Disorders - Depressive Disorders
Esfandiari, N., Mansouri, S.
The purpose of the research is to
investigate the effect of listening to light and heavy music on reducing the symptom of depression. The participants in this study were 30 female
students with depressive disorder. They were randomly assigned to three groups: (1) Experiment group receiving light music; (2) Experiment group
receiving heavy music; (3) Control group. The results showed that participants in both experimental groups reported decreased levels of depression.
The experiment groups, after 14 sessions, had significantly lower scores on the Beck Depression Inventory in comparison with the two other groups (
p= 0.05).Music can be used therapeutically for reducing the symptoms of depressive disorder in psychiatric hospitals or individually, and it benefits
the nurse. (copyright) 2014 Elsevier Ltd.
Arts in
Psychotherapy, 41(2) : 211-213
- Year: 2014
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Creative expression: music, dance, drama, art
Cox, Georgina. R., Callahan,
Patch., Churchill, Rachel., Hunot, Vivien., Merry, Sally.
N., Parker, Alexandra. G., Hetrick, Sarah. E.
Background: Depressive disorders are common in children and adolescents and, if
left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning.;
Objectives: To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of
depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression
measures, and suicide-related outcomes.; Search Methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised
Register (CCDANCTR) to 11 June 2014. The register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register
of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date).; Selection Criteria: RCTs were eligible
for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and
antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy
and antidepressant medication with a placebo or'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication
with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18
years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International
Classification of Diseases (ICD) criteria.; Data Collection and Analysis: Two review authors independently selected studies, extracted data and
assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean
difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on
different scales.; Main Results: We included eleven studies, involving 1307 participants in this review. We also identified one ongoing study, and
two additional ongoing studies that may be eligible for inclusion. Studies recruited participants with different severities of disorder and with a
variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk
of bias in studies, just under half the studies had adequate allocation concealment (there was insufficient information to determine allocation
concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on
incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically
significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that
antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio
(OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated
as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective
than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to
2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission.
There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission
immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-relate Serious Adverse Events (SAEs) were reported in various ways across
studies and could not be combined in meta-analyses. However, some trials measured suicidal ideation using standardised assessment tools suitable for
meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group
(18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months
(OR 0.26, 95% CI 0.07 to 0.98), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group
reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or
psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear
across the various comparisons in the review.Limited data and conflicting results based on other outcome measures make it difficult to draw
conclusions regarding the effectiveness of any specific intervention based on these outcomes.; Authors' Conclusions: There is very limited evidence
upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these
interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and
adolescents cannot be established. Further appropriately powered RCTs are required.;
Cochrane Database of Systematic
Reviews, 11 : CD008324
- Year: 2014
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any)
Corrieri, S., Heider,
D., Conrad, I., Blume, A., Konig, H-H., Riedel-Heller, S. G.
School-based interventions are considered a promising effort to prevent the
occurrence of mental disorders in adolescents. This systematic review focuses on school-based prevention interventions on depression and anxiety
disorders utilizing an RCT design, starting from the year 2000. Based on an online search (PubMed, Scirus, OVID, ISI) and bibliographic findings in
the eligible articles, 28 studies providing information were reviewed. The search process ended on 2 May 2011. The majority of interventions turn out
to be effective, both for depression (65%) and anxiety (73%). However, the obtained overall mean effect sizes calculated from the most utilized
questionnaires can be considered rather small (CDI: -0.12; RCMAS: -0.29). The majority of the reviewed school-based interventions shows effectiveness
in reducing or preventing mental disorders in adolescents. However, effect size computation revealed only small-scale effectiveness. Future studies
have to consider the impact of program implementation variations.; © The Author (2013). Published by Oxford University Press. All rights reserved.
For Permissions, please email: [email protected].
Health Promotion International, 29(3) : 427-
441
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Diaz-Caneja, C. M., Espliego, A., Parellada, M., Arango, C., Moreno, C.
The aim of this study was to review current
epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available
efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies,
and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in
polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most
frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and
safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination
of antidepressants and antipsychotics in the management of refractory obsessive-compulsive disorder and some residual symptoms in major depressive
disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity
disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events
mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although
there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy
patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.
(copyright) 2012 CINP.
International Journal
of Neuropsychopharmacology, 17(7) : 1063-1082
- Year: 2014
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any)
Donaldson, A. E., Gordon, M. S., Melvin, G. A., Barton, D. A., Fitzgerald, P. B.
