School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG, UK.
Eur Child Adolesc Psychiatry. 2021 Jun;30(6):849-860. doi: 10.1007/s00787-020-01564-x. Epub 2020 Jun 13.
Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based interventions exist but it is unclear how effective targeted approaches are for reducing symptoms of anxiety. This review and meta-analysis aimed to determine the effectiveness of school-based indicated interventions for symptomatic children and adolescents. The study was registered with PROSPERO [CRD42018087628]. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library for randomised-controlled trials comparing indicated programs for child and adolescent (5-18 years) anxiety to active or inactive control groups. Data were extracted from papers up to December 2019. The primary outcome was efficacy (mean change in anxiety symptom scores). Sub-group and sensitivity analyses explored intervention intensity and control type. We identified 20 studies with 2076 participants. Eighteen studies were suitable for meta-analysis. A small positive effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = - 0.28, CI = - 0.50, - 0.05, k = 18). This benefit was maintained at 6 (g = - 0.35, CI = - 0.58, - 0.13, k = 9) and 12 months (g = - 0.24, CI = - 0.48, 0.00, k = 4). Based on two studies, > 12 month effects were very small (g = - 0.01, CI = - 0.38, 0.36). No differences were found based on intervention intensity or control type. Risk of bias and variability between studies was high (I = 78%). Findings show that school-based indicated programs for child and adolescent anxiety can produce small beneficial effects, enduring for up to 12 months. Future studies should include long-term diagnostic assessments.
焦虑障碍是最常见的青少年心理健康障碍之一。早期干预可以减轻焦虑症状。目前已经存在基于学校的干预措施，但针对减少焦虑症状的靶向方法的有效性尚不清楚。本综述和荟萃分析旨在确定针对有症状的儿童和青少年的基于学校的针对性干预措施的有效性。该研究已在 PROSPERO（CRD42018087628）上注册。我们检索了 MEDLINE、EMBASE、PsycINFO 和 Cochrane Library，以比较针对儿童和青少年（5-18 岁）焦虑的有针对性计划与积极或非活跃对照组的随机对照试验。数据从截至 2019 年 12 月的论文中提取。主要结果是疗效（焦虑症状评分的平均变化）。亚组和敏感性分析探讨了干预强度和控制类型。我们确定了 20 项研究，涉及 2076 名参与者。其中 18 项研究适合进行荟萃分析。与对照组相比，针对计划对自我报告的焦虑症状在测试后有较小的积极影响（g = -0.28，CI = -0.50，-0.05，k = 18）。这种益处在 6 个月（g = -0.35，CI = -0.58，-0.13，k = 9）和 12 个月（g = -0.24，CI = -0.48，0.00，k = 4）时仍然存在。基于两项研究，超过 12 个月的效果非常小（g = -0.01，CI = -0.38，0.36）。基于干预强度或控制类型，未发现差异。研究间的偏倚风险和变异性较高（I = 78%）。研究结果表明，针对儿童和青少年焦虑的基于学校的有针对性计划可以产生较小的有益效果，持续长达 12 个月。未来的研究应包括长期的诊断评估。
