PREVENTING CHILD AND ADOLESCENT ANXIETY DISORDERS: OVERVIEW OF SYSTEMATIC REVIEWS.
Overviews of systematic reviews (OSRs) provide rapid access to high quality, consolidated research evidence about prevention intervention options, supporting evidence-informed decision-making, and the identification of fruitful areas of new research. This OSR addressed three questions about prevention strategies for child and adolescent anxiety: (1) Does the intervention prevent anxiety diagnosis and/or reduce anxiety symptoms compared to passive controls? (2) Is the intervention equal to or more effective than active controls? (3) What is the evidence quality (EQ) for the intervention? Prespecified inclusion criteria identified systematic reviews and meta-analyses (2000-2014) with an AMSTAR quality score ≥ 3/5. EQ was rated using Oxford evidence levels EQ1 (highest) to EQ5 (lowest). Three reviews met inclusion criteria. One narrative systematic review concluded school-based interventions reduce anxiety symptoms. One meta-analysis pooled 65 randomized controlled trials (RCTs; any intervention) and reported a small, statistically significant reduction in anxiety symptoms and diagnosis incidence. Neither review provided pooled effect size estimates for specific intervention options defined by type (i.e., universal/selective/indicated), intervention content, or comparison group (i.e., passive/active control), thus precluding EQ ratings. One meta-analysis pooled trials of vigorous exercise and reported small, nonstatistically significant reductions in anxiety symptoms for comparisons against passive and active controls (EQ1). Better use of primary studies in meta-analyses, including program-specific pooled effect size estimates and network meta-analysis is needed to guide evidence-informed anxiety prevention program choices. RCTs of innovative community/primary care based interventions and web-based strategies can fill knowledge gaps.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Kathryn
K
Bennett
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Katharina
K
Manassis
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Stephanie
S
Duda
Department of Psychiatry, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Alexa
A
Bagnell
Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota.
Gail A
GA
Bernstein
Department of Psychiatry, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
E Jane
EJ
Garland
Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, British Columbia, Canada.
Lynn D
LD
Miller
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Amanda
A
Newton
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Lehana
L
Thabane
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Pamela
P
Wilansky
D000293:Adolescent; D001008:Anxiety Disorders / Q000517:prevention & control*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012572:School Health Services
adolescent; anxiety; anxiety disorders; child; mental health; preventive psychiatry; primary prevention