Psychobiotic interventions for anxiety in young people: a systematic review and meta-analysis, with youth consultation.
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ABSTRACT:
SUBMITTER: Cohen Kadosh K
PROVIDER: S-EPMC8206413 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundRecent research has investigated the use of serious games as a form of therapeutic intervention for depression and anxiety in young people.AimsTo conduct a systematic review and meta-analysis into the effectiveness of gaming interventions for treating either depression or anxiety in individuals aged 12-25 years.MethodAn electronic search was conducted on the 30 March 2020, using PsycINFO, ISI Web of Science Core Collection, Medline and EMBASE databases. Standardised effect sizes (Hedge's g) were calculated for between-participant comparisons between experimental (therapeutic intervention) and control conditions, and within-participant comparisons between pre- and post-intervention time points for repeated measures designs.ResultsTwelve studies (seven randomised controlled trials (RCTs) and five non-randomised studies) were included. For RCTs, there was a statistically significant and robust effect (g = -0.54, 95% CI -1.00 to -0.08) favouring the therapeutic intervention when treating youth depression. For non-RCTs, using a repeated measures design, the overall effect was also strong (g = -0.75, 95% CI -1.64 to 0.14) favouring therapeutic intervention, but this was not statistically significant. Interestingly, we found no statistically significant effect for treating youth anxiety.ConclusionsThere is preliminary evidence to suggest that gaming interventions are an effective treatment for youth depression, but not anxiety. Further research is warranted to establish the utility, acceptability and effectiveness of gaming interventions in treating mental health problems in young people.
| S-EPMC8811791 | biostudies-literature
Project description:BackgroundMental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP).ObjectiveIn this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP.MethodsSystematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol.ResultsA total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=-0.25, 95% CI -0.38 to -0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=-0.27, 95% CI -0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=-0.01, 95% CI -0.23 to 0.21; P=.94).ConclusionsThe results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP.Trial registrationPROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171.
| S-EPMC9136650 | biostudies-literature
Project description:BackgroundGrowing evidence suggests that community-based interventions may be effective for anxiety and depression. This study aimed to describe studies of community interventions delivered to adults and/or young people, either in person or online, evaluated in randomised controlled trials and provide an indication as to their effectiveness, acceptability, quality of data and where possible, mechanisms of action. We included interventions delivered at and/or by museums, art galleries, libraries, gardens, music groups/choirs and sports clubs.MethodWe developed and followed a preregistered protocol: PROSPERO CRD42020204471. Randomised controlled trials in adults and young people were identified in an extensive search with no date/time, language, document type and publication status limitations. Studies were selected according to predetermined eligibility criteria and data independently extracted and then assessed using Risk of Bias 1. The studies were deemed too heterogeneous for meta-analysis and were therefore reported using a narrative synthesis.ResultsOur analysis included 31 studies, with 2898 participants. Community interventions most studied in randomised controlled trials were community music (12 studies, 1432 participants), community exercise (14 studies, 955 participants) and community gardens/gardening (6 studies, 335 participants). The majority of studies were from high-income countries - many were in specific populations (such as those with physical health problems) and were generally of low quality. Dropout rates across the included studies were low (1 participant on average per 100 participants). The inadequate description of interventions limited identification of potential mechanisms of action.DiscussionThe uncertainty of the evidence allows only a weak recommendation in support of community interventions for anxiety and depression. The results suggest community engagement is a promising area for wide-reaching interventions to be implemented and evaluated, but more high-quality trials are needed, especially in young people and under-represented communities.
| S-EPMC10466972 | biostudies-literature
Project description:BackgroundRates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.MethodsWe did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.Findings1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.InterpretationConsidering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.FundingUK National Institute for Health Research.
