Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression

Published on Oct 1, 2017in JAMA Psychiatry15.916
· DOI :10.1001/jamapsychiatry.2017.2509
Patricia Moreno-Peral9
Estimated H-index: 9
Sonia Conejo-Cerón7
Estimated H-index: 7
+ 11 AuthorsJuan Ángel Bellón19
Estimated H-index: 19
Importance To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis Data extraction and assessment of risk of bias (Cochrane Collaboration’s tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was −0.31 (95% CI, −0.40 to −0.21; P I 2  = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, −0.27; 95% CI, −0.37 to −0.17; P P  = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P  = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
Figures & Tables
  • References (65)
  • Citations (9)
📖 Papers frequently viewed together
7 Authors (Saira Sanjida, ..., Monika Janda)
6 Citations
9 Citations
17 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
9 CitationsSource
#1Maurice Topper (UvA: University of Amsterdam)H-Index: 8
#2Paul M. G. Emmelkamp (Netherlands Institute for Advanced Study)H-Index: 67
Last. Thomas Ehring (LMU: Ludwig Maximilian University of Munich)H-Index: 27
view all 4 authors...
Abstract Background This randomized controlled trial evaluated the efficacy of a preventive intervention for anxiety disorders and depression by targeting excessive levels of repetitive negative thinking (RNT; worry and rumination) in adolescents and young adults. Methods Participants ( N = 251, 83.7% female) showing elevated levels of RNT were randomly allocated to a 6-week cognitive-behavioral training delivered in a group, via the internet, or to a waitlist control condition. Self-report meas...
27 CitationsSource
#1Aliza Werner-Seidler (UNSW: University of New South Wales)H-Index: 13
#2Yael Perry (UNSW: University of New South Wales)H-Index: 10
Last. Helen Christensen (UNSW: University of New South Wales)H-Index: 103
view all 5 authors...
Abstract Depression and anxiety often emerge for the first time during youth. The school environment provides an ideal context to deliver prevention programs, with potential to offset the trajectory towards disorder. The aim of this review was to provide a comprehensive evaluation of randomised-controlled trials of psychological programs, designed to prevent depression and/or anxiety in children and adolescents delivered in school settings. Medline, PsycINFO and the Cochrane Library were systema...
104 CitationsSource
#1E. Theo Vos (UW: University of Washington)H-Index: 107
#2Christine Allen (UW: University of Washington)H-Index: 16
Last. Christopher Margono (UW: University of Washington)H-Index: 162
view all 637 authors...
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the...
1,210 CitationsSource
#1Pim Cuijpers (VU: VU University Amsterdam)H-Index: 104
#2Ioana A. CristeaH-Index: 18
Last. Marcus J.H. Huibers (UPenn: University of Pennsylvania)H-Index: 37
view all 5 authors...
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute ...
105 CitationsSource
BACKGROUND: Not enough is known about universal prevention of depression in adults. OBJECTIVE: To evaluate the effectiveness of an intervention to prevent major depression. DESIGN: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. ( NCT01151982) SETTING: 10 primary care centers in each of 7 cities in Spain. PARTICIPANTS: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each cen...
8 CitationsSource
#1Emily Stockings (NDARC: National Drug and Alcohol Research Centre)H-Index: 14
#2Louisa Degenhardt (NDARC: National Drug and Alcohol Research Centre)H-Index: 91
Last. George C. Patton (Royal Children's Hospital)H-Index: 90
view all 7 authors...
Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5-18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to A...
72 CitationsSource
#1Hilde P. A. van der Aa (VU: VU University Amsterdam)H-Index: 6
#2Ger H. M. B. van Rens (VU: VU University Amsterdam)H-Index: 16
Last. Ruth M. A. van Nispen (VU: VU University Amsterdam)H-Index: 6
view all 7 authors...
Study question Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? Methods 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitatio...
23 CitationsSource
#1Golda S. Ginsburg (ASU: Arizona State University)H-Index: 48
#2Kelly L. Drake (ASU: Arizona State University)H-Index: 11
Last. Mark A. Riddle (ASU: Arizona State University)H-Index: 59
view all 5 authors...
Objective:The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents.Method:Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6–13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administ...
32 CitationsSource
#1Cathrine Mihalopoulos (Deakin University)H-Index: 29
#2E. Theo Vos (UW: University of Washington)H-Index: 107
Last. Rob Carter (Deakin University)H-Index: 36
view all 7 authors...
BACKGROUND: Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-mone...
