Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program. Evaluation of a Primary Prevention Program for Anxiety Disorders Using Story Books with Children Aged 9–12 Years An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy. Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. The Child Anxiety Prevention Study: intervention model and primary outcomes. Prevention of Generalized Anxiety Disorder Using a Web Intervention, iChill: Randomized Controlled Trial Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Evaluation of a DVD-based self-help program in highly socially anxious individuals--pilot study. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention. Feasibility and effectiveness of activity-scheduling as a guided self-help intervention for the prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial. Intervention to Prevent Major Depression in Primary Care Prevention and early intervention for anxiety disorders: a controlled trial. Efficacy of a brief school-based program for selective prevention of childhood anxiety Reducing depression in 9-10 year old children in low SES schools: a longitudinal universal randomized controlled trial. Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study. Efficacy of a prevention program for postpartum obsessive-compulsive symptoms. A prevention programme for somatoform disorders is effective for affective disorders. Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial. Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial. Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability. Prevention of anxiety and depression in Chinese: a randomized clinical trial testing the effectiveness of a stepped care program in primary care. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial
In this study , the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective . Children ( aged 8 - 12 ) were recruited via primary schools , selecting children scoring as high-anxious on an anxiety screening question naire . Participating children and their parents were r and omized to a  child -- a parent-focused , or non-intervention group .  All groups completed a diagnostic interview and st and ardized cost-diaries at pretest , and 1- and 2-year follow-up . Incremental cost-effectiveness ratios per ' ADIS improved ' child ( based on diagnostic information ) were calculated and cost-effectiveness acceptability curves and frontiers were plotted . The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention , and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious . The child-focused intervention was dominant when analyses were performed from a healthcare perspective , for boys , and for children of grade s 7 - 8 of primary school This article reports the results of a study evaluating a book-supported primary prevention program “ Dominique ’s H and y Tricks ” for anxiety disorders in children aged 9–12 years . This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions . The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management . Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems . In our r and omized control trial with 46 children , participation in the program led to a significant improvement in coping skills , perceived self-efficacy , anxiety sensitivity , as well as in symptoms of anxiety and fear . The theoretical and practical elements underlying the delivery of this primary prevention program are described . Conclusion : It is suggested that such an approach , without any labelling specific to anxiety disorders , can be useful in primary prevention programs Consistent with a risk reduction model of targeted prevention , the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking . Members of a high risk cohort , defined by high levels of anxiety sensitivity and current daily smoking ( n=96 ) , were r and omly assigned to either ( 1 ) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or ( 2 ) a health information control condition of comparable length . Participants were followed for 6 months . Consistent with hypotheses , those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period . Limited evidence also suggested the intervention increased motivation to quit smoking . We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations CONTEXT Given the public health significance of late-life depression and anxiety , and the limited capacity of treatment , there is an urgent need to develop effective strategies to prevent these disorders . OBJECTIVE To determine the effectiveness of an indicated stepped-care prevention program for  depression and anxiety disorders in the elderly . DESIGN R and omized controlled trial with recruitment between October 1 , 2004 , and October 1 , 2005 . SETTING Thirty-three primary care practice s in the northwestern part of the Netherl and s. PARTICIPANTS A total of 170 consenting individuals , 75 years and older , with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders . INTERVENTION Participants were r and omly assigned to a preventive stepped-care program ( n = 86 ) or to usual care ( n = 84 ) . Stepped-care participants sequentially received a watchful waiting approach , cognitive behavior therapy-based bibliotherapy , cognitive behavior therapy-based problem-solving treatment , and referral to primary care for medication , if required . MAIN OUTCOME MEASURES The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview . RESULTS The intervention halved the 12-month incidence of depressive and anxiety disorders , from 0.24 ( 20 of 84 ) in the usual care group to 0.12 ( 10 of 86 ) in the stepped-care group ( relative risk , 0.49 ; 95 % confidence interval , 0.24 to 0.98 ) . CONCLUSIONS Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective The article presents the intervention model and primary outcomes of a preventive intervention design ed to reduce anxiety symptoms and