BACKGROUND: At any given time, 14% of Canadian children experience clinically significant mental disorders, which frequently persist into adulthood. Canadian public policy has emphasized specialized treatment services, yet these services only reach 25% of children with disorders. Prevention programs hold potential to reduce the number of children with disorders in the population. To inform policy-making, we systematically reviewed the best available research evidence on programs for preventing conduct disorder (CD), anxiety and depression, three of the most prevalent mental disorders in children. METHODS: We systematically identified and reviewed randomized controlled trials (RCTs) on programs intended to prevent CD, anxiety and depression in children aged 0-18 years. RESULTS: Fifteen RCTs met selection criteria: nine (on eight programs) for preventing CD; one for anxiety; four (on three programs) for depression; and one for all three. Ten RCTs demonstrated significant reductions in child symptom and/or diagnostic measures at follow-up. The most noteworthy programs, for CD, targeted at-risk children in the early years using parent training (PT) or child social skills training (SST); for anxiety, employed universal cognitive-behavioural training (CBT) in school-age children; and for depression, targeted at-risk school-age children, also using CBT. Effect sizes for these noteworthy programs were modest but consequential. There were few Canadian studies and few that evaluated costs. DISCUSSION: Prevention programs are promising but replication RCTs are needed to determine effectiveness and cost-effectiveness in Canadian settings. Four program types should be priorities for replication: targeted PTand child SST for preventing CD in children's early years; and universal and targeted CBTfor preventing anxiety and depression in children's school-age years. Conducting RCTs through research-policy partnerships would enable implementation in realistic settings while ensuring rigorous evaluation. Prevention merits new policy and research investments as part of a comprehensive public health strategy to improve children's mental health in the population.
BACKGROUND: At any given time, 14% of Canadian children experience clinically significant mental disorders, which frequently persist into adulthood. Canadian public policy has emphasized specialized treatment services, yet these services only reach 25% of children with disorders. Prevention programs hold potential to reduce the number of children with disorders in the population. To inform policy-making, we systematically reviewed the best available research evidence on programs for preventing conduct disorder (CD), anxiety and depression, three of the most prevalent mental disorders in children. METHODS: We systematically identified and reviewed randomized controlled trials (RCTs) on programs intended to prevent CD, anxiety and depression in children aged 0-18 years. RESULTS: Fifteen RCTs met selection criteria: nine (on eight programs) for preventing CD; one for anxiety; four (on three programs) for depression; and one for all three. Ten RCTs demonstrated significant reductions in child symptom and/or diagnostic measures at follow-up. The most noteworthy programs, for CD, targeted at-risk children in the early years using parent training (PT) or child social skills training (SST); for anxiety, employed universal cognitive-behavioural training (CBT) in school-age children; and for depression, targeted at-risk school-age children, also using CBT. Effect sizes for these noteworthy programs were modest but consequential. There were few Canadian studies and few that evaluated costs. DISCUSSION: Prevention programs are promising but replication RCTs are needed to determine effectiveness and cost-effectiveness in Canadian settings. Four program types should be priorities for replication: targeted PTand child SST for preventing CD in children's early years; and universal and targeted CBTfor preventing anxiety and depression in children's school-age years. Conducting RCTs through research-policy partnerships would enable implementation in realistic settings while ensuring rigorous evaluation. Prevention merits new policy and research investments as part of a comprehensive public health strategy to improve children's mental health in the population.
Authors: J Hundert; M H Boyle; C E Cunningham; E Duku; J Heale; J McDonald; D R Offord; Y Racine Journal: J Child Psychol Psychiatry Date: 1999-10 Impact factor: 8.982
Authors: Paul McArdle; David Moseley; Toby Quibell; Rob Johnson; Ann Allen; Donna Hammal; Ann leCouteur Journal: J Child Psychol Psychiatry Date: 2002-09 Impact factor: 8.982
Authors: Brian R Flay; Anthony Biglan; Robert F Boruch; Felipe González Castro; Denise Gottfredson; Sheppard Kellam; Eve K Mościcki; Steven Schinke; Jeffrey C Valentine; Peter Ji Journal: Prev Sci Date: 2005-09
Authors: Norito Kawakami; Emad Abdulrazaq Abdulghani; Jordi Alonso; Evelyn J Bromet; Ronny Bruffaerts; José Miguel Caldas-de-Almeida; Wai Tat Chiu; Giovanni de Girolamo; Ron de Graaf; John Fayyad; Finola Ferry; Silvia Florescu; Oye Gureje; Chiyi Hu; Matthew D Lakoma; William Leblanc; Sing Lee; Daphna Levinson; Savita Malhotra; Herbert Matschinger; Maria Elena Medina-Mora; Yosikazu Nakamura; Mark A Oakley Browne; Michail Okoliyski; Jose Posada-Villa; Nancy A Sampson; Maria Carmen Viana; Ronald C Kessler Journal: Biol Psychiatry Date: 2012-04-21 Impact factor: 13.382
Authors: Mariette J Chartier; James M Bolton; Okechukwu Ekuma; Natalie Mota; Jennifer M Hensel; Yao Nie; Chelsey McDougall Journal: Can J Psychiatry Date: 2021-11-19 Impact factor: 5.321
Authors: Camille C Cioffi; Leslie D Leve; Misaki N Natsuaki; Daniel S Shaw; David Reiss; Jody M Ganiban; Jenae M Neiderhiser Journal: Depress Anxiety Date: 2021-06-29 Impact factor: 6.505