Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety

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Abstract

A systematic review was conducted of school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%). Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher delivery.

Section snippets

Effectiveness of school-based prevention and early intervention programs for anxiety

Anxiety is one of the most common psychological disorders in school aged children and adolescents. Current prevalence rates range from 4% to 25%, with an average rate of 8% (Boyd et al., 2000, Cole et al., 1998, Tomb and Hunter, 2004). The actual rate of prevalence, however, may be even higher, with many children and adolescents remaining unidentified and untreated.

The effects of anxiety disorders on the well-being of children and adolescents are substantial, with the child's social, emotional,

Search and screening procedures

The Cochrane Library, PsycInfo and PubMed databases were electronically searched, for articles published between 1987 and February 2008, with the key search terms “school⁎ OR school-based OR adolescen⁎ OR child⁎ OR youth”, “prevent⁎ OR early intervent⁎”, and “anxiety OR anxious”. The titles and abstracts of the 5725 articles initially identified by these searches were screened by the primary author to determine their relevance to the review. Completely irrelevant articles that were unrelated to

Results

Overall, 27 randomized controlled trials were identified in the review, describing 20 individual school-based prevention and early intervention programs for anxiety. Table 1, Table 2, Table 3 present the efficacy and effectiveness data for the universal, indicated and selective programs identified respectively, as well as the quality ratings and program details for each trial.

Program evaluation outcomes

Overall the results of this review support the value of prevention interventions for anxiety, with over three-quarters of the trials reporting a significant reduction in symptoms of anxiety. Small (0.11) to large (1.37) effect sizes were reported both at post-test and follow-up. The sizes of effects were quite variable, with possible explanations for the variability unclear, although differences in program fidelity, leader rapport, relevant content and audience appeal are possible explanations.

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