Background Depressive
disorders are among the most commonly experienced mental health concerns and a leading cause of mortality in adolescence. Current treatment
guidelines recommend the use of antidepressant medication, cognitive behavioral therapy or both treatments. Unfortunately 40-60% of adolescents fail
to respond to these treatments, therefore a new effective alternative treatment modality would be of particular benefit. rTMS is effective in
addressing treatment resistant depression in adults and investigation into its effectiveness with adolescent populations has begun. Objective To
examine the existing literature regarding the efficacy and safety of rTMS treatment with adolescents experiencing depressive symptoms, especially
research conducted since the last published review. Methods A systematic review was conducted in accordance with PRISMA guidelines. The databases of
OVID PsycINFO, PubMed, Ovid Medline and Web of Science were searched for research utilizing rTMS treatment with adolescents experiencing depressive
symptomology. Results The review identified seven studies that examined rTMS as a treatment for depressive symptomology in adolescence. Findings
indicate rTMS is likely to be an effective treatment for young people with preliminary longitudinal results suggesting maintenance of effects 3 years
post-treatment. Reported side effects have included headaches, scalp discomfort and single incidences of hypomania and seizure. All side effects were
transitory and did not recur. Conclusion Preliminary results suggest rTMS is an effective and well tolerated antidepressant treatment for adolescents
with treatment resistant depressive symptomology. Further research allowing for comparison across studies is necessary to establish the efficacy of
rTMS in adolescent depression. (copyright) 2014 Elsevier Inc. All rights reserved.
Brain Stimulation, 7(1) : 7-
12
- Year: 2014
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS)
Davies, E. B., Morriss, R., Glazebrook,
C.
Background: Depression and anxiety are common
mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help
from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used
to improve students' mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable
prevention strategies for university students. Objective: The intent of the study was to systematically review and analyze trials of Web-based and
computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods: Several
databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for
studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2)
the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled
trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-
analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results:
A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for
meta-analysis. The majority (n = 13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795
participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods
and seven explicitly conducted completers' analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in
improving anxiety (pooled standardized mean difference [SMD] -0.56; 95% CI -0.77 to -0.35, P < .001), depression (pooled SMD -0.43; 95% CI -0.63 to
-0.22, P < .001), and stress (pooled SMD -0.73; 95% CI -1.27 to -0.19, P=.008). In comparison to active controls, sensitivity analyses did not
support either condition for anxiety (pooled SMD -0.18; 95% CI -0.98 to 0.62,P = .66) or depression (pooled SMD -0.28; 95% CI -0.75 to -0.20, P =
.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD -0.10; 95% CI -0.39
to 0.18, P = .48) or depression (pooled SMD -0.33; 95% CI -0.43 to 1.09, P = .40). Conclusions: The findings suggest Web-based and computer-delivered
interventions can be effective in improving students' depression, anxiety, and stress outcomes when compared to inactive controls, but some caution
is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student
samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and
address post-intervention skewed data. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal of Medical Internet
Research, 16(5) : 18-39
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS)
De-Arellano, M. A. R., Lyman, R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., Delphin-Rittmon, M. E.
Objective: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment
developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic
stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base.
Methods: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social
Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of
research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described
the evidence of effectiveness. Results: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted
independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although
it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns
about investigator bias and exclusion of vulnerable populations. Conclusions: TF-CBT is a viable treatment for reducing trauma-related symptoms among
some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service
in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various
racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.
Psychiatric Services, 65(5) : 591-
602
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Deady, M., Teesson, M., Kay-
Lambkin, F. J.
Background: Depression and problematic substance use represent two of the major
social and health problems facing young people internationally. Frequently, these conditions co-occur and this co-occurrence is associated with
greater functional impact, poorer treatment outcomes, and increased costs to both society and the individual. Objective: This review aims to identify
peer-reviewed published trials of interventions for co-occurring substance use and depression delivered to young people, describe these
interventions, and critique the methodological quality of the studies. Method: Eleven electronic databases were searched. The reference lists of
relevant review papers were searched manually for additional studies not identified by the electronic database search. Results: Initially, 1,976
studies were identified, of which 22 were classified as trial studies of youth-based treatment interventions for co-occurring substance use and
depression. Ten of these studies met criteria for review. The majority (60%) utilized a pharmacotherapy component, but found it to be generally no
better than placebo when both groups received adjunct counselling. Methodological quality of studies varied. Conclusions: There is a dearth of trials
of interventions for co-occurring depression and substance use disorders in young people. The limited data available is promising regarding the
overall effectiveness of a psychological counselling approach. Given the importance of early intervention, and the difficulties faced when engaging
youth in treatment, there is a need for further focused effort amongst this group. This may require more innovative techniques in intervention design
and implementation. Recent advances in Internet- and mobile phone-based therapies present a potential avenue for further research.