prevent the onset of anxiety disorders  in the offspring of parents with anxiety disorders . Participants were 40 volunteer children ( mean age = 8.94 years ; 45 % girls ; 90 % Caucasian ) whose parents met criteria for a broad range of anxiety disorders . Families were r and omly assigned to an 8-week cognitive-behavioral intervention , the Coping and Promoting Strength program ( CAPS ; n = 20 ) or a wait list control condition ( WL ; n = 20 ) . Independent evaluators ( IEs ) conducted diagnostic interviews , and children and parents completed measures of anxiety symptoms . Assessment s were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment . On the basis of intent to treat analyses , 30 % of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0 % in the CAPS group . IE and parent-reported ( but not child-reported ) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group . Parental satisfaction with the intervention was high . Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders Background Generalized Anxiety Disorder ( GAD ) is a high prevalence , chronic disorder . Web-based interventions are acceptable , engaging , and can be delivered at scale . Few r and omized controlled trials evaluate the effectiveness of prevention programs for anxiety , or the factors that improve effectiveness and engagement . Objective The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults , and to determine the role of telephone and email reminders . Methods A 5-arm r and omized controlled trial with 558 Internet users in the community , recruited via the Australian Electoral Roll , was conducted with 6- and 12-month follow-up . Five interventions were offered over a 10-week period . Group 1 ( Active website ) received a combined intervention of psycho-education , Internet-delivered Cognitive Behavioral Therapy ( ICBT ) for anxiety , physical activity promotion , and relaxation . Group 2 ( Active website with telephone ) received the identical Web program plus weekly telephone reminder calls . Group 3 ( Active website with email ) received the identical Web program plus weekly email reminders . Group 4 ( Control ) received a placebo website . Group 5 ( Control with telephone ) received the placebo website plus telephone calls . Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale ( GAD-7 ) ( at post-test , 6 , and 12 months ) . Secondary measures were GAD caseness , measured by the Mini International Neuropsychiatric Interview ( MINI ) at 6 months , Centre for Epidemiologic Studies -Depression scale ( CES-D ) , Anxiety Sensitivity Index ( ASI ) , Penn State Worry Question naire ( PSWQ ) , and Days out of Role . Results GAD-7 symptoms reduced over post-test , 6-month , and 12-month follow-up . There were no significant differences between Group 4 ( Control ) and Groups 1 ( Active website ) , 2 ( Active website with telephone ) , 3 ( Active website with email ) , or 5 ( Control with telephone ) at any follow-up . A total of 16 cases of GAD were identified at 6 months , comprising 6.7 % ( 11/165 ) from the Active groups ( 1 , 2 , 3 ) and 4.5 % ( 5/110 ) from the Control groups ( 4 , 5 ) , a difference that was not significant . CES-D , ASI , and PSWQ scores were significantly lower for the active website with email reminders at post-test , relative to the control website condition . Conclusions Indicated prevention of GAD was not effective in reducing anxiety levels , measured by GAD-7 . There were significant secondary effects for anxiety sensitivity , worry , and depression . Challenges for indicated prevention trials are discussed . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 76298775 ; http://www.controlled-trials.com/IS RCT N76298775 ( Archived by WebCite at http://www.webcitation.org/6S9aB5MAq ) Background Family caregivers of dementia patients are at increased risk of developing depression or anxiety . A multi-component program design ed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers . However , the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated . This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients . Methods A r and omized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients . Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline . Participants were r and omized to the family meetings intervention ( n = 96 ) or usual care ( n = 96 ) condition . The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year . Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms ( primary outcomes ) , caregiver burden and quality of life ( secondary outcomes ) . Intention-to-treat as well as per protocol analyses were performed . Results A substantial number of caregivers ( 72/192 ) developed a depressive or anxiety disorder within 12 months . The intervention was not superior to usual care either in reducing the risk of disorder onset ( adjusted IRR 0.98 ; 95 % CI 0.69 to 1.38 ) or in reducing depressive ( r and omization-by-time interaction coefficient = −1.40 ; 95 % CI −3.91 to 1.10 ) or anxiety symptoms ( r and omization-by-time interaction coefficient = −0.55 ; 95 % CI −1.59 to 0.49 ) . The intervention did not reduce caregiver burden or their health related quality of life . Conclusion This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers . Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose , when applied for therapeutic purpose s or targeted towards subgroups of caregivers . Trial Registration Controlled-Trials.com IS RCT BACKGROUND We tested whether a brief psychological intervention could prevent anxiety or depressive disorders among newly diagnosed cancer patients . PATIENTS AND METHODS Patients free of anxiety or depressive disorder were r and omised to receive immediate intervention ( start of cancer treatment ) , delayed intervention ( 8 weeks after starting treatment ) or usual care . They were stratified according to risk of developing anxiety or depressive disorders . Primary outcome was measured using a st and ardised psychiatric interview to detect any anxiety or depressive disorder at 6 and 12 months following the cancer diagnosis . Analyses used conditional odds logistic regression models adjusting for age , gender , concerns and past history to compare outcome of all intervention patients with usual care . RESULTS A total of 465 patients were recruited . In all , 313 ( 79 % ) of the 397 well enough to be interviewed completed the study . At 12 months , there was no difference between the groups receiving the intervention and usual care [ odds ratio ( OR ) = 0.69 , 95 % confidence interval ( CI ) 0.41 - 1.17 , P = 0.17 ] . In high-risk patients , those who received the intervention were less likely to develop an anxiety or depressive disorder compared with those who received usual care ( OR = 0.54 , 95 % CI 0.29 - 1.00 , P = 0.050 ) . In low-risk patients , there was no difference ( OR = 1.50 , 95 % CI 0.51 - 4.43 , P = 0.47 ) . CONCLUSION A brief intervention , delivered by nonspecialists , promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders High social anxiety is a risk factor for the incidence of social anxiety disorder ( SAD ) . Early diagnosis and intervention may prevent more severe psychiatric courses . Self-help programs may be a convenient , accessible , and effective intervention . This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety . A total of 24 highly socially anxious individuals were r and omly assigned to a DVD-based self-help program or to a wait-list control group . The self-help program is based on the cognitive model according to Clark and Wells ( 1995 ; adapted to German by Stangier , Clark , & Ehlers , 2006 ) and comprises eight sessions . ANOVAs based on an intention-to-treat model were used for data analyses . The self-help program was well accepted ; just one person withdrew during the intervention . There were significant Time × Group interactions on all primary outcome measures . For the intervention group moderate to high within-groups effect sizes up to Cohen 's d = 1.05 were obtained . Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention . The newly developed DVD-based self-help program seems to be a promising intervention for  highly socially anxious individuals as it reduces social anxiety symptoms BACKGROUND In order to reduce the high prevalence of depression , early interventions for people at risk of depression are warranted . This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy ( ACT ) for reducing depressive symptomatology . METHOD Participants with mild to moderate depressive symptomatology were recruited from the general population and r and omized to the self-help programme with extensive email support ( n=125 ) , the self-help programme with minimal email support ( n=125 ) or to a waiting list control group ( n=126 ) . Participants completed measures before and after the intervention to assess depression , anxiety , fatigue , experiential avoidance , positive mental health and mindfulness . Participants in the experimental conditions also completed these measures at a 3-month follow-up . RESULTS In the experimental conditions significant reductions in depression , anxiety , fatigue , experiential avoidance and improvements in positive mental health and mindfulness were found , compared with the waiting list condition ( effect sizes Cohen 's d=0.51 - 1.00 ) . These effects were sustained at the 3-month follow-up . There were no significant differences between the experimental conditions on the outcome measures . CONCLUSIONS The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology OBJECTIVE The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents . METHOD Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6 - 13 years of age without an anxiety disorder . Families were r and omly assigned to the family-based intervention ( N=70 ) or to an information-monitoring control condition ( N=66 ) . All families were expected to complete assessment s , administered by blind interviewers , at baseline , at the end of the intervention ( or 8 weeks after r and omization ) and at 6- and 12-month follow-ups . Onset of any anxiety disorder and anxiety symptom severity ( assessed using the Anxiety Disorders Interview Schedule for Children ) at 12 months were the primary and secondary outcome measures , respectively . RESULTS The incidence of child anxiety disorders was 31 % in the control group and 5 % in the intervention group ( odds ratio=8.54 , 95 % CI=2.27 , 32.06 ) . At the 1-year follow-up , youths in the control group also had higher anxiety symptoms ratings than those in the intervention group . Effect sizes were medium to large ( 0.81 at 6 months and 0.57 at 12 months for anxiety symptoms ) , and the number needed to treat was 3.9 at 12 months . Significant moderators included baseline levels of child anxiety ; significant mediators were parental distress and modeling of anxiety . Child maladaptive cognitions and parental anxiety did not mediate outcomes . CONCLUSIONS A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents BACKGROUND Elderly people living in residential homes are at high risk for developing major depressive and anxiety disorders , and therefore deserve attention in terms of preventive interventions . We evaluated the feasibility and effectiveness of a guided self-help intervention for the prevention of depression and anxiety in these residents . METHODS We conducted a pragmatic r and omized controlled trial in two parallel groups comparing the intervention with usual care in 14 residential homes in and surrounding the city of Amsterdam in the Netherl and s. A total of 129 residents with a score of 8 or more on the Centre for Epidemiologic Studies Depression Scale ( CES-D ) screening instrument , who did not meet the full diagnostic