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. 2023 Oct 24;2023(10):CD014722. doi: 10.1002/14651858.CD014722.pub2

Summary of findings 5. Summary of findings table ‐ Selective prevention interventions compared to control group in preventing mental disorders in children.

Selective prevention interventions compared to control group in preventing mental disorders in children
Patient or population: preventing mental disorders
Setting: low‐ and middle‐income countries (Uganda (1 study), Thailand (1 study), Democratic Republic of Congo (1 study), Brazil (1 study))
Intervention: selective 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 selective 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)   MD 1.1 higher
(3.32 lower to 1.12 higher) 115
(1 RCT) ⊕⊝⊝⊝
Very lowa,b It is uncertain whether selective prevention interventions have any effect on quality of life among children with risk factors for mental disorders/lack of protective factors (at post‐intervention) compared with usual care. [There is a small effect according to Cohen 1992]1
Adverse events at study endpoint No studies that measured this outcome were identified.   (0 studies)  
Psychological functioning and impairment at study endpoint (higher score = higher disability)   MD 0.02 higher
(0.09 lower to 0.05 higher) 479
(1 RCT) ⊕⊕⊝⊝
Lowc,d There is no evidence that selective prevention interventions improve functional impairment in children with risk factors for mental disorders/lack of protective factors (at post‐intervention) compared to usual care. 1
Depressive symptoms at study endpoint (higher score = higher severity) SMD 0 SD 
(0.16 lower to 0.15 higher) 638
(2 RCTs) ⊕⊕⊕⊝
Moderated Scores estimated based on an SMD of 0.0 (95% CI ‐0.16 to 0.15). Selective prevention interventions for children with risk factors for mental disorders/lack of protective factors probably slightly reduce depressive symptoms (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)   MD 4.5 higher
(12.05 lower to 21.05 higher) 28
(1 RCT) ⊕⊕⊝⊝
Lowe Selective prevention interventions may make little or no difference to anxiety symptoms in children with risk factors for mental disorders/lack of protective factors (at post‐intervention) compared to usual care. 1
Distress/PTSD symptoms at study endpoint (higher score = higher severity)   MD 2.14 lower
(3.77 lower to 0.51 lower) 159
(1 RCT) ⊕⊕⊕⊝
Moderateb Selective prevention interventions for children with risk factors for mental disorders/ lack of protective factors probably slightly reduce distress/PTSD symptoms (at post‐intervention) compared to usual care. [There is a small 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; SMD: standardised mean difference
GRADE Working Group grades of evidenceHigh 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_429913697396673091.

a Downgraded 2 levels owing to study limitations (over 30% of RCTs had high risk of bias due to deviations from intended interventions and missing outcome data, in measurement of the outcome, and in selection of the reported result)
b Downgraded 1 level owing to imprecision (outcome based on a small number of participants, less than 200)
c Downgraded 1 level owing to indirectness (outcome measures as proxy of psychological functioning and impairment)
d Downgraded 1 level owing to imprecision (confidence interval ranged from favouring selective prevention intervention to no clinical effect)
e Downgraded 2 levels owing to imprecision (outcome based on a small number of participants, less than 200, and confidence interval ranged from favouring selective prevention intervention to no clinical effect)
1 J, Cohen. A power primer. Psychological Bulletin ; 1992.