| S-EPMC7029281 | biostudies-literature
Project description:BackgroundThe majority of internet-based anxiety and depression intervention studies have targeted adults. An increasing number of studies of children, youth, and young adults have been conducted, but the evidence on effectiveness has not been synthesized. The objective of this research is to systematically review the most recent findings in this area and calculate overall (pooled) effect estimates of internet-based anxiety and/or depression interventions.MethodsWe searched five literature databases (PubMed, EMBASE, CINAHL, PsychInfo, and Google Scholar) for studies published between January 1990 and December 2012. We included studies evaluating the effectiveness of internet-based interventions for children, youth, and young adults (age <25 years) with anxiety and/or depression and their parents. Two reviewers independently assessed the risk of bias regarding selection bias, allocation bias, confounding bias, blinding, data collection, and withdrawals/dropouts. We included studies rated as high or moderate quality according to the risk of bias assessment. We conducted meta-analyses using the random effects model. We calculated standardized mean difference and its 95% confidence interval (95% CI) for anxiety and depression symptom severity scores by comparing internet-based intervention vs. waitlist control and internet-based intervention vs. face-to-face intervention. We also calculated pooled remission rate ratio and 95% CI.ResultsWe included seven studies involving 569 participants aged between 7 and 25 years. Meta-analysis suggested that, compared to waitlist control, internet-based interventions were able to reduce anxiety symptom severity (standardized mean difference and 95% CI = -0.52 [-0.90, -0.14]) and increase remission rate (pooled remission rate ratio and 95% CI =3.63 [1.59, 8.27]). The effect in reducing depression symptom severity was not statistically significant (standardized mean difference and 95% CI = -0.16 [-0.44, 0.12]). We found no statistical difference in anxiety or depression symptoms between internet-based intervention and face-to-face intervention (or usual care).ConclusionsThe present analysis indicated that internet-based interventions were effective in reducing anxiety symptoms and increasing remission rate, but not effective in reducing depression symptom severity. Due to the small number of higher quality studies, more attention to this area of research is encouraged.Trial registrationPROSPERO registration: CRD42012002100.
| S-EPMC4110069 | biostudies-literature
Project description:BackgroundSchool connectedness reflects the quality of students' engagement with peers, teachers, and learning in the school environment. It has attracted attention from both the health and education sectors as a potentially modifiable protective factor for common mental health problems. However, the extent to which school connectedness may prevent the onset of youth depression or anxiety or promote their remission is unclear. This systematic review examined evidence for prospective relationships between school connectedness and depression and anxiety, and the effect of interventions to improve school connectedness on depression and anxiety.MethodsWe searched MEDLINE, PsycINFO, PubMed, and ERIC electronic databases for peer-reviewed quantitative longitudinal, or intervention studies published from 2011-21 in English examining relationships between school connectedness and anxiety and/or depression. Participants were 14-24 years old when depression and anxiety outcomes were assessed in any education setting in any country. We partnered with five youth advisers (aged 16-21 years) with lived experience of mental health problems and/or the schooling system in Australia, Indonesia, and the Philippines to ensure that youth perspectives informed the review.ResultsOur search identified 3552 unique records from which 34 longitudinal and 2 intervention studies were ultimately included. Studies were primarily from the United States of America (69.4%). Depression and anxiety outcomes were first measured at 14 years old, on average. Most studies found a significant protective relationship between higher levels of school connectedness and depressive and/or anxiety symptoms; more measured depression than anxiety. A few studies found a non-significant relationship. Both intervention studies designed to increase school connectedness improved depression, one through improvements in self-esteem and one through improvements in relationships at school.ConclusionsThese findings suggest that school connectedness may be a novel target for the prevention of depression and anxiety. We were not able to determine whether improving school connectedness promotes remission in young people already experiencing depression and anxiety. More studies examining anxiety, diagnostic outcomes, and beyond North America are warranted, as well as intervention trials.Trial registrationPROSPERO 2021 CRD42021270967.
| S-EPMC9694921 | biostudies-literature
Project description:BackgroundDisrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited.ObjectiveThe aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years.MethodsA systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework.ResultsOf the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted.ConclusionsD-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.
