, 1995); Symptom Questionnaire (SQ; Kellner, 1987).

Measures of depression were: in descending order, Children’s Depression Inventory (CDI; Kovacs, 1985); Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977); Reynolds Adolescent Depression Scale (RADS; Reynolds & Mazza, 1998); Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961); Symptom Questionnaire (SQ; Kellner, 1987); in one study, Mood and Feelings Questionnaire –short form (SMFQ; Messer, Angold, Costello, & Loeber, 1995); Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000); Short Depression Inventory for Children (SDIC; Meijer, Mellenbergh, & de Wit, 1986); The Self-Report Questionnaire-Depression (SBB-DES; Dopfner & Lehmkuhl, 2000).

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Ahlen, J., Lenhard, F. & Ghaderi, A. Universal Prevention for Anxiety and Depressive Symptoms in Children: A Meta-analysis of Randomized and Cluster-Randomized Trials. J Primary Prevent 36, 387–403 (2015). https://doi.org/10.1007/s10935-015-0405-4

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