criteria for disorders , and were not suffering from cognitive impairment were recruited between April 2007 and December 2008 . Participants were r and omized to a guided self-help intervention ( n = 67 ) or to usual care ( n = 62 ) . The main outcome measures were improvement in the level of symptoms of depression and anxiety . The secondary outcome was improvement in participation in organized activities in the residential homes . The study is registered in de Dutch Cochrane Centre , under number IS RCT N27540731 . RESULTS Only 21 % of the participants ( mean age 84.0 years ( SD 6.7 ) , 72.1 % suffering from two or more chronic illnesses ) completed the intervention . Although we found some large positive effect sizes on the CES-D , none of these effects was statistically significant . CONCLUSION Although guided self-help may be promising in the prevention of depression and anxiety , it proved to be difficult to apply in this very old and vulnerable group of people living in residential homes Context Depression is a common condition that often responds to treatment , but not enough is known about prevention . Contribution These research ers developed a predictor of individual risk for depression . A physician-delivered program to prevent depression was directed at individual risk factors . A cluster r and omized trial found that the program had a modest benefit that was not statistically significant . Caution Self- selection of persons into the trial may have influenced the results . Implication Additional study of a modified program may be warranted . Depression is an important cause of human suffering . Recent studies have shown that the 12-month prevalence of major depression is 5 % in representative countries worldwide ( 1 ) and that levels are higher ( 11 % ) in primary care patients ( 2 ) . Major depression also has substantial economic consequences ( 3 ) . In 2010 , it ranked fourth for illness burden in western Europe and Australia and fifth in North America ( 4 ) . It is projected to rank as the greatest contributor to disease burden in high-income countries by 2030 ( 5 ) . In addition , although effective treatments for depression are available , they can reduce the burden by only 20 % ( 6 ) because not all cases are diagnosed and not all persons with diagnosed depression are treated or adhere to treatment . Depression is also possible to prevent ( 79 ) , and most of these efforts encourage cognitive behavioral changes ( 9 , 10 ) . The effects are modest , but the number needed to treat ( NNT ) to prevent an episode of depression ( NNT , 20 ) ( 9 ) compares favorably with the NNT with statins to prevent myocardial infa rct ion ( NNT , 216 ) or nonfatal stroke ( NNT , 335 ) ( 11 ) . Previous trials that have evaluated efforts to prevent depression have had limitations . Most studies included only children and adolescents , and most interventions were implemented by specialists in mental health ( 10 ) . Also , few trials on depression prevention have been done in primary care setting s ( 1215 ) , although we believe that this setting is ideal because so many patients receive primary care . To prepare for such a study , we previously developed an instrument that uses historical and clinical information to predict an individual 's risk for depression and identify specific factors that can be modified to prevent it ( the predictD risk algorithm ) ( 16 , 17 ) . We report here how we used the instrument to study whether an intervention delivered in primary care setting s could prevent depression ( the predictD-CCRT [ cluster r and omized , controlled trial ] ) ( 18 ) . Methods We conducted a national , multicenter , r and omized , controlled trial with 2 parallel groups ; cluster assignment by primary care center ; and 18-month follow-up . Setting and Participants We conducted the study in 7 Spanish cities , and local institutional review boards in each city approved the protocol . Of the 220 eligible primary care centers , those that had used electronic medical records for less than 2 years were excluded , and we invited the remaining centers to participate . In each city , we r and omly selected 10 centers that agreed to participate . We then met with primary care physicians ( PCPs ) at each center to explain the study and identify PCPs who would be present during the subsequent 18 months and agree to participate . We r and omly selected 2 PCPs per center . R and om selection of centers and PCPs was done using closed opaque envelopes by an independent investigator who was central ly located but not part of the research team . Research assistants then r and omly selected 4 to 6 patients per day from patients who had recently attended the practice s. Physicians review ed the lists of patients to identify those who met exclusion criteria ( Supplement Table 1 ) . This process continued until there were 26 to 27 eligible patients for each PCP . All eligible patients were invited to participate , and those who agreed were informed about the study by research assistants . Although patients could not give individual consent to r and om assignment , which was done at the center level , those in intervention centers agreed to receive the intervention and all consented to data collection . Patients had a Composite International Diagnostic Interview to detect major depression within 2 weeks of agreeing to participate . Patients with a diagnosis of major depression during the previous 6 months were excluded from the trial . Supplement . Supplemental Material R and omizing and Blinding In each city , 5 primary care centers were assigned to the control group and 5 to the intervention group . Neither the patients nor the PCPs were blinded to the intervention , which is common for trials that evaluate psychosocial interventions ( 19 ) . The interviewers who assessed outcomes and the PCPs who delivered the