| S-EPMC8726025 | biostudies-literature
Project description:Context"Youth-friendly" family planning services, services tailored to meet the particular sexual and reproductive health needs of young people (aged 10-24 years), may improve reproductive health outcomes, including reduction of unintended pregnancy. The objectives of this systematic review were to summarize the evidence of the effect of youth-friendly family planning services on reproductive health outcomes and to describe key characteristics of youth-friendly family planning interventions. The review, conducted in 2011, was used to inform national recommendations on quality family planning services.Evidence acquisitionSeveral electronic bibliographic databases, including PubMed, PsycINFO, and Popline, were used to identify relevant articles published from January 1985 through February 2011.Evidence synthesisNineteen articles met the inclusion criteria. Of these, six evaluated outcomes relevant to unintended pregnancy, contraceptive use, and knowledge or patient satisfaction. The 13 remaining studies identified perspectives on youth-friendly characteristics. Of the studies examining outcomes, most had a positive effect (two of three for unintended pregnancy, three of three for contraceptive use, and three of three for knowledge and/or patient satisfaction). Remaining studies described nine key characteristics of youth-friendly family planning services.ConclusionsThis review demonstrates that there is limited evidence that youth-friendly services may improve reproductive health outcomes for young people and identifies service characteristics that might increase their receptivity to using these services. Although more rigorous studies are needed, the interventions and characteristics identified in this review should be considered in the development and evaluation of youth-friendly family planning interventions in clinical settings.
| S-EPMC6648673 | biostudies-literature
Project description:AIMS: To synthesize evidence from randomized and non-randomized studies of physical activity interventions in children and young people with Type 1 diabetes so as to explore clinically relevant health outcomes and inform the promotion of physical activity. METHOD: We conducted a search of CINAHL Plus, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, SCOPUS, SportDiscus and Web of Science between October and December 2012. Eligible articles included subjects aged ?18 years with Type 1 diabetes and a physical activity intervention that was more than a one-off activity session. Physiological, psychological, behavioural or social outcomes were those of interest. RESULTS: A total of 26 articles (10 randomized and 16 non-randomized studies), published in the period 1964-2012, were reviewed. Although there was heterogeneity in study design, methods and reporting, 23 articles reported at least one significant beneficial health outcome at follow-up. Meta-analyses of these studies showed potential benefits of physical activity on HbA1c (11 studies, 345 participants, standardized mean difference -0.52, 95% CI -0.97 to -0.07; P = 0.02), BMI (four studies, 195 participants, standardized mean difference -0.41, 95% CI -0.70 to -0.12; P = 0.006) and triglycerides (five studies, 206 participants, standardized mean difference -0.70, 95% CI -1.25 to -0.14; P = 0.01).The largest effect size was for total cholesterol (five studies, 206 participants, standardized mean difference -0.91, 95% CI -1.66 to -0.17; P = 0.02). CONCLUSIONS: Physical activity is important for diabetes management and has the potential to delay cardiovascular disease, but there is a lack of studies that are underpinned by psychological behaviour change theory, promoting sustained physical activity and exploring psychological outcomes. There remains a lack of knowledge of how to promote physical activity in people with Type 1 diabetes.
| S-EPMC4232875 | biostudies-other
Project description:Background:Evidence suggests that exercise can alleviate symptoms associated with multiple sclerosis (MS). However, it is unclear whether exercise alleviates symptoms of anxiety, present in one-third of people with MS. This systematic review and meta-analysis investigates whether exercise interventions are effective in reducing anxiety in people with MS. Methods:CINAHL, Embase, MEDLINE, PsycINFO, and the Cochrane Controlled Clinical Trials Register were searched to identify relevant randomized controlled trials (RCTs) published up to March 30, 2018. The primary outcome was postintervention difference in anxiety scores between intervention and control groups. Using a restricted maximum likelihood random-effects model, standardized mean differences were pooled and heterogeneity was estimated. Risk of bias was assessed using an a priori modified Cochrane Risk of Bias 2.0 tool. Results:Four RCTs with 133 participants were included. Exercise type included walking, aerobic activities, and cycling. Intervention duration ranged from 8 to 26 weeks. The pooled standardized mean difference in anxiety score was -0.16 (95% CI, -0.50 to 0.19), without heterogeneity. Two studies had high risk of bias, and two had some risk of bias. Conclusions:Based on available RCT data, exercise does not seem to have an effect on anxiety in people with MS. These results should be interpreted with caution because studies had concerns of bias and small sample sizes, and anxiety was not the primary outcome measure. Future studies should exhibit sufficient reporting standards, alongside publishing protocols. There is opportunity to investigate the effect of exercise in people with MS experiencing clinically relevant levels of anxiety rather than in the general MS population.
| S-EPMC7307872 | biostudies-literature