15 CitationsSource
Cited By9
#1Sunyoung KimH-Index: 17
#2Kang-Seob OhH-Index: 6
Last. Young-Chul Shin (SKKU: Sungkyunkwan University)H-Index: 7
view all 8 authors...
Abstract Background : Maintaining adequate levels of sleep and physical activity (PA) as self-help for the prevention of new-onset anxiety symptoms is becoming more important. Methods : A cohort study was performed with 134,957 adults, free of anxiety symptoms at baseline who underwent at least two comprehensive health screening examinations between 2012 and 2017. At baseline, the amount of PA was measured using the International Physical Activity Questionnaire-Short Form and sleep duration per ...
Abstract Although efforts have been undertaken to determine how psychological interventions exert their effects, research on mediators and mechanisms of change remains limited, especially in the field of prevention. We aimed to assess available evidence on mediators of psychological and psychoeducational interventions for the prevention of depression and anxiety in varied populations. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and the Cochrane Central Register ...
#1Maree Teesson (USYD: University of Sydney)H-Index: 50
#2Nicola C. Newton (USYD: University of Sydney)H-Index: 17
Last. Gavin Andrews (UNSW: University of New South Wales)H-Index: 91
view all 11 authors...
Summary Background Substance use, depression, and anxiety in adolescence are major public health problems requiring new scalable prevention strategies. We aimed to assess the effectiveness of a combined online universal (ie, delivered to all pupils) school-based preventive intervention targeting substance use, depression, and anxiety in adolescence. Methods We did a multicentre, cluster-randomised controlled trial in secondary schools in Australia, with pupils in year 8 or 9 (aged 13–14 years). ...
1 CitationsSource
#1Paolo Fusar-Poli (South London and Maudsley NHS Foundation Trust)H-Index: 66
#2Gonzalo Salazar de Pablo ('KCL': King's College London)
Last. Therese van Amelsvoort (UM: Maastricht University)H-Index: 41
view all 11 authors...
ABSTRACT Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Di...
Anxiety is prevalent in childhood and adolescence. Youth with maladaptive responses to common situations and stressors are at risk of having anxiety disorders. Persistent anxiety symptoms and anxiety disorders can be debilitating with long-term adverse outcomes in adulthood. Hence, decreasing the burden of anxiety disorders is an important public health priority. Development of anxiety disorders has a multifactorial etiology. There is a considerable complex interaction of genetics, temperament, ...
#1Paolo Fusar-PoliH-Index: 66
#2Michael Bauer (TUD: Dresden University of Technology)H-Index: 71
Last. Celso Arango (Hospital General Universitario Gregorio Marañón)H-Index: 53
view all 21 authors...
Abstract Prevention is the most promising way to reduce the high personal, familial, societal, clinical and economic costs of mental disorders in Europe and worldwide. A complementary approach is to go beyond the prevention of mental ill health, to promote good mental health. This manuscript highlights the first European consortium fostering cutting-edge multidisciplinary research in these two areas. The ECNP-funded Network on the Prevention of Mental Disorders and Mental Health Promotion (ECNP ...
1 CitationsSource
#1Ashley N. Howell (MUSC: Medical University of South Carolina)H-Index: 8
#2Alyssa A. Rheingold (MUSC: Medical University of South Carolina)H-Index: 19
Last. Constance Guille (MUSC: Medical University of South Carolina)H-Index: 16
view all 4 authors...
ABSTRACTMedical and health science graduate students report greater anxiety problems than the general population, but they are less likely to seek treatment due to cultural and logistical barriers....
2 CitationsSource
#1Robert J. Ludwig (Columbia University)H-Index: 8
#2Martha G. Welch (Columbia University)H-Index: 14
Modern scientific theories of emotional behavior, almost without exception, trace their origin to Charles Darwin, and his publications On the Origin of Species (1859) and The Expression of the Emotions in Man and Animals (1872). The most famous evolutionary dilemma Darwin acknowledged as a challenge to his theory of natural selection was the incomplete sub Cambrian fossil record. However, Darwin struggled with two other rarely referenced theoretical and scientific dilemmas that confounded his th...
2 CitationsSource
#1Amy GoughH-Index: 3
#2Beverley CassidyH-Index: 1
Last. Keri-Leigh CassidyH-Index: 3
view all 6 authors...
2 CitationsSource
#1David Daniel Ebert (VU: VU University Amsterdam)H-Index: 34
#2Mathias HarrerH-Index: 4
Last. Harald Baumeister (University of Ulm)H-Index: 30
view all 4 authors...
Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the preventi...