Current Drug Abuse Reviews, 7(1) : 3-
17
- Year: 2014
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Ekers, D., Webster, L., Van-Straten, A., Cuijpers, P., Richards, D., Gilbody, S.
Background: Depression is a
common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent
years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and
examines moderators of treatment effect. Method: Randomised trials of behavioural activation for depression versus controls or anti-depressant
medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators
were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively. Results: Twenty six randomised controlled
trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural
activation to be superior to controls (SMD - 0.74 CI -0.91 to -0.56, k = 25, N = 1088) and medication (SMD -0.42 CI -0.83 to-0.00, k = 4, N = 283).
Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis
showed limited association between moderators and effect size. Conclusions: The results in this meta-analysis support and strengthen the evidence
base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed
to strengthen the evidence base. (copyright) 2014 Ekers et al.
PLoS
ONE, 9(6) :
- Year: 2014
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Ghaziuddin, N., Merchant, C., Dopp, R., King, C.
Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among
depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization. Methods: One hundred twenty adolescents,
who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent
medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication
groups: SSRI antidepressant only (n = 71); SSRI plus mood stabilizer (n = 17); SSRI plus antipsychotic (n = 20); and SSRI plus antipsychotic and mood
stabilizer (n = 12). Standardized instruments were used. Results: Mean age = 15.5 (plus or minus) 1.3, Caucasian = 80.8%, female = 74.2%, mean CDRS-R
= 61.7 (plus or minus) 12.1, suicide attempt during month prior to hospitalization = 58.6%. During the 3-month post-hospitalization period: (1) there
were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity
was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were
associated with greater reduction in suicidal ideation at 3-months. Conclusion: Declines in suicidal ideation, depression severity, and suicide
attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in
combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify
medication adherence is a study limitation.
Asian Journal of Psychiatry, 11 : 13-
19
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)
Hyun, M.-S., Chung, H-I. C., De-Gagne, J. C., Kang, H.
S.
This quasi-experimental study examined the effects of cognitive-
behavioral therapy (CBT) to control depression, anger, and self-control in soldiers from South Korea. Using a pretest-posttest design, the sample was
composed of an experimental group (n = 16) and a control group (n = 12). The experimental group participated in four sessions of CBT. No significant
differences were found between the groups with regard to demographic characteristics. Changes in the variables after the intervention were analyzed
using Wilcoxon's signed-rank sum test. The depression scores decreased significantly after the intervention (z = -3.05, p = 0.002); whereas, the
scores of state-trait anger and self-control did not change. In the control group, none of the outcome variable scores changed significantly. The
results indicate that the developed CBT program might be an effective modality to decrease the depression of soldiers who are in military service.;
Copyright 2014, SLACK Incorporated.
Journal of Psychosocial Nursing & Mental
Health Services, 52(2) : 22-28
- Year: 2014
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Jegannathan, B., Dahlblom, K., Kullgren, G.
Background: Most of the school-based interventions to prevent suicide are from high income countries and
there is a need for evidence based interventions in resource-poor settings. The aim of this study is to evaluate the outcome of a school based
intervention to reduce risk factors for suicide among young people in Cambodia by promoting life skills. Method: Six classes were randomly selected
from two schools each, one designated as experimental and the other as control school, respectively. In experimental school 168 young people (M = 92,
F = 76) received 6 sessions of life skills education and in the control school 131 students (M = 53, F = 78) received three general sessions on
health. We looked at the pre-post differences on Life-Skills Development Scale Adolescent Form (LSDS-AF)- and Youth Self-Report (YSR) questionnaire
to measure the effect size (ES) from the intervention after 6 months. We analyzed the data by stratifying for gender and for those who reported more
severe suicidal expressions at baseline (high-risk group). Results: The girls showed improvement in Human Relationship (ES = 0.57), Health
Maintenance (ES = 0.20) and the Total Life Skills Dimensions (ES = 0.24), whereas boys with high-risk behavior improved on Human Relationship (ES =
0.48), Purpose in Life (ES = 0.26) and Total Life Skills Dimensions (ES = 0.22). Effect size for YSR-syndrome scores among all individuals showed no
improvement for either gender. Among high-risk individuals boys had a small to moderate effect size from intervention on Withdrawn/Depressed (ES =
0.40), Attention problems (ES = 0.46), Rule breaking behavior (ES = 0.36), Aggressive behavior (ES = 0.48) and Externalizing syndrome (ES = 0.64).
Conclusion: Promoting life skills in schools may enhance the overall mental health of young people, indirectly influencing suicide, particularly
among boys with high-risk behavior in Cambodia. (copyright) 2014 Elsevier B.V.
Asian Journal of
Psychiatry, 9 : 78-84
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Skills training