intervention were different groups ; the interviewers were blinded to allocations . In addition , PCPs were blinded to research outcomes , as were research staff who interacted with patients but did not assess outcomes . Investigators who did the statistical analyses were blinded to group allocations . Intervention Group The intervention , which has been described in detail elsewhere ( 18 ) , was delivered by PCPs who created it from the following 5 components : a 10- to 15-hour training workshop for PCPs ; the patient 's risk factors for depression and overall probability of developing depression from the Spanish version of the predictD algorithm ( www.rediapp.org/predict/index.php?idioma=en ) , which has good discriminative validity ( 17 ) and testretest reliability ( 20 , 21 ) ; a patient-oriented booklet about preventing depression ; measures to activate and empower patients ; and a tailored bio-psycho-family-social intervention that the PCP assembled for each patient to prevent depression ( Supplement ) ( 18 ) . Physicians created interventions without input from investigators and delivered them to patients at baseline and during 6- and 12-month follow-up visits . A 5-minute video that shows a PCP delivering an intervention is available at www.youtube.com/watch?v=kbFhVVDNFGE . Control Group Physicians in the  control group did not receive information about their patients ' profiles and levels of risk , nor did they attend the training workshop .  Patients in the control group continued to receive usual care , except that they were assessed for depression , anxiety , and other information at the same intervals as patients in the intervention group . Outcomes and Follow-up The primary outcome was new occurrence of major depression during the 18-month study , as measured by the depression section of the Composite International Diagnostic Interview , which has been adapted for use in many countries and has good interrater reliability and validity ( 22 , 23 ) . The research assistants who interviewed patients for this study were trained by accredited instructors for 20 hours to ensure st and ardization . Secondary outcomes included the incidence of depression at 6 and 12 months as measured by the Composite International Diagnostic Interview and the incidence of anxiety at 18 months as measured by the Primary Care Evaluation of Mental Disorders ( 24 , 25 ) . Other information we collected from patients , PCPs , and primary care centers is described in detail elsewhere ( 18 , 20 , 21 ) ( Supplement and Tables 1 , 2 and 3 ) . All patient variables were assessed at baseline and 6 , 12 , and 18 months in both study groups . Physicians participating in the trial completed a self-administered question naire at baseline . Table 1 . Baseline Characteristics : Primary Care Centers Table 2 . Baseline Characteristics : PCPs * Table 3 . Baseline Characteristics : Patients * Ethical Considerations The predictD-CCRT Study complies with the Declaration of Helsinki . The following ethics committees in each participating city approved the study : Ethics Committee on Human Research of the University of Granada , Ethics and Research Committee of Primary Health District of Mlaga , Ethics Committee on Clinical Research of Sant Joan de Du Foundation ( Barcelona ) ( PIC CEIC-62 - 09 ) , Ethics Committee of Clinical Research of Aragon ( CP06/05/2009 ) , Ethics Committee for Health Research of the Jan Hospital , Ethics Committee for Clinical Research of Euskadi ( 03/2009 ) , and Ethics Committee for Clinical Research of the Rio Hortega Hospital of Valladolid ( 04/2009 ) . Statistical Analysis We calculated the sample size on the assumption that the incidence of depression would be 12 % ( 17 ) in the  control group and 7 % in the intervention group . We expected an intraclass correlation coefficient for the primary care centers of 0.06 ( 17 ) and that the distribution of 2 PCPs and 48 patients per center would be homogeneous ( coefficients of variation of cluster sizes < 0.23 ) ( 26 ) . For a significance level of 0.05 and a power of 80 % , we calculated that we needed 3286 patients . We did all analyses using Stata , version 13.1 ( StataCorp ) , and analyzed participants according to their r and omized treatment . We compared the incidence of depression by study group using generalized estimating equations to account for the cluster r and omized design with multiple imputation to account for missing outcomes . We fitted generalized estimating equation models ( xtgee in Stata ) with a binomial-family , logit-link function ; included terms for intervention group and baseline probability of depression ; and included an exchangeable correlation structure and robust SEs for clustering on center . The intraclass correlation coefficient for center was 0.099 . We decided a priori to adjust for baseline probability of depression ( 18 ) because it was considered strongly predictive of the outcome and thus clinical ly prognostic ( 27 , 28 ) . We calculated st and ardized probabilities of depression during the 18-month study using the margins in Stata . We accounted for missing outcomes using multiple imputations with chained equations ( ice in Stata ) ( 29 ) , under a missing-at-r and om framework . We generated 50 imputed sample s and combined estimates using Rubin rules ( 30 ) . More details about imputation models are available in The Queensl and Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of  anxiety problems in children . A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children 's self-report . After recruitment and diagnostic interviews , 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group . Both groups showed improvements immediately postintervention . At 6 months follow-up , the improvement maintained in the intervention group only , reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders . Overall , the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program Abstract Anxiety sensitivity ( AS ) is recognized as an early risk factor for the development of anxiety disorders . This study evaluates whether a brief school-based selective prevention program reduces AS and anxious and depressive symptoms in children and youth . Participants scoring high in AS but without any current psychopathological disorder were selected from a sample of 613 individuals ( 61 % female , 11–17 years old ) and r and omly assigned to the prevention program ( n=47 ) or to a waiting-list control ( WLC ) ( n=45 ) group . A  normal control ( NC ) group ( n=53 ) was also included . After treatment , a significant decrease in AS and in anxiety and depressive symptoms were observed in both prevention and WLC groups . Differences between experimental conditions only emerged , partially , at six-month follow-up ( FU ) with the prevention group ( PG ) exhibiting significantly lower AS ( p<.05 ) , and equalling NCs . Although the magnitude of change in the PG is comparable to that reported in previous studies with longer and more complex prevention programs , a parallel reduction in the WLCs suggests that the observed decrease in the short term could be mostly time-linked . Despite this , our results encourage research into brief preventive interventions at an individual level The Aussie Optimism : Positive Thinking Skills Program ( AOP-PTS ) is an innovative curriculum-based mental health promotion program based on cognitive and behavioural strategies . The program is aim ed at preventing depressive and anxiety symptoms and disorders in middle primary school children aged 9 - 10 years . Students from 22 low SES primary schools ( N = 910 ) were r and omly assigned to an intervention or a control group and assessed at baseline , post-test , 6 months and 18 months . The intervention group received the program implemented by teachers and the control group received their regular Health Education curriculum . Students completed question naires on depression , anxiety , and attribution style . At risk students were further assessed with the computerised Diagnostic Interview for Children and Adolescents . Parents reported on their children 's externalising and internalising problems at home . Children in the intervention condition reported a significant pre-post reduction in depressive symptoms , and there was a significant pre-post reduction in parent-reported emotional difficulties which was maintained at 6 month follow-up ; no changes were evident in the control group . Both groups showed significant improvements in child-reported anxiety and attribution style , and significant improvements in parent-reported pro-social behaviours . For both groups , there were no significant post-baseline changes in incidence and recovery rates for depression , anxiety , or internalising symptoms . These findings suggest that AOP-PTS has the potential to treat depressive symptomatology in the immediate term but the effects were not sustained . There is also evidence of improved emotional resilience up to 6 months following the program . Further follow-up to investigate longer term effects is needed BACKGROUND This r and omized controlled trial evaluated the efficacy of a preventive intervention for  anxiety disorders and depression by targeting excessive levels of repetitive negative thinking ( RNT ; worry and rumination ) in adolescents and young adults . METHODS Participants ( N = 251 , 83.7 % female ) showing elevated levels of RNT were r and omly allocated to a 6-week cognitive-behavioral training delivered in a group , via the internet , or to a waitlist control condition .  Self-report measures were collected at pre-intervention , post-intervention , 3 m and 12 m follow-up . RESULTS Both versions of the preventive intervention significantly reduced RNT ( d = 0.53 to 0.89 ) , and symptom levels of anxiety and depression ( d = 0.36 to 0.72 ) . Effects were maintained until 12 m follow-up . The interventions result ed in a significantly lower 12 m prevalence rate of depression ( group intervention : 15.3 % , internet intervention : 14.7 % ) and generalized anxiety disorder ( group intervention : 18.0 % , internet intervention : 16.0 % ) , compared to the waitlist ( 32.4 % and 42.2 % , respectively ) . Mediation analyses demonstrated that reductions in RNT mediated the effect of the interventions on the prevalence of depression and generalized anxiety disorder . CONCLUSIONS Results provide evidence for the efficacy of this preventive intervention targeting RNT and support a selective prevention approach that specifically targets a known risk factor to prevent multiple disorders This article reports results from a universal preventive program aim ed at ( a ) reducing social anxiety and ( b ) preventing the development of syndromal social anxiety among a population -based sample of older children and young adolescents during a 1-year period . Pupils ( N = 1,748 ) from 2 counties were cluster r and omized to either an intervention or a control condition . In the intervention condition , the Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)-which educates pupils , parents/guardians , teachers/school staff , and county health workers-was administered . The results indicate that NUPP-SA had a significant specific intervention effect for reducing social anxiety in the total sample as well as among the syndromal subjects . Further , significantly fewer subjects from the intervention county developed syndromal social anxiety during the 1-year period , thus showing a prevention effect . The results demonstrate the value of an intervention specifically aim ed at reducing social anxiety and preventing the development of syndromal social anxiety  among young people Obsessive-Compulsive Disorder ( OCD ) has emerged as a common and impairing