Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs

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 (I2 = 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

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research

Using the FRIENDS Programs to Promote Resilience in Cross-Cultural Populations

Childhood and adolescence is a time of rapid biological, psychological, and social growth. Prevalence rates around the world currently estimate approximately one in five adolescents experience mental health difficulties. As factors are increasingly implicated in the etiology of behavioral and emotional difficulties, clinicians and researchers have identified the need for resilience-enhancing prevention programs. The current authors redefine resilience as not only being able to navigate towards and negotiate for resources in the face of adversity, but also to embrace positive life challenges. This chapter discusses protective and risk factors of emotional well-being in youths to provide a framework for the development of resilience-building programs. A brief review of resilience enhancement in youths is provided as well as introduction to the FRIENDS protocol, four socio-emotional skills programs. The FRIENDS programs are robustly supported and the only program endorsed by the World Health Organization for the prevention and treatment of anxiety and depression in children and youth (Prevention of mental disorders: Effective interventions and policy options, Geneva, Switzerland, 2004). Description of the FRIENDS programs, research evaluating intervention outcomes, and strategies to adapt techniques for use in diverse youth populations are also included. Lastly, recent innovations in conceptualization, research, assessment, and treatment of resilience as well as future directions for research are discussed