Disorders - Depressive Disorders
Dowling, K., Simpkin, A. J., Barry, M. M.
School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n=497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p=0.035), use of more positive coping strategies [reduced avoidance coping p=<0.001) and increased social support coping p=0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p=0.017) and depressive symptoms (p=0.030) as well as reduced anxiety scores for females students (p=0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.
Journal of youth and adolescence., :
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Goff, D. C., Freudenreich, O., Cather, C., Holt, D., Bello, I., Diminich, E., Tang, Y., Ardekani, B. A., Worthington, M., Zeng, B., Wu, R., Fan, X., Li, C., Troxel, A., Wang, J., Zhao, J.
Antidepressants are frequently prescribed in first episode schizophrenia (FES)patients for negative symptoms or for subsyndromal depressive symptoms, but therapeutic benefit has not been established, despite evidence of efficacy in later-stage schizophrenia. We conducted a 52 week, placebo-controlled add-on trial of citalopram in patients with FES who did not meet criteria for major depression to determine whether maintenance therapy with citalopram would improve outcomes by preventing or improving negative and depressive symptoms. Primary outcomes were negative symptoms measured by the Scale for Assessment of Negative Symptoms and depressive symptoms measured by the Calgary Depression Scale for Schizophrenia; both were analyzed by an intent-to-treat, mixed effects, area-under-the-curve analysis to assess the cumulative effects of symptom improvement and symptom prevention over a one-year period. Ninety-five patients were randomized and 52 (54%)completed the trial. Negative symptoms were reduced with citalopram compared to placebo (p =.04); the effect size of citalopram versus placebo was 0.32 for participants with a duration of untreated psychosis (DUP)of <18 weeks (median split)and 0.52 with a DUP >18 weeks. Rates of new-onset depression did not differ between groups; improvement in depressive symptoms was greater with placebo than citalopram (p =.02). Sexual side effects were more common with citalopram, but overall treatment-emergent side effects were not increased compared to placebo. In conclusion, citalopram may reduce levels of negative symptoms, particularly in patients with longer DUP, but we found no evidence of benefit for subsyndromal depressive symptoms. Copyright © 2019 The Authors
Schizophrenia Research, 208 : 331-337
- Year: 2019
- Problem: Depressive Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Psychoeducation
Olive, L.S., Byrne, D., Cunningham, R.B., Telford, R.M., Telford, R.D.
Physical activity may benefit mental health, yet the potentially protective role of elementary school physical education (PE) on childhood mental health is unknown. The aim of the current study was to determine the effect of a specialist-taught PE program on indicators of childhood mental health. In this cluster-randomized controlled trial, participants were initially 821 healthy children (8 years, 406 girls) from 29 schools. Thirteen schools were allocated to the 4-year intervention program of specialist-taught PE, with the remaining schools forming the control group. Mental health indicators of depression, body image, and stress were measured at ages 7, 8, and 12 years. Assessments of covariates included percent body fat (DEXA), physical activity (pedometers), puberty (Tanner stages), and socioeconomic status. After receiving 1 year of specialist-taught PE, children of the intervention group reported a -0.71-unit decrease in body dissatisfaction compared to a 3.01-unit increase in control group children (p = .042); and a mean decrease in depressive symptoms (ineffectiveness), which was -0.27 units more than the control group (p = .005). Mixed-model analyses investigating longer-term effects revealed that the early positive effect of the intervention on body dissatisfaction and depression was not sustained over time. In fact, there was evidence of an intervention effect of an overall increase in depressive symptoms over the 4 years of the study for girls only. While our specialist-taught PE intervention had a positive influence on girls' body dissatisfaction and boys' depressive symptoms in the first year, this was not sustained over the 4-year duration of the study. (PsycINFO Database Record (c) 2019 APA, all rights reserved) Impact Statement Educational Impact and Implications Statement-Physical activity may benefit mental health, yet the potentially protective role of elementary school physical education (PE) on mental health is unknown. The aim of the current study was to determine how PE taught by specialist-trained PE teachers influences children's levels of stress, depression. and body image. In this investigation, spanning 4 years, our specialist-taught PE intervention had a positive influence on girls' body dissatisfaction and boys' depressive symptoms in the first year. However, this was not sustained over the 4-year duration of the intervention. In fact, there was evidence that girls receiving the intervention, and therefore having greater exposure to PE, had an overall increase in depressive symptoms. These findings demonstrate that PE can influence childhood mental health, for the better or worse, and suggest that PE could provide a useful vehicle through which to deliver well-being programs, in which case, teachers tasked with the delivery of PE might benefit from additional training to minimize any potential negative impact of PE on children's mental health. These findings have important implications for educational policymakers and emphasize the need to acknowledge the psychological and physiological differences between boys and girls when developing PE curricula. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Educational Psychology, : No Pagination Specified
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Dai, Q., Hu, L., Feng, Z.
