Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs

Abstract

Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based interventions exist but it is unclear how effective targeted approaches are for reducing symptoms of anxiety. This review and meta-analysis aimed to determine the effectiveness of school-based indicated interventions for symptomatic children and adolescents. The study was registered with PROSPERO [CRD42018087628]. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library for randomised-controlled trials comparing indicated programs for child and adolescent (5-18 years) anxiety to active or inactive control groups. Data were extracted from papers up to December 2019. The primary outcome was efficacy (mean change in anxiety symptom scores). Sub-group and sensitivity analyses explored intervention intensity and control type. We identified 20 studies with 2076 participants. Eighteen studies were suitable for meta-analysis. A small positive effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = - 0.28, CI = - 0.50, - 0.05, k = 18). This benefit was maintained at 6 (g = - 0.35, CI = - 0.58, - 0.13, k = 9) and 12 months (g = - 0.24, CI = - 0.48, 0.00, k = 4). Based on two studies, > 12 month effects were very small (g = - 0.01, CI = - 0.38, 0.36). No differences were found based on intervention intensity or control type. Risk of bias and variability between studies was high (I² = 78%). Findings show that school-based indicated programs for child and adolescent anxiety can produce small beneficial effects, enduring for up to 12 months. Future studies should include long-term diagnostic assessments.

Keywords: Adolescent; Anxiety; Child; Early intervention; Meta-analysis; School-based interventions.

Fig. 1

Flow diagram of selection of studies for inclusion. CBT cognitive behavioural therapy, CBM cognitive bias modification, MBCT-C mindfulness-based cognitive therapy for children, WM working memory, ERT + HRV emotion regulation training and heart rate variability

Fig. 2

Forest plot of effect sizes for comparisons between intervention (CBT or non CBT) and control conditions (waitlist, attention control, or no intervention) on post-intervention anxiety symptoms. The vertical line indicates the line of no effect, the horizontal lines indicates the 95% confidence intervals, and the green dots represent the effect estimates from individual studies. Black diamonds indicate the pooled results of the studies