postpartum condition . Prospect i ve studies have identified psychological vulnerabilities for the emergence of postpartum obsessive-compulsive symptoms ( OCS ) , including general anxiety symptoms , pre-existing OCS , and specific cognitive distortions . The identification of these factors makes feasible the development of prevention programs that could reduce the impact of postpartum OCS . The present investigation examined a cognitive-behavioral prevention program using a r and omized , double blind , controlled trial . Expecting mothers in their 2nd or 3rd trimester with an empirically established , malleable risk factor for postpartum OCS received either the prevention program ( N=38 ) or a credible control program ( N=33 ) , both of which were incorporated into traditional childbirth education classes . Results revealed that at 1 month , 3 months , and 6 months postpartum , the prevention program was associated with significantly lower levels of obsessions and compulsions than was the control condition ( all p's<0.05 ) . Group differences remained significant even after controlling for baseline OCS and depression symptoms . Those in the prevention condition also reported decreasing levels of cognitive distortions , in contrast to the control condition ( p's<0.05 ) . Results support the potential utility of incorporating a CBT-based OCS prevention program into childbirth education classes OBJECTIVE To assess the effectiveness of a psycho-educational programme for the primary prevention of somatoform disorders in healthy primary care patients . METHODS R and omized , controlled trial . Participants ( N=104 ) were r and omly assigned to : ( 1 ) a psycho-educational intervention , or ( 2 ) no intervention at all . The primary outcome measure was somatoform disorder psychiatric diagnosis at 5-year follow-up . Secondary outcome measures were hypochondriasis , locus of control and attribution of symptoms and psychological distress . RESULTS At 3 and 6 months , and 5 years , the intervention group significantly decreased hypochondriasis and somatic attributions ; and increased psychological and normalizing attributions and internal locus of control . Five years after baseline , the prevalence of somatoform disorders showed no differences between both groups . Nevertheless , overall psychiatric morbidity was less prevalent in the intervention group ( odds ratio : 2.72 ; 95%CI:1.10 - 6.72 ) . In addition , a decrease in depression and anxiety subscales and in overall General Health Question naire scoring ( p<.05 ) was found in the intervention group . CONCLUSIONS A primary prevention programme for somatization seems to be useful , not to decrease somatoform disorders , but to prevent anxiety and depressive disorders . The effects of overlapping psychobiological mechanisms are discussed OBJECTIVE  Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life . Elsewhere , we demonstrated that a stepped-care prevention approach was successful in halving the incidence of these disorders over a period of 12 months . As a decreasing effect over time is to be expected , our aim was to investigate the longer-term effects . DESIGN R and omized controlled trial . SETTING Thirty-three primary care practice s in the Netherl and s. PARTICIPANTS One hundred seventy consenting individuals , age 75 years and older , presenting with subthreshold depression or anxiety , not meeting the diagnostic criteria . INTERVENTION Participants were r and omized to a preventive intervention or usual care .  In the first 12 months , the preventive intervention entailed watchful waiting , minimally supported CBT-based self-help intervention , problem-solving treatment , and referral to a primary care physician for medication , if required . In the last 12 months , 95 % of the participants ceased to receive such support . MEASUREMENTS Mini International Neuropsychiatric Interview . RESULTS The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , major depression or anxiety disorder over a period of 24 months was halved by the intervention , from 33 of 84 ( 39.3 % ) in the usual care group to 17 of 86 ( 19.8 % ) in the intervention group ( odds ratio = 0.38 ; 95 % confidence interval = 0.19–0.76 ) , which was significant ( z = 2.75 ; p = 0.006 ) . The corresponding number needed to treat was 5 ( 95 % confidence interval = 3–16 ) . CONCLUSIONS A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year , but these favorable effects were also sustained over 24 months BACKGROUND The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes . METHODS A pragmatic r and omized controlled trial was conducted to compare the intervention with usual care in 14 residential homes in the Netherl and s. A total of 185 residents with a minimum score of 8 on the Centre for Epidemiologic Studies Depression Scale , who did not meet the diagnostic criteria for a depressive or anxiety disorder , and were not suffering from severe cognitive impairment , were recruited between April 2007 and December 2008 . They were r and omized to a stepped-care program ( N = 93 ) or to usual care ( N = 92 ) . The stepped-care participants sequentially underwent watchful waiting , a self-help intervention , life review , and a consultation with the general practitioner . The primary outcome measure was the incidence of a major depressive disorder ( MDD ) or anxiety disorder during a period of one year according to the Mini International Neuropsychiatric Interview . RESULTS The intervention was not effective in reducing the incidence of the combined outcome of depression and anxiety ( incidence rate ratio ( IRR ) = 0.50 ; 95 % confidence interval ( CI ) = 0.23 - 1.12 ) . However , the intervention was superior to usual care in reducing the risk of MDD incidence ( IRR = 0.26 ; 95 % CI = 0.12 - 0.80 ) contrary to anxiety incidence ( IRR = 1.32 ; 95 % CI = 0.48 - 3.62 ) . CONCLUSIONS