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The Lancet. Psychiatry Dec 2019Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and...
BACKGROUND
Rates 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.
METHODS
We 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searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials.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.
FINDINGS
1512 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.
INTERPRETATION
Considering 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.
FUNDING
UK National Institute for Health Research.
Topics: Adolescent; Anxiety; Child; Child, Preschool; Cognitive Behavioral Therapy; Depression; Humans; Network Meta-Analysis; School Health Services; Suicidal Ideation
PubMed: 31734106
DOI: 10.1016/S2215-0366(19)30403-1 -
Movement Disorders : Official Journal... Feb 2021The aim of this systematic review was (1) to identify the brain regions involved in anxiety in Parkinson's disease (PD) based on neuroimaging studies and (2) to... (Review)
Review
BACKGROUND
The aim of this systematic review was (1) to identify the brain regions involved in anxiety in Parkinson's disease (PD) based on neuroimaging studies and (2) to interpret the findings against the background of dysfunction of the fear circuit and limbic cortico-striato-thalamocortical circuit.
METHODS
Studies assessing anxiety symptoms in PD patients and studies using magnetic resonance imaging, positron emission tomography, or single-photon emission computed tomography were included.
RESULTS
The severity of anxiety was associated with changes in the fear circuit and the cortico-striato-thalamocortical limbic circuit. In the fear circuit, a reduced gray-matter volume of the amygdala and the anterior cingulate cortex (ACC); an increased functional connectivity (FC) between the amygdala and orbitofrontal cortex (OFC) and hippocampus and between the striatum and the medial prefrontal cortex (PFC), temporal cortex, and insula; and a reduced FC between the lateral PFC and the OFC, hippocampus, and amygdala were reported. In the cortico-striato-thalamocortical limbic circuit, a reduced FC between the striatum and ACC; a reduced dopaminergic and noradrenergic activity in striatum, thalamus, and locus coeruleus; and a reduced serotoninergic activity in the thalamus were reported.
CONCLUSION
To conclude, anxiety is associated with structural and functional changes in both the hypothesized fear and the limbic cortico-striato-thalamocortical circuits. These circuits overlap and may well constitute parts of a more extensive pathway, of which different parts play different roles in anxiety. The neuropathology of PD may affect these circuits in different ways, explaining the high prevalence of anxiety in PD and also the associated cognitive, motor, and psychiatric symptoms. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Topics: Amygdala; Anxiety; Anxiety Disorders; Humans; Magnetic Resonance Imaging; Neuroimaging; Parkinson Disease
PubMed: 33289195
DOI: 10.1002/mds.28404 -
Journal of the American Academy of... Aug 2020Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted.
OBJECTIVE
We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety.
METHODS
A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region.
RESULTS
Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region.
LIMITATIONS
Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature.
CONCLUSIONS
Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.
Topics: Acne Vulgaris; Adolescent; Adult; Age Factors; Anxiety; Depression; Dermatology; Humans; Mass Screening; Practice Guidelines as Topic; Psychiatry; Psychology, Adolescent; Referral and Consultation; Risk Factors; Self Concept
PubMed: 32088269
DOI: 10.1016/j.jaad.2020.02.040 -
The Gerontologist Nov 2019Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim...
UNLABELLED
Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia.
METHOD
A systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017.
RESULTS
The search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis.
CLINICAL IMPLICATIONS
The most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.
Topics: Aged; Anxiety; Dementia; Humans; Nursing Homes
PubMed: 31054222
DOI: 10.1093/geront/gnz020 -
International Journal of Chronic... 2021Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as... (Review)
Review
BACKGROUND
Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes.
OBJECTIVE
This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD.
METHODS
English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently.
RESULTS
A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions.
CONCLUSION
The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.
Topics: Anxiety; Anxiety Disorders; Depression; Humans; Patient Compliance; Pulmonary Disease, Chronic Obstructive
PubMed: 34262270
DOI: 10.2147/COPD.S313841 -
Journal of Pediatric Nursing 2021The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital... (Review)
Review
PROBLEM
The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital settings.
ELIGIBILITY CRITERIA
Studies published during the period 2014-2019 including original articles in English, Spanish and Portuguese. Databases consulted: SCOPUS, MEDLINE/PubMed, WoS, and CUIDEN (Nursing database in Spanish).
SAMPLE
Seventeen relevant records were selected. After critical reading using the CASPe (Critical Appraisal Skills Programme in Spanish) instrument, 7 articles were rejected and 10 were finally selected.
