Summary of findings 6. Summary of findings table ‐ Indicated prevention interventions compared to control group in preventing mental disorders in children.
| Indicated prevention interventions compared to control group in preventing mental disorders in children | ||||||
| Patient or population: preventing mental disorders Setting: low‐ and middle‐income countries (China (1 study), Tanzania (1 study), Kenya (1 study), Sri Lanka (1 study), Belize (1 study)) 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) | 336 per 1000 | 259 per 1000 (171 to 393) | RR 0.77 (0.51 to 1.17) | 220 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | It is uncertain whether indicated prevention interventions have any effect on the risk of mental disorders in children 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 0.65 SD lower (2.09 lower to 0.79 higher) | ‐ | 152 (2 RCTs) | ⊕⊝⊝⊝ Very lowd,e,f | Scores estimated based on an SMD of ‐0.65 (95% CI ‐2.09 to 0.79). It is uncertain whether indicated prevention interventions have any effect on quality of life among children 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 | No studies that measured this outcome were identified. | (0 studies) | ‐ | |||
| Psychological functioning and impairment at study endpoint (higher score = higher disability) | ‐ | SMD 0.29 SD lower (0.47 lower to 0.1 lower) | ‐ | 448 (2 RCTs) | ⊕⊕⊕⊕ High | Scores estimated based on an SMD of ‐0.29 (95% CI ‐0.47 to ‐0.1). Indicated prevention interventions decrease slightly functional impairment in children 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 |
| Depressive symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 0.18 SD lower (0.32 lower to 0.04 lower) | ‐ | 771 (4 RCTs) | ⊕⊕⊕⊕ High | Scores estimated based on an SMD of ‐0.18 (95% CI ‐0.32 to ‐0.04). Indicated prevention interventions decrease slightly depressive symptoms in children 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 0.09 lower (0.22 lower to 0.04 higher) | ‐ | 888 (3 RCTs) | ⊕⊝⊝⊝ Very lowg,h | Scores estimated based on an SMD of ‐0.09 (95% CI ‐0.22 to 0.04). It is uncertain whether indicated prevention interventions have any effect on anxiety symptoms in children 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 |
| Distress/PTSD symptoms at study endpoint (higher score = higher severity) | ‐ | SMD 0.24 SD higher (1.28 lower to 1.76 higher) | ‐ | 448 (2 RCTs) | ⊕⊕⊝⊝ Lowi,j | Scores estimated based on an SMD of 0.24 (95% CI ‐1.28 to 1.76). Indicated prevention interventions may slightlyreduce distress/PTSD symptoms in children 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 |
| *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_429913780370754267. | ||||||
a Downgraded 1 level owing to study limitations (RCT did not provided information about allocation concealment, and outcome assessment was not described as masked) b Downgraded 1 level owing to indirectness (outcome measures as proxy of depression) c Downgraded 1 level owing to imprecision (outcome based on wide confidence interval ranging from favouring indicated prevention intervention to no clinical effect) d Downgraded 2 levels owing to study limitations (over 30% of RCTs had high risk in selection of the reported result) e Downgraded 1 level owing to indirectness (outcome measures as proxy of quality of life) f Downgraded 1 level owing to imprecision (outcome based on a small number of participants, less than 200) g 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) h Downgraded 1 level owing to indirectness (outcome measures as proxy of anxiety) i Downgraded 1 level owing to inconsistency (point estimates vary widely across studies) j Downgraded 1 level owing to imprecision (outcome based on wide confidence interval that included no effect and appreciable benefit and harm) 1 J, Cohen. A power primer. Psychological Bulletin ; 1992.