Effectiveness of indicated school‐based interventions for adolescent depression and anxiety – Brioney Gee video abstract

Annie Vencl
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Brioney Gee gives a video abstract of her ‘Practitioner Review: Effectiveness of indicated school‐based interventions for adolescent depression and anxiety – a meta‐analytic review’ first published in Journal of Child Psychology & Psychiatry (JCPP) 6 April 2020.
Read the paper doi.org/10.1111/jcpp.13209

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Background

Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. The paper aims to provide a meta‐analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10–19 with elevated symptoms of depression and/or anxiety.

Full authors: Brioney Gee, Shirley Reynolds, Ben Carroll, Faith Orchard, Tim Clarke, David Martin, Jon Wilson & Laura Pass

Brioney Gee

Brioney Gee is a post-doctoral researcher working as part of Norfolk and Suffolk NHS Foundation Trust’s research development programme. Her research focuses on prevention and treatment of mental health difficulties in children and young people.

Transcript

My name is Brioney Gee and I work for Norfolk and Suffolk NHS Foundation Trust and this video abstract is intended to give a very brief summary of a practitioner review my colleagues and I completed titled Effectiveness of Indicated School-based Interventions for Adolescent Depression and Anxiety and Meta-analytic Review which was recently published in the Journal of Child Psychology and Psychiatry. The review was inspired by recent policy changes here in the UK which has resulted in an increased role for schools and colleges in the provision of mental health support and there have been some excellent recent reviews of school-based interventions designed to prevent the onset of mental difficulties.

Typically universal interventions delivered to all pupils, but we felt it be useful to do a review looking specifically at the evidence for indicated school-based interventions. So aiming to reduce symptoms in young people that are already experiencing mental health difficulties. So to do this we conducted a systematic search for randomised control trials of indicators psychological interventions delivered in an education setting and we focussed on  trials of interventions for adolescents aged ten to 19 with elevated symptoms of either depression or anxiety and we identified 45 trials which met our criteria for inclusion in the meta-analysis most of which were of CBT based interventions and when we pulled together the findings of these trials we found that immediately post intervention the school-based interventions were successful at reducing depression and anxiety symptoms.

The size of the effect was small for depression symptoms and medium for anxiety symptoms. We also looked at longer term follow-up data where this was available and there was some evidence that effects on depression were maintained at short-term follow up. So up to six months, but not at follow ups longer than this. We didn’t find evidence that the effects on anxiety were maintained beyond the end of the intervention, but these findings and for longer-term follow-ups were based on a relatively small pool of studies. So further trials incorporating longer-term follow-ups I needed to be able to say confidently whether the effects of indicated school-based interventions are maintained beyond the end of the intervention.

We also conducted a number of subgroup analysis to begin exploring factors that might explain the significant heterogeneity we found in study effect sizes and the findings of these study effect sizes need to be interpreted very cautiously, but something that we found that we think is worth further exploration is that the trials of interventions that were delivered by internal school staff didn’t have a significant effect on symptoms.

Whereas those delivered by external practitioners did and given that there might be issues with sustainability of schools who rely on external staff to come in and deliver interventions we think this might be something to look at further and perhaps consider the training and supervision that might be needed to enable school-based staff to deliver intervention successfully.

So the conclusions we drew from the review where the indicated school-based interventions are effective at reducing symptoms of depression anxiety and adolescents immediately post intervention, but based on the current evidence we can’t be confident that these reductions are sustained. So further high-quality trials of school-based interventions for anxiety and depression incorporating longer-term follow-ups are needed. Something else that we noted was that although trials of interventions delivered in sixth form or further education colleges were eligible for inclusion in the review, we didn’t actually identify any trials of interventions delivered in this setting and given that in the UK many young people aged 16 to 18 including some of the most disadvantaged attend further education colleges rather than schools we felt this was a significant gap in the literature that would be worth highlighting.

Thank you for watching this. If you’d like to know more about the review it’s now available online.

Discussion

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Your conclusion actually coincides with the findings of the recently published study in the AUS/NZ Journal of Psychiatry that overall, CBT is non-effective for depression and anxiety. When will the re-examining of this as an “evidence-based” intervention, start – as it appears, the only success is that psychologists are the only ones benefitting (financially). The 3 main causations of childhood mental health have not changed – bullying, domestic violence and divorce – so how does CBT change that for a child?

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Hi Brioney, congratulations to you and your team on your great research & publication 👍

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Hi Brioney, were any of the studies identified carried out in the UK?
Thanks,
Ana

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I completely agree. We need to focus more on interventions for parents and adults rather than interventions for children and young people. In UK school-based counselling, the most common problems discussed were related to family conflict. If we want to help children and young people we need to help parents first.

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