RESULTS
Each of eight studies showed significant evidence for the role of therapeutic play in the reduction of anxiety and pain and in the overall wellbeing of paediatric patients.
IMPLICATIONS
This review aimed to critically assess and synthesize the existing empirical evidence on the contributions of therapeutic play interventions for reducing anxiety, pain and improving the overall wellbeing of paediatric patients.
CONCLUSIONS
Based on these findings, it may be safe to say that therapeutic play interventions are effective in reducing the negative emotional manifestations of children, decreasing preoperative anxiety and pain, improving compliance with the induction of anaesthesia and reducing anxiety and postoperative pain. There is also evidence that dramatic puppetry is an effective preoperative care and preparation strategy for reducing anxiety in children undergoing surgery.
Topics: Anxiety; Anxiety Disorders; Child; Emotions; Humans; Pain, Postoperative; Preoperative Care
PubMed: 33711642
DOI: 10.1016/j.pedn.2021.02.022 -
Medicina Clinica May 2021The aim of this study was to assess the psychological impact among healthcare workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it with the rest... (Review)
Review
The aim of this study was to assess the psychological impact among healthcare workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it with the rest of healthcare professionals, by means of a systematic review of Western publications. The systematic review was carried out in PubMed, Scopus and Web of Science databases and 12 descriptive studies were reviewed. The European and American quantitative studies reported moderate and high levels of stress, anxiety, depression, sleep disturbance and burnout, with diverse coping strategies and more frequent and intense symptoms among women and nurses, without conclusive results by age. In the first line of assistance the psychological impact was greater than in the rest of the health professionals and in the Asian area. It is necessary to go deeper into the emotional experiences and professional needs for emotional support in order to design effective interventions for protection and help.
Topics: Anxiety; COVID-19; Delivery of Health Care; Depression; Female; Health Personnel; Humans; Pandemics; SARS-CoV-2; Stress, Psychological
PubMed: 33478809
DOI: 10.1016/j.medcli.2020.11.009 -
JMIR MHealth and UHealth Apr 2021Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of... (Review)
Review
BACKGROUND
Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management.
OBJECTIVE
The aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness.
METHODS
A systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted.
RESULTS
After final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients' preferring traditional therapy, were reported in studies addressing patients with specific physical health issues.
CONCLUSIONS
The use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed.
Topics: Anxiety; Anxiety Disorders; Biofeedback, Psychology; Child; Humans; Mental Health; Students
PubMed: 33792548
DOI: 10.2196/26038 -
Journal of Youth and Adolescence Sep 2019Given the recent rise in adolescent mental health issues, many researchers have turned to school-based mental health programs as a way to reduce stress, anxiety, and... (Meta-Analysis)
Meta-Analysis
Given the recent rise in adolescent mental health issues, many researchers have turned to school-based mental health programs as a way to reduce stress, anxiety, and depressive symptoms among large groups of adolescents. The purpose of the current systematic review and meta-analysis is to identify and evaluate the efficacy of school-based programming aimed at reducing internalizing mental health problems of adolescents. A total of 42 articles, including a total of 7310 adolescents, ages 11-18, met inclusion for the meta-analyses. Meta-analyses were completed for each of the three mental health outcomes (stress, depression, and anxiety) and meta-regression was used to determine the influence of type of program, program dose, sex, race, and age on program effectiveness. Overall, stress interventions did not reduce stress symptoms, although targeted interventions showed greater reductions in stress than universal programs. Overall, anxiety interventions significantly reduced anxiety symptoms, however higher doses may be necessary for universal programs. Lastly, depression interventions significantly reduced depressive symptoms, but this reduction was moderated by a combination of program type, dose, race, and age group. Although, school-based programs aimed at decreasing anxiety and depression were effective, these effects are not long-lasting. Interventions aimed at reducing stress were not effective, however very few programs targeted or included stress as an outcome variable. Implications for practice, policy and research are discussed.
Topics: Adolescent; Anxiety; Child; Depression; Female; Humans; Male; Primary Prevention; Program Evaluation; School Health Services; Stress, Psychological; Students
PubMed: 31346924
DOI: 10.1007/s10964-019-01085-0 -
PloS One 2021There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to... (Meta-Analysis)
Meta-Analysis
There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.
Topics: Adaptation, Psychological; Anxiety; Anxiety Disorders; Caregiver Burden; Caregivers; Depression; Depressive Disorder; Humans; Quality of Life; Risk Factors
PubMed: 33647035
DOI: 10.1371/journal.pone.0247143