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Mental Health: Targeted School-Based Cognitive Behavioral Therapy Programs to Reduce Depression and Anxiety Symptoms

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What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to mental health:

Werner-Seidler A, Perry Y, Calear AI, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clinical Psychology Review 2017;51;30-47.

The systematic review included 81 studies (search period through 2015). The team examined CBT programs for targeted school-based programs (29 studies) and universal school-based programs (38 studies) separately. Ten studies from the published review were excluded because they either did not evaluate CBT programs or they did not provide data for analysis.

The team examined a subset of 11 targeted studies from the United States and abstracted supplemental information about study, intervention, and population characteristics; and performed data analysis. Data from the subset were compared with the overall body of evidence.

The CPSTF finding is based on results from the published review, additional information from the subset of studies, and expert input from team members and the CPSTF.

Context

Anxiety and depression are common among children and adolescents, and they can persist into adulthood, increasing risks for suicide, risk-taking behavior (e.g., substance abuse, sexual experimentation), teenage pregnancy, conduct disorder, delinquency, and poor academic outcomes (Anxiety and Depression Association of America, 2018; Weller et al., 2000; Werner-Sielder et al., 2017).

Schools can play an important role in preventing and reducing anxiety and depression. Cognitive behavioral therapy (CBT), the most commonly used therapy for anxiety and depression, helps children and adolescents change negative thoughts into more positive, effective behaviors.

Implementing CBT programs in schools supports several components of the Whole School, Whole Community, Whole Child (WSCC) Model focused on promoting students’ health (CDC, 2018).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 29 studies of targeted school-based CBT.

  • Small decreases were reported for symptoms of depression (21 studies) and anxiety (14 studies).
  • Interventions delivered by external mental health professionals showed larger effects than those delivered by trained school staff.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

The CPSTF finding should be applicable to school aged children (aged 7-18 years) in the United States.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

Evidence gaps identified in systematic review.

  • How can advances in technology be used to improve intervention reach and availability at a population level?
  • How do program results differ when asymptomatic youth participate?
  • What effect does parental involvement have on outcomes? Which strategies work best to incentivize and engage parents or caregivers?
  • What are the infrastructure and personnel needs required to sustain programs?

The CPSTF further identified the following evidence gaps as areas for future research:

  • Which strategies best balance the need for parental awareness with child confidentiality?
  • What are the long-term effects of early interventions to reduce anxiety and depression symptoms?
  • Are programs as effective if implemented in private schools?
  • What are the follow-up approaches that best support the maintenance of program effects over time?

Study Characteristics

  • Depression symptoms were most frequently measured with the Children’s Depression Inventory, followed by the Beck Depression Inventory, and the Kiddie-Schedule for Affective Disorders and Schizophrenia.
  • Anxiety symptoms were most frequently measured with the Spence Children’s Anxiety Scale, followed by the Revised Children’s Manifest Anxiety Scale.
  • The included studies from the United States targeted adolescents (10-17 years), and were delivered by external mental health professionals (8 studies) or trained school staff (3 studies). Study populations represented a range of racial and ethnic groups.