Evidence map›Paper›PMID 31734106›Full record

SynthesisThe lancet. Psychiatry2019

School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis.

Deborah M Caldwell, Sarah R Davies, Sarah E Hetrick, Jennifer C Palmer, Paola Caro, José A López-López, David Gunnell, Judi Kidger, James Thomas, Clare French and 3 more

Erratum issuedOpen access · hybridAbstract readNetwork Meta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The lancet. Psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 141 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
141citing papers in PubMed, 24 pooled it
28.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

141 citing papers in PubMed, 24 syntheses or guidelines pooled it, 326 citations in OpenAlex.

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81 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 4 countries.

Deborah M CaldwellPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: d.m.caldwell@bristol.ac.uk.
Sarah R DaviesSchool for Policy Studies, University of Bristol, Bristol, UK.
Sarah E HetrickFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Jennifer C PalmerPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Paola CaroSchool for Policy Studies, University of Bristol, Bristol, UK.
José A López-LópezPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Spain.
David GunnellPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Judi KidgerPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
James ThomasEPPI-Centre, University College, London, UK.
Clare FrenchPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Emily StockingsNational Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Rona CampbellPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Nicky J WeltonPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
University of Bristol · GBUniversidad de Murcia · ESUniversity College London · GBUniversity Hospitals Bristol NHS Foundation Trust · GBUniversity of Auckland · NZUNSW Sydney · AU

Funding

Department of Health PHR/15/49/08Medical Research Council MR/K025643/1Medical Research Council MR/M005615/1Medical Research Council MR/P015298/1
6 · The paper itself

Abstract

backgroundRates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.

methodsWe did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.

findings1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.

interpretationConsidering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.

fundingUK National Institute for Health Research.

Indexed as

AnxietyDepressionSchool Health ServicesAdolescentChildChild, PreschoolCognitive Behavioral TherapyHumansSuicidal Ideation

Identifiers

PMID31734106
PMCPMC7029281
OpenAlexW2988840012

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.