A meta-analysis of the effects of suicide preventive interventions for adolescents: Analyses depending on primary, secondary, and tertiary preventive approaches

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.)

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Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis

Current Opinion in Psychiatry ◽

10.1097/yco.0000000000000342 ◽

2017 ◽

Vol 30 (4) ◽

pp. 283-299 ◽

Cited By ~ 32

Author(s):

Martina Thanhäuser ◽

Gunnar Lemmer ◽

Giovanni de Girolamo ◽

Hanna Christiansen

Keyword(s):

Systematic Review ◽

Mentally Ill ◽

Meta Analysis ◽

Preventive Interventions ◽

Mentally Ill Parents

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Universal prevention of distress aimed at pregnant women: a systematic review and meta-analysis of psychological interventions

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03752-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marjolein Missler ◽

Tara Donker ◽

Roseriet Beijers ◽

Marketa Ciharova ◽

Charlotte Moyse ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Psychological Symptoms ◽

Meta Analysis ◽

Maternal Distress ◽

Psychological Interventions ◽

Universal Prevention ◽

Preventive Interventions ◽

Infant Outcomes ◽

Registration Number

Abstract Background There is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included. Method We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. Results Overall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress (d = .52), on depressive symptoms (d = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness. Conclusions This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant. Systematic review registration number International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.

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