Difficulty in clinical antidepressant treatment leads to the pursuit of alternative treatments, such as cognitive-behavior therapy (CBT). CBT combined with regular antidepressants have indicated an optimal therapeutic effect in clinic. Attentional bias is important in the occurrence and remission of depression, however, few studies have explored the effect of attentional bias modification (ABM) on depression, and inconsistent results have been obtained due to the heterogeneity in the targeted populations, training tasks, strategies, and materials. Hence, the current study aimed to explore the therapeutic effect of ABM on depression in clinical depression. Study I was designed to explore the optimal training methods regarding task (dot-probe vs. cue-target), material (faces vs. self-referent words), and strategy (mixed ABM toward positive and away from negative stimuli vs. positive ABM toward positive stimuli) in unselected undergraduates once daily for 10 days (N = 309). Study II was carried out to observe the effect of 10 days ABM toward positive and away from negative faces (based on Study I) on clinical depression (N = 32). Depression level was assessed via a self-reporting questionnaire and a structured interview, while attentional bias was tested by cue-target task and attention to positive and negative inventory (APNI). In unselected undergraduates (Study I), two strategies significantly reduced the self-reporting depression scores: mixed ABM toward positive stimuli and away from negative stimuli with emotional faces, and positive ABM toward positive materials only with self-referent words. In patients with major depressive disorder (MDD) (Study II), the mixed ABM with emotional faces resulted in enhanced attentional bias toward happy materials in the cue-target task and APNI, which predicted a delayed depression reduction in clinical depression at the one-month follow-up investigation. Our finding confirms the literature and broadens the knowledge with the evidence of the optimal therapeutic effect of ABM combined with regular antidepressants in clinical depression. The findings that a quick enhancement in positive attentional bias, predicting a later therapeutic effect on clinical depression reduction, indicate a potential mechanism that could underlie the therapeutic process of ABM in depression. The findings that two training strategies are effective in depression reduction suggest that different strategies should be utilized to treat different types of depression. This study offers a potential way to cure depression and could be further practiced in clinic. Copyright © 2018
Journal of Psychiatric Research, 109 : 145-155
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Vera, F. M., Manzaneque, J. M., Rodriguez, F. M., Vadillo, M., Navajas, F., Heiniger, A. I., Perez, V., Blanca, M. J.
Qigong is an ancient form of health maintenance, which is part of Traditional China Medicine. Numerous beneficial mental and physical effects have been classically ascribed to this traditional psychosomatic method. The purpose of this work has been to assess the effects of Taoist qigong practice on several hormonal parameters of the Hipotalamic-Pituitary-Adrenal axis and specific measures of psychological well-being in healthy subjects. Forty-three healthy volunteers participated in the study, of whom 22 were randomly allocated to the experimental group, and 21 were assigned to the control group. Experimental participants underwent a qigong training program for one month. Blood samples for the quantification of hormonal parameters, and several instruments to assess anxiety and depression symptoms as well as subjective sleep quality, were obtained before and after the program. Statistically significant differences were found between the experimental and control groups, with the experimental group showing lower blood levels of adrenocorticotropic hormone (ACTH). This study shows that Taoist qigong is a psychosomatic method able to exert a modulatory action on ACTH levels in healthy subjects. We consider the need to continue exploring the psychobiological modulation of this qigong method and its possible repercussion for human health care.
Scandinavian Journal of Psychology, 60(1) : 43-49
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Weisz, J. R., Kuppens, S., Ng, M. Y., Vaughn-Coaxum, R. A., Ugueto, A. M., Eckshtain, D., Corteselli, K. A.
With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963-2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.
Perspectives on Psychological Science : A Journal of the Association for Psychological Science, 14(2) : 216-237
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Davey, C. G., Hetrick, S., Chanen, A. M., Cotton, S. M., Ratheesh, A., Amminger, G. P., Koutsogiannis, J., Phelan, M., Mullen, E., Harrison, B. J., Rice, S., Williams, A., Kerr, M., Quinn, A. L., Baird, S., Ferguson, N., Brodie, R., Incerti, L., Dean, O. M., McGorry, P.D., Berk, M.
