Summary of findings 4. Summary of findings table ‐ Promotion/universal prevention interventions compared to control group in preventing mental disorders in children.
| Promotion/universal prevention interventions compared to control group in preventing mental disorders in children | ||||||
| Patient or population: preventing mental disorders Setting: low‐ and middle‐income countries (Brazil (1 study), Uganda (1 study), Mexico (1 study), Tanzania (1 study), Mauritius (1 study), Iran (1 study)) Intervention: promotion/universal 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 promotion/universal prevention interventions | |||||
| Diagnosis of mental disorders at study endpoint | No studies that measured this outcome were identified. | (0 studies) | ‐ | |||
| Quality of life at study endpoint (higher score = better quality of life) | ‐ | SMD 0.25 SD lower (0.39 lower to 0.11 lower) | ‐ | 803 (2 RCTs) | ⊕⊕⊝⊝ Lowa,b | Scores estimated based on an SMD of ‐0.25 (95% CI ‐0.39 to ‐0.11). Promotion/universal prevention interventions may improve the quality of life of children without risk factors for mental disorders (at post‐intervention) compared to usual care. [There is a small effect according to Cohen 1992]1 |
| Adverse events at study endpoint (RR < 1 indicates lower risk of adverse events) | Not pooled | Not pooled | Not pooled | (1 RCT) | ⊕⊕⊝⊝ Lowc,d | Promotion/universal prevention interventions may reduce adverse events in children without risk factors for mental disorders (at post‐intervention) compared to usual care |
| Psychological functioning and impairment at study endpoint (higher score = higher disability) | ‐ | SMD 0.04 higher (0.9 lower to 0.98 higher) | ‐ | 212 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,e,f,g | Scores estimated based on an SMD of 0.04 (95% CI ‐0.9 to 0.98). It is uncertain whether promotion/universal prevention interventions have any effect on functional impairment in children without risk factors for mental disorders (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) | MD 3.04 SD lower (6 lower to 0.08 lower) | ‐ | 160 (1 RCT) | ⊕⊕⊝⊝ Lowc,h | Promotion/universal prevention interventions may slightly reduce depression symptoms in children without risk factors for mental disorders (at post‐intervention) compared to usual care. [There is a large effect according to Cohen 1992]1 | |
| Anxiety symptoms at study endpoint (higher score = higher severity) | MD 2.77 higher (3.13 lower to 1.41 lower) | ‐ | 183 (1 RCT) | ⊕⊕⊝⊝ Lowc,h | Promotion/universal prevention interventions may slightly reduce anxiety symptoms in children without risk factors for mental disorders (at post‐intervention) compared to usual care. [There is a medium effect according to Cohen 1992]1 | |
| Distress/PTSD symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 0.83 SD lower (2.48 lower to 0.82 higher) | ‐ | 800 (2 RCTs) | ⊕⊝⊝⊝ Very lowi,j,k,l | Scores estimated based on an SMD of ‐0.83 (95% CI ‐2.48 to 0.82). It is uncertain whether promotion/universal prevention interventions have any effect on distress/PTSD symptoms in children without risk factors for mental disorders (at post‐intervention) compared to usual care. [There is a large 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; MD: mean difference; 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_429913294102284283. | ||||||
a Downgraded 1 level owing to study limitations (all RCTs had some concerns for the deviations from the intended interventions and in measurement of the outcome) b Downgraded 1 level owing to indirectness (outcome measures as proxy of quality of life) c Downgraded 1 level owing to study limitations (RCT had some concerns for the deviations from the intended interventions and in measurement of the outcome) d Downgraded 1 level owing to imprecision (0 total events) e Downgraded 2 levels owing to inconsistency (I2 was higher than 75%, point estimates vary widely across RCTs, and CIs show minimal overlap) f Downgraded 1 level owing to indirectness (outcome measures as proxy of psychological functioning and impairment) g Downgraded 1 level owing to imprecision (outcome based on wide confidence interval that included no effect and appreciable benefit and harm) h Downgraded 1 level owing to imprecision (outcome based on a small number of participants, less than 200) i Downgraded 2 level owing to study limitations (over 30% of RCTs had high risk of bias due to deviations from the intended interventions and missing outcome data) j Downgraded 2 levels owing to inconsistency (I2 was higher than 75%, P < 0.00001, point estimates vary widely across studies, and CIs show no overlap) k Downgraded 1 level owing to indirectness (outcome measures as proxy of distress) l Downgraded 1 level owing to imprecision (wide confidence interval ranged from favouring promotion/prevention intervention to no clinical effect) 1 J, Cohen. A power primer. Psychological Bulletin ; 1992.