Effectiveness of school-based interventions to prevent anxiety & depression in young people. (13th November 2019) - Caldwell, D.
Abstract: Background: The prevalence of anxiety and depression is increasing among children and young people (CYP). Evidence suggests 1/2 of mental illness is apparent by age 14 and 3/4 by early adulthood. Globally, there is growing interest in prevention of anxiety and depression in CYP. Methods: We report the findings from a systematic review and network meta-analysis (NMA) of school-based interventions to prevent anxiety and depression in CYP. NMA enables the simultaneous comparison of multiple interventions in a single evidence synthesis, retaining the identity of each intervention analysed and ranking of interventions according to the probability that each is best for a given outcome. Bayesian analyses were conducted in OpenBUGS, & random effects NMA were conducted for the primary outcomes of post-intervention self-report anxiety and depression. Results: NMA were conducted for universal and targeted populations, in primary, secondary & tertiary educational settings. In universal primary settings, there is no evidence that any intervention reduced depression or anxiety. In universal secondary settings, CBT & mindfulness-based interventions suggest a reduction in anxiety symptoms relative to usual curriculum but was not observed for depression symptoms. In targeted secondary settings, exercise appears effective for reducing anxiety symptoms relative to no intervention. For prevention of depression symptoms, CBT appears effective. In targeted primary settings, there is no evidence that any intervention is effective. Few tertiary institution-based interventions met our inclusion criteria. Conclusions: standard meta-analyses require lumping over interventions such that intervention specific effects may be masked (e.g. psychological intervention vs control). This NMA has identified the specific interventions which may prevent anxiety and depression in CYP. However, we observed considerable uncertainty and no intervention appears effective across every population and setting. Key messages: Network meta-analysis enables the simultaneous comparison of multiple interventions in a single evidence synthesis, retaining the distinct identity of each intervention analysed. We observed considerable uncertainty for effectiveness of school-based interventions to prevent anxiety and depression. No single intervention appears effective across every population and setting.