Summary of findings 3. Summary of findings table ‐ Indicated prevention interventions compared to control group in preventing mental disorders in adults.
| Indicated prevention interventions compared to control group in preventing mental disorders in adults | ||||||
| Patient or population: preventing mental disorders Setting: low‐ and middle‐income countries (Turkey, Iran (2 studies), China (4 studies), Malaysia, Guatemala, India (3 studies), Bosnia and Herzegovina, Brazil (3 studies), Vietnam, South Africa (3 studies), Tanzania, Kenya, Nepal, Burundi, Jamaica (2 studies), Ghana, Philippines) Intervention: indicated prevention interventions Comparison: control group | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control group | Risk with indicated prevention interventions | |||||
| Diagnosis of mental disorders at study endpoint (RR < 1 denotes lower risk of mental diagnosis) | 170 per 1000 | 51 per 1000 (10 to 267) | RR 0.30 (0.06 to 1.57) | 843 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c,d | It is uncertain whether indicated prevention interventions have any effect on the risk of mental disorders in adults with a high vulnerability to develop mental disorders (at post‐intervention) compared to usual care. |
| Quality of life at study endpoint (higher score = better quality of life) | ‐ | SMD 0.36 lower (0.61 lower to 0.12 lower) | ‐ | 1136 (8 RCTs) | ⊕⊝⊝⊝ Very lowe,f | Scores estimated based on an SMD of ‐0.36 (95% CI ‐0.61 to ‐0.12). It is uncertain whether indicated prevention interventions have any effect on quality of life among adults with a high vulnerability to develop mental disorders (at post‐intervention) compared with usual care. [There is a small effect according to Cohen 1992]1 |
| Adverse events at study endpoint | Not pooled | Not pooled | Not pooled | (1 RCT) | ⊕⊕⊝⊝ Lowg,h | Indicated prevention interventions may reduce adverse events in adults with a high vulnerability to develop mental disorders (at post‐intervention) compared to usual care. |
| Psychological functioning and impairment at study endpoint (higher score = higher disability) | ‐ | SMD 0.12 lower (0.39 lower to 0.15 higher) | ‐ | 663 (4 RCTs) | ⊕⊕⊕⊝ Moderatei | Scores estimated based on an SMD of ‐0.12 (95% CI ‐0.39 to 0.15). Indicated prevention interventions for adults with a high vulnerability to develop mental disorders probably slightly reduce functional impairment (at post‐intervention)compared to usual care. [There is a small effect according to Cohen 1992]1 |
| Depressive symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 0.16 lower (0.3 lower to 0.03 lower) | ‐ | 2341 (18 RCTs) | ⊕⊝⊝⊝ Very lowj,k,l | Scores estimated based on an SMD of ‐0.16 (95% CI ‐0.3 to ‐0.03). It is uncertain whether indicated prevention interventions have any effect on depressive symptoms in adults with a high vulnerability to develop mental disorders (at post‐intervention) compared to usual care. [There is a small effect according to Cohen 1992]1 |
| Anxiety symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 1.19 lower (2.02 lower to 0.35 lower) | ‐ | 250 (5 RCTs) | ⊕⊝⊝⊝ Very lowm,n | Scores estimated based on an SMD of ‐1.19 (95% CI ‐2.02 to ‐0.035). It is uncertain whether indicated prevention interventions have any effect on depressive symptoms in adults with a high vulnerability to develop mental disorders (at post‐intervention) compared to usual care. [There is a large effect according to Cohen 1992]1 |
| Distress/PTSD symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 0.54 lower (0.95 lower to 0.14 lower) | ‐ | 2536 (19 RCTs) | ⊕⊝⊝⊝ Very lowl,n | Scores estimated based on an SMD of ‐0.54 (95% CI ‐0.95 to ‐0.14). It is uncertain whether indicated prevention interventions have any effect on distress/PTSD symptoms in adults with a high vulnerability to develop mental disorders (at post‐intervention) compared to usual care. [There is a medium effect according to Cohen 1992]1 |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
| See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_429913973563280333. | ||||||
a Downgraded 2 levels owing to study limitations (over 30% of RCTs had high risk of bias due to missing outcome data and in selection of the reported result) b Downgraded 2 levels owing to inconsistency (I2 was higher than 75%, point estimates vary widely across studies) c Downgraded 1 level owing to indirectness (outcome measures as proxy of diagnosis of mental disorders) d Downgraded 1 level owing to imprecision (outcome based on wide confidence interval ranged from favouring Indicated Prevention Intervention to no clinical effect) e Downgraded 2 levels owing to inconsistency (I2 was higher than 75%, P = 0.003) f Downgraded 1 level owing to indirectness (outcome measures as proxy of quality of life) g Downgraded 1 level owing to publication bias (only 1 "negative" RCT) h Downgraded 1 level owing to study limitations i Downgraded 1 level owing to indirectness (outcome measures as proxy of psychological functioning and impairment) j Downgraded 1 level owing to study limitations (all RCTs had some concerns in measurement of the outcome; over 10% of studies had high concerns due to deviations from intended interventions) k Downgraded 1 level owing to inconsistency (I2 between 50% and 75%, P = 0.002) l Downgraded 1 level owing to publication bias (funnel plot suggests high asymmetry: RCTs expected in the bottom right quadrant are missing) m Downgraded 1 level owing to study limitations (over 30% of RCTs had some concerns due to deviations from intended interventions and in measurement of the outcome) n Downgraded 2 levels owing to study limitations (over 30% of RCTs had some concerns due to deviations from intended interventions and in measurement of the outcome) 1 J, Cohen. A power primer. Psychological Bulletin ; 1992.