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Preventing Mental Disorders in Children

A Systematic Review to Inform Policy-Making

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Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Background

At any given time, 14% of Canadian children experience clinically significant mental disorders, which frequently persist into adulthood. Canadian public policy has emphasized specialized treatment services, yet these services only reach 25% of children with disorders. Prevention programs hold potential to reduce the number of children with disorders in the population. To inform policy-making, we systematically reviewed the best available research evidence on programs for preventing conduct disorder (CD), anxiety and depression, three of the most prevalent mental disorders in children.

Methods

We systematically identified and reviewed randomized controlled trials (RCTs) on programs intended to prevent CD, anxiety and depression in children aged 0–18 years.

Results

Fifteen RCTs met selection criteria: nine (on eight programs) for preventing CD; one for anxiety; four (on three programs) for depression; and one for all three. Ten RCTs demonstrated significant reductions in child symptom and/or diagnostic measures at follow-up. The most noteworthy programs, for CD, targeted at-risk children in the early years using parent training (PT) or child social skills training (SST); for anxiety, employed universal cognitive-behavioural training (CBT) in school-age children; and for depression, targeted at-risk school-age children, also using CBT. Effect sizes for these noteworthy programs were modest but consequential. There were few Canadian studies and few that evaluated costs.

Discussion

Prevention programs are promising but replication RCTs are needed to determine effectiveness and cost-effectiveness in Canadian settings. Four program types should be priorities for replication: targeted PT and child SST for preventing CD in children’s early years; and universal and targeted CBT for preventing anxiety and depression in children’s school-age years. Conducting RCTs through research-policy partnerships would enable implementation in realistic settings while ensuring rigorous evaluation. Prevention merits new policy and research investments as part of a comprehensive public health strategy to improve children’s mental health in the population.

Résumé

Contexte

En tout temps, 14 % des enfants canadiens éprouvent des troubles mentaux patents, qui persistent souvent jusqu’à l’âge adulte. Les politiques gouvernementales du Canada mettent l’accent sur les services de traitement spécialisés, et pourtant ces services n’atteignent que 25 % des enfants qui présentent des troubles. Les programmes de prévention pourraient réduire le nombre d’enfants atteints de troubles mentaux dans la population. Pour améliorer la formulation des politiques, nous avons systématiquement examiné les meilleurs résultats de recherche disponibles sur les programmes de prévention de trois des troubles mentaux les plus fréquents chez les enfants: le trouble des conduites, l’anxiété et la dépression.

Méthode

Nous avons systématiquement répertorié et examiné les études randomisées et contrôlées (ERC) portant sur les programmes de prévention du trouble des conduites, de l’anxiété et de la dépression chez les enfants de 0 à 18 ans.

Résultats

Quinze ERC respectaient nos critères de sélection: neuf de ces études (associées à huit programmes) portaient sur la prévention du trouble des conduites, une étude portait sur l’anxiété, quatre études (associées à trois programmes) portaient sur la dépression, et une seule étude portait sur les trois troubles à la fois. Dix ERC faisaient état d’une baisse significative des symptômes chez les enfants et/ou des mesures diagnostiques lors du suivi. Pour le trouble des conduites, les programmes dignes de mention ciblaient les jeunes enfants à risque au moyen de la formation parentale ou de l’acquisition de compétences sociales par les enfants; pour l’anxiété, les programmes les plus intéressants faisaient appel à la formation cognitivo-comportementale universelle chez les enfants d’âge scolaire; et pour la dépression, ils ciblaient seulement les enfants d’âge scolaire à risque, mais comme les programmes de prévention de l’anxiété, ils utilisaient la formation cognitivo-comportementale. Tous ces programmes méritoires ont eu des effets modestes, mais indirects. Les études canadiennes étaient peu nombreuses, tout comme les études analysant les coûts des programmes.

Analyse

Les programmes de prévention sont prometteurs, mais pour en déterminer l’efficacité et la rentabilité, il faudrait reproduire les ERC dans un contexte canadien. Quatre types de programmes devraient être étudiés en priorité: ceux qui utilisent la formation parentale et l’acquisition de compétences sociales par les enfants pour prévenir le trouble des conduites chez les enfants en bas âge; et ceux qui utilisent la formation cognitivo-comportementale, universelle ou ciblée, pour prévenir l’anxiété et la dépression chez les enfants d’âge scolaire. Des partenariats entre chercheurs et décideurs permettraient de mener de telles études en milieu naturel et garantiraient leur évaluation rigoureuse. La prévention est une stratégie qui mérite que l’on investisse dans de nouveaux projets de politiques et de recherche s’inscrivant dans une stratégie de santé publique globale pour améliorer la santé mentale des enfants à l’échelle de la population.

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Authors and Affiliations

  1. Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Room 7248, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada

    Charlotte Waddell MSc, MD (Associate Professor and Director), Orion M. Garland BA & Kimberley McEwan PhD

  2. Department of Psychology, University of Victoria, Victoria, BC, Canada

    Josephine M. Hua BSc

  3. Department of Psychology, Queen’s University, Kingston, ON, Canada

    Ray DeV. Peters PhD

Authors
  1. Charlotte Waddell MSc, MD
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  2. Josephine M. Hua BSc
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  3. Orion M. Garland BA
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  4. Ray DeV. Peters PhD
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  5. Kimberley McEwan PhD
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Corresponding author

Correspondence to Charlotte Waddell MSc, MD.

Additional information

Acknowledgements: We are indebted to Cody Shepherd for his advice on data analysis and interpretation. We thank Jayne Barker, Jane Fitzgerald and Margo Craig Garrison for consulting on policy implications. The suggestions of our reviewers also greatly strengthened the manuscript. Charlotte Waddell is a Scholar with the Michael Smith Foundation for Health Research. The Canadian Population Health Initiative with the Canadian Institute for Health Information, the New Emerging Team Program with the Canadian Institutes of Health Research, and the Human Early Learning Partnership with the University of British Columbia provided funding for this work. Finally, we remember Dan Offord who collaborated with us on this study.

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Waddell, C., Hua, J.M., Garland, O.M. et al. Preventing Mental Disorders in Children. Can J Public Health 98, 166–173 (2007). https://doi.org/10.1007/BF03403706

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