Background & aims: The effectiveness and safety of antidepressant medications for young people with depression has been contested. In particular, it is not clear whether medication should be added to CBT as first-line treatment for youth depression. The aim of the Youth Depression Alleviation-Combined Treatment (YoDA-C) trial was to determine whether fluoxetine was more effective than placebo when added to CBT for young people with depression. Method(s): The trial was a randomised, double-blind, placebo-controlled, multicentre clinical trial. Participants were 15-to 25-year-olds with moderate-to-severe major depressive disorder, and were randomised to receive either fluoxetine 20-40 mg (CBT+FLX, n = 76) or a matching placebo pill (CBT+PBO, n = 77). All participants attended weekly CBT sessions for 12 weeks. Our primary outcome measure was change in the Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to 12 weeks. Result(s): There were no significant differences between groups for change in MADRS scores or for change in self-reported depressive symptoms, measured with the Quick Inventory of Depression Symptomatology (QIDS). There was, however, evidence of a greater reduction in anxiety symptoms in the CBT+FLX group compared to the CBT+PBO group, as measured by the Generalized Anxiety Disorder 7-item scale (GAD7). Subgroup analysis of participants under the age of 18 showed no evidence of between-group differences on the measures. For participants 18 and older, however, those in the CBT+FLX group showed evidence of greater reduction in MADRS, QIDS, and GAD7 scores than participants in the CBT+PBO group. Conclusion(s): There is no evidence to support the addition of fluoxetine to CBT as first-line treatment for young people with moderate-to-severe depression. This is particularly so for participants under the age of 18. There is some evidence that the addition of medication might be helpful for co-morbid anxiety symptoms, and for older youth.
Bipolar Disorders, 21 (Supplement 1) : 13
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Calear, A. L.
Objectives: This presentation will test the effectiveness of 2 universal online, self-directed CBT programs in preventing and reducing symptoms of depression and anxiety in an adolescent school-based population. Method(s): Two cluster RCTs were conducted. In the first trial (n = 1477), the MoodGYM program was compared with a wait-list control condition and delivered over 5 weeks to adolescents aged 12-17 years. The second trial (n = 540) was also implemented over 5 weeks to adolescents aged 15-16 years, evaluating SPARX-R against an attention control condition. Both trials measured depressive and anxiety symptom outcomes at preintervention, postintervention, and at 6 months follow-up and were analyzed using mixed-model repeated measure intention-to-treat approaches. Result(s): At postintervention and 6 months follow-up, the MoodGYM program was found to have a significant effect on anxiety for both males and females (Cohen's d = 0.15-0.25) and on depression for males only (d = 0.27-0.43). The SPARX-R program had a significant effect on depression, but not anxiety, at postintervention and at 6 months follow-up (d = 0.13-0.29). Greater adherence to the MoodGYM program was indicative of stronger intervention effects, with improved adherence associated with being in year 9 (ages 14-15 years), living in a rural location, and/or having higher preintervention levels of depressive symptoms or self-esteem. Conclusion(s): Although small to moderate, the effects obtained in the current studies provide support for the use of universal online prevention programs for depression in schools. Future research into methods to increase adherence and engagement with online programs is needed. DDD, TVM, CBT Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S35
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Bettis, A. H., Forehand, R., Sterba, S. K., Preacher, K. J., Compas, B. E.
The current study examined effects of a preventive intervention on patterns of change in symptoms of anxiety and depression in a sample of children of depressed parents. Parents with a history of depression (N = 180) and their children (N = 242; 50% female; Mage = 11.38; 74% Euro-American) enrolled in an intervention to prevent psychopathology in youth. Families were randomized to a family group cognitive behavioral intervention (FGCB) or a written information (WI) control condition. Parents and youth completed the Child Behavior Checklist and Youth Self Report at baseline, 6-, 12-, 18-, and 24-month follow up. Youth in the FGCB intervention reported significantly greater declines in symptoms of both anxiety and depression at 6, 12, and 18 months compared to youth in the WI condition. Youth with higher baseline levels of each symptom (e.g., anxiety) reported greater declines in the other symptom (e.g., depression) from 0 to 6 months in the FGCB intervention only. Changes in anxiety symptoms from 0 to 6 months predicted different patterns of subsequent changes in depressive symptoms from 6 to 12 months for the two conditions, such that declines in anxiety preceded and predicted greater declines in depression for FGCB youth but lesser increases in depression for WI youth. Findings inform transdiagnostic approaches to preventive interventions for at-risk youth, suggesting that both initial symptom levels and initial magnitude of change in symptoms are important to understand subsequent patterns of change in response to intervention.
