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School-based interventions for depression and anxiety in children and adolescents
  1. Paul Stallard
  1. Correspondence to Professor Paul Stallard, Department of Health, University of Bath and Head of Psychological Therapies Oxford Health NHS Foundation Trust, Bath BA2 7AY, UK; P.Stallard{at}bath.ac.uk

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By the age of 18 up to 20% of children will have suffered with an emotional disorder of anxiety or depression.1 Anxiety and depressive disorders frequently co-occur, are persistent and adversely impact on everyday functioning, academic achievement, peer and family relationships.2 They are associated with significant morbidity both during childhood and early adulthood and are leading causes of health-related burden.1 ,3

Empirically supported psychological treatments for anxiety and depression have been developed although the availability of these within clinical services is limited. Of those who receive evidence-based treatments the effects are often modest. Approximately half show a clinically meaningful improvement with relapse, particularly for depression, being common.4 ,5 However, comparatively few children with emotional disorders are ever identified and referred for treatment with the majority having no contact with mental health services.6

Prevention

The limited availability, reach and effectiveness of psychological treatments have led to interest in preventive and early intervention approaches. These approaches aim to develop emotional resilience and are typically conceptualised as universal, selective or indicated reflecting the population upon which they are targeted.7 Universal programmes are provided to all members of a target population regardless of risk status (eg, children aged 11) whereas selective interventions are targeted upon groups with an increased risk of developing a disorder (eg, children of depressed parents). While universal and selective programmes may improve current psychological functioning their primary aim is to reduce the onset of new disorders developing. Indicated programmes are targeted upon those already showing increased signs of emotional problems (ie, subdiagnostic threshold) with the aim of preventing symptoms from escalating into disorders.

Universal approaches offer the potential for good population coverage, are less stigmatising, can easily be provided and reach large numbers of children. However they typically result in smaller treatment effects …

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