Stockings E A, Degenhardt L, Dobbins T, Lee Y Y, Erskine H E, Whiteford H A, Patton G
National Drug and Alcohol Research Centre (NDARC),University of New South Wales (UNSW),Randwick,New South Wales,Australia.
Queensland Centre for Mental Health Research (QCMHR),The Park Centre for Mental Health,Wacol,Queensland,Australia.
Psychol Med. 2016 Jan;46(1):11-26. doi: 10.1017/S0033291715001725. Epub 2015 Aug 28.
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 August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37-0.60], selective (RR 0.61, 95% CI 0.43-0.85) or indicated (RR 0.48, 95% CI 0.29-0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.).
抑郁和焦虑（内化性障碍）是导致年轻人非致命性健康负担的最大因素。这是第一项在考虑儿童和青少年（5至18岁）抑郁和焦虑共病情况的同时，检验普遍、选择性和针对性预防干预措施对二者联合疗效的荟萃分析。我们对1980年至2014年8月期间Medline、PsycINFO和Cochrane系统评价图书馆中的综述进行了系统回顾。多变量荟萃分析分别检验了预防干预对抑郁和焦虑结局的疗效，以及对两种障碍的联合疗效。荟萃回归根据一系列研究变量检验了效应的异质性。结局指标为疾病的相对风险（RR）和症状的标准化均值差（科恩d值）。146项随机对照试验（46072名参与者）评估了普遍预防（未识别出风险的儿童，n = 54）、选择性预防（因共同风险因素而患内化性障碍风险增加的儿童群体亚组，n = 45）和针对性预防（有轻微但可检测到的内化性障碍症状的儿童，n = 47），大多数试验仅采用心理策略（n = 105）。干预后长达9个月内，内化性障碍的发病有所减少，无论是普遍预防（RR 0.47，95%置信区间[CI] 0.37 - 0.60）、选择性预防（RR 0.61，95% CI 0.43 - 0.85）还是针对性预防（RR 0.48，95% CI 0.29 - 0.78）。普遍预防干预后长达12个月内，内化性症状有所减少；然而，选择性预防和针对性预防仅在短期内症状有所减少。普遍、选择性和针对性预防干预措施在短期内对减少内化性障碍和症状有效。它们可被视为在整个儿童期和青少年期学校环境中的反复干预措施。（国际前瞻性系统评价注册编号：CRD42014013990。）
