Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18

Highlights

• Preventive parenting interventions can reduce child internalizing problems.

• The effects of parenting interventions can last for up to 11 years.

• Preventive interventions directed primarily at parents can have long-term benefits for children.

• We should increase parental involvement in preventing child internalizing problems.

Abstract

Purpose of the research

Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term.

Principal results

Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6 months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6 months up to 15 years for internalizing measures, 5.5 years for depressive measures, and 11 years for anxiety measures.

Major conclusions

Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.

Introduction

Mental disorders are the largest contributors to disability in young people, with one in four youths affected during their lifetime (Patel, Flisher, Hetrick, & McGorry, 2007). Anxiety and mood disorders are amongst the most common disorders, with lifetime prevalence rates of 38% and 18% respectively amongst young people aged 13–17 years (Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012). Given the deleterious long-term sequelae resulting from early onset disorders (Last et al., 1997, Rao et al., 1995), there is a strong impetus for an effective, integrated approach to prevent these disorders in young people.

There is substantial overlap between depression and anxiety symptoms especially in childhood (Hankin et al., 2005, Lahey et al., 2008), and increasing evidence indicates that anxiety and depression comprise an ‘internalizing cluster’ (Schleider and Weisz, 2016, Weersing et al., 2012). In addition to their phenomenological and diagnostic similarities, depression and anxiety disorders share some risk factors, including parental factors (Dozois et al., 2009, Schleider and Weisz, 2016, Wilamowska et al., 2010). Of note, extant evidence indicates that many parental factors examined in depression and anxiety research are not specific to either disorder (e.g., Bögels and Brechman-Toussaint, 2006, Restifo and Bögels, 2009, Yap and Jorm, 2015, Yap et al., 2014). Consequently, an increasing number of researchers have called for transdiagnostic approaches to prevention of these disorders (Dozois et al., 2009, Schleider and Weisz, 2016, Yap and Jorm, 2015, Yap et al., 2014), because of their potential to enhance the efficacy, generalizability, and cost-effectiveness of such interventions, as well as to facilitate their implementation. Moreover, studies examining internalizing outcomes across childhood and adolescence tend to use a range of measures assessing anxiety symptoms, depressive symptoms, or a combination of both, otherwise termed ‘internalizing’ symptoms. Hence, this review takes a transdiagnostic approach by including both depression and anxiety as outcomes of interest, along with measures of internalizing symptoms. Henceforth, the broad term ‘internalizing cluster or problems’ will be used to refer to measures of internalizing, anxiety or depressive symptoms or disorders.