Prevention programmes for children of parents with a mood/anxiety disorder: Systematic review of existing programmes and meta-analysis of their efficacy

Abstract

Objectives: To systematically describe the characteristics and techniques of prevention programmes for children of parents with mood/anxiety disorders. In addition, recruitment approaches and difficulties were identified and a meta-analysis was conducted to examine the efficacy of these prevention programmes.

Methods: Randomized controlled trials assessing the efficacy of a prevention programme for children (6-25 years) of parents with mood and/or anxiety disorders were included. A systematic literature search was conducted in PubMed, PsychINFO, and CENTRAL from the earliest record to March 2019. In addition, programme manuals of identified prevention programmes were requested for a content analysis.

Results: Twenty-two articles containing eight unique prevention programmes involving 1,325 subjects were identified. Programmes varied in the number and types of techniques, but all provided psychoeducation. Results suggested that recruitment via clinicians was more successful than recruitment via health maintenance organization databases. In a meta-analysis, a significant risk difference was found in favour of prevention programmes on the risk of developing a depressive/anxiety disorder in offspring at short-term (9-18 months follow-up; RR = 0.37, 95% CI [0.21; 0.66]) and long-term follow-up (24 months or longer follow-up; RR = 0.71, 95% CI [0.57; 0.87] and on symptom levels in offspring at post-intervention (SMD = -0.19, 95% CI [-0.36; -0.02]) and at 12-months follow-up (SMD = -0.31, 95% CI [-0.57; -0.06]).

Conclusions: The prevention programmes combined psychoeducational elements with skills training and/or cognitive-behavioural therapy elements. The recruitment process and the content of these programmes are sometimes insufficiently described. Nevertheless, they appear to be effective, indicating a need to further examine how these programmes exactly work and for whom.

Practitioner points: Preventive interventions for children of parents with mood/anxiety disorders appear to be effective in preventing these disorders in offspring. Available preventive intervention programmes focus mostly on psychoeducation, cognitive-behavioural therapy, and family processes. More effort should be made into describing preventive interventions so that they can be easily implemented by practitioners. Studies should further examine why and for whom preventive interventions for children of parents with mood/anxiety disorders are effective.

Keywords: anxiety; bipolar; depression; offspring; prevention.

Figure 1

Flow‐chart.

Figure 2

(a) Effect of prevention programme versus any control condition on the incidence of depression/anxiety disorder (short‐term follow‐up). (b) Effect of prevention programme versus any control condition on the incidence of depression/anxiety disorder (long‐term follow‐up).

Figure 3

Funnel plot of incidence of depression/anxiety at 12‐month follow‐up.

Figure 4

(a) Effect of prevention programme versus any control condition on depressive/anxiety symptoms (post‐intervention). (b) Effect of prevention programme versus any control condition on depressive/anxiety symptoms (12‐month follow‐up).

Figure 5

Risk of bias assessment across included studies.