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(4) : 581-594
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Psychoeducation, Skills training
Topooco, N., Berg, M., Johansson, S., Liljethorn, L., Radvogin, E., Vlaescu, G., Nordgren, L. B., Zetterqvist, M., Andersson, G.
Background Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment.Aims To evaluate the efficacy of internet-based cognitive-behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression.Method Seventy adolescents, 15-19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II).Results Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22-1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months.Conclusions The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people.Declaration of interest N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linkoping University and run on a non-for-profit basis. None of the authors receives any income from the programme. Copyright © The Royal College of Psychiatrists 2018.
BJPsych Open, 4(4) : 199-207
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Saleh, D., Camart, N., Sbeira, F., Romo, L.
In our research, we examined the efficacy of an Internet-based stress management program. Our interest in evaluating this type of intervention is based on the increasing accessibility of the Internet today, the growth of Internet-based interventions for various psychopathological problems, and the observation that despite the prevalence of stress among university students, only a fraction of students ever seek professional help. Methodology: "I'm managing my stress" ("Je gere mon stresse"), an Internet-based self-help program composed of four sessions, was examined in this study. The aforementioned program is based on cognitive-behavioral therapy and was inspired by the "Funambule" program in Quebec. Four questionnaires (Perceived Stress Scale, Rosenberg Self-Esteem Scale, Scale of Satisfaction in Studies, and General Health Questionnaire) uploaded online were answered thrice: during "preintervention", "postintervention", and "follow-up" stages, the latter of which occurred three months after the intervention. The sample comprised 128 university students, with the majority being women (81.25%). The subjects were divided randomly into two groups (an experimental group and a control group that did not follow the program). Result(s): The self-esteem scores of the control group were significantly higher than those of the experimental group at the preintervention stage, but this difference disappeared at the postintervention and follow-up stages. There were also significantly lower scores on the General Health Questionnaire subfactors of somatic symptoms and anxiety/insomnia in the experimental group than in the control group during the postintervention stage, though no differences were observed before the intervention. These differences no longer remained after three months. ANOVA revealed significant effects of the intervention over time in the experimental group. Effects were observed at both the postintervention and follow-up stages for self-esteem, perceived stress, satisfaction in studies, and in the somatic symptoms, anxiety and insomnia and severe depression aspects of the General Health Questionnaire (Cohen's d = 0.38 to 4.58). In contrast, no effects were observed in the control group. Conclusion(s): This type of Internet-based program has the ability to reach a large number of students due to its rather short format and accessibility. It has already shown improvements in terms of the levels of perceived stress, psychological distress and satisfaction with studies. The option of online interventions could appeal specifically to students who do not seek professional help. However, even though these results are promising at the postintervention stage, they are limited, as indicated by the lack of significant differences between the two groups after the initial three months of follow-up. We still, specifically, need to improve this intervention program and, generally, need more research to address the methodological problems raised by this type of intervention. Copyright © 2018 Saleh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PLoS ONE, 13 (9) (no pagination)(e0200997) :
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Tokolahi, E., Vandal, A. C., Kersten, P., Pearson, J., Hocking, C.
Background: The impact of occupational therapy on mental health outcomes for children is largely unexplored. The aim of this study was to investigate an evidence-based occupational therapy intervention designed to increase participation in daily occupations to prevent symptoms of mental illness for children and run in schools. Method(s): The study used a pragmatic, cluster-randomised controlled trial design with two arms. Fourteen clusters (schools), equating to 151 child participants, were stratified by school decile-rank category and block randomised. Blinding of participants post-randomisation was not feasible; however, outcomes assessors were blinded. Outcomes were measured at baseline, after the parallel and crossover phases, and at follow-up; and were anxiety symptoms (primary), depression symptoms, self-esteem, participation and wellbeing. Intention-to-treat analysis was applied and mixed linear modelling was used to account for clusters and repeated measures, and to adjust for covariates identified. Result(s): This trial found significant positive effects of the intervention on child-rated satisfaction with their occupational performance and teacher-rated child anxiety. No evidence was found to support the effect of the intervention on anxiety and depression symptoms, self-esteem and wellbeing. Conclusion(s): This was the first known cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. No compelling evidence was found to support the use of the intervention in schools in its current format, however, results were promising that the focus on occupations influenced participation. Recommendations are made to redesign the intervention as an embedded intervention in the classroom, cotaught by teachers and including parental involvement. Copyright © 2018 Association for Child and Adolescent Mental Health
Child and Adolescent Mental Health, 23(4) : 313-327
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Other service delivery and improvement interventions