These results suggest that the stepped-care program is effective in reducing the incidence of depression , but is not effective in preventing the onset of anxiety disorders in elderly people living in residential homes Fear of arousal symptoms , often referred to as anxiety sensitivity ( AS ) appears to be associated with risk for anxiety pathology and other Axis I conditions . Findings from a longitudinal prevention program targeting AS are reported . Participants ( n=404 ) scoring high on the Anxiety Sensitivity Index ( ASI ) were r and omly assigned to receive a brief intervention design ed to reduce AS ( Anxiety Sensitivity Amelioration Training ( ASAT ) ) or a control condition . Participants were followed for up to 24 months . Findings indicate that ASAT produced greater reductions in ASI levels compared with the control condition . Moreover , reductions were specific to anxiety sensitivity relative to related cognitive risk factors for anxiety . ASAT also produced decreased subjective fear responding to a 20 % CO(2 ) challenge delivered postintervention . Data from the follow-up period show a lower incidence of Axis I diagnoses in the treated condition though the overall group difference was not statistically different at all follow-up intervals . Overall , findings are promising for the preventative efficacy of a brief , computer-based intervention design ed to decrease anxiety sensitivity BACKGROUND Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program ( SCP ) in Western countries , such programs have not been evaluated in the east , which has a different services system structure and cultural nuances in seeking help for mental illness . Furthermore , only a few studies have used SCP for depression and anxiety prevention . We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and /or anxiety in Hong Kong . METHODS Subthreshold depression and /or anxiety patients were r and omized into the SCP group ( n=121 ) or care as usual ( CAU ) group ( n=119 ) . The SCP included watchful waiting , telephone counseling , problem solving therapy , and family doctor treatment within one year . The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months . The secondary outcomes were depressive and anxiety symptoms , quality of life and time absent from work due to any illness . RESULTS Survival analysis showed no differences between the SCP and CAU groups ( the cumulative probability of onset at 15 month was 23.1 % in the SCP group and 20.5 % in the CAU group ; Hazard Ratio=1.62 ; 95 % Confidence Interval : 0.82 - 3.18 ; p=0.16 ) . No significant differences were found in secondary outcomes . LIMITATIONS Sample size might not have been large enough . CONCLUSIONS SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care . As a large majority of patients improved overtime without any intervention , we are not able to exclude the possibility that the intervention might be effective . Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening Study question Is stepped care compared with usual care effective in preventing the onset of major depressive , dysthymic , and anxiety disorders  in older people with visual impairment ( caused mainly by age related eye disease ) and subthreshold depression and /or anxiety ? Methods 265 people aged ≥50 were r and omly assigned to a stepped care programme plus usual care ( n=131 ) or usual care only ( n=134 ) . Supervised occupational therapists , social workers , and psychologists from low vision rehabilitation organisations delivered the stepped care programme , which comprised watchful waiting , guided self help based on cognitive behavioural therapy , problem solving treatment , and referral to a general practitioner . The primary outcome was the 24 month cumulative incidence ( seven measurements ) of major depressive dysthymic and /or anxiety disorders ( panic disorder , agoraphobia , social phobia , and generalised anxiety disorder ) . Secondary outcomes were change in symptoms of depression and anxiety , vision related quality of life , health related quality of life , and adaptation to vision loss over time up to 24 months ’ follow-up . Study answer and limitations 62 participants ( 46 % ) in the usual care group and 38 participants ( 29 % ) from the stepped care group developed a disorder . The intervention was associated with a significantly reduced incidence ( relative risk 0.63 , 95 % confidence interval 0.45 to 0.87 ; P=0.01 ) , even if time to the event was taken into account ( adjusted hazard ratio 0.57 , 0.35 to 0.93 ; P=0.02 ) . The number needed to treat was 5.8 ( 3.5 to 17.3 ) . The dropout rate was fairly high ( 34.3 % ) , but rates were not significantly different for the two groups , indicating that the intervention was as acceptable as usual care . Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general ( responders were significantly younger than non-responders ) , thereby reducing the generalisability of the outcomes . What this study adds Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults . This approach could lead to st and ardised strategies for the screening , monitoring , treatment , and referral of visually impaired older adults with depression and anxiety . Funding , competing interests , data sharing Funded by ZonMw InZicht , the Dutch Organisation for Health Research and Development-InSight Society . There are no competing interests . Full data set and statistical code are available from the corresponding author . Study registration www.trialregister.nl NTR3296
Importance To our knowledge , no systematic review s or meta-analyses have been conducted to assess the effectiveness of preventive psychological and /or educational interventions for anxiety in varied population s. Objective To evaluate the effectiveness of preventive psychological and /or educational interventions for anxiety in varied population types .