The Prevention of Childhood Anxiety in Socioeconomically Disadvantaged Communities: A Universal School-Based Trial

Anxiety disorders are among the most prevalent psychiatric disorders in children and adolescents, with up to 25% of children experiencing clinical anxiety at some point (Boyd, Kostanski, Gullone, Ollendick, & Shek, 2000; Essau, Conradt, & Petermann, 2000; Neil & Christensen, 2009; Tomb & Hunter, 2004). The impact of childhood anxiety is far-reaching, resulting in compromised functioning across a range of psychosocial domains, and typically persisting well into adolescence and adulthood (Pine, 1997). This issue is compounded by the fact that the majority of children with anxiety disorders do not receive the treatment they require (Esser, Schmidt, & Woemer, 1990; Hirschfeld et al., 1997; Olfson, Gameroff, Marcus, & Waslick, 2003; Sawyer, Kosky, Graetz, Arney, Zubrick, & Baghurst, 2000). Consequently, research efforts have prioritised the evaluation of universal interventions for anxiety delivered within the school system, providing a more cost-effective model of intervention. Research to date has been promising, indicating that universal school-based prevention of anxiety is effective in reducing internalising symptoms in children and adolescents (Neil & Christensen, 2009). The issue of childhood anxiety is magnified in areas of socioeconomic disadvantage, with children from these populations at an increased risk of developing anxiety disorders and other psychiatric disorders (Kessler et al., 1994; Miech, Caspi, Moffitt, Entner Wright, & Silva, 1999; Xue, Leventhal, Brooks-Gunn, & Earls, 2005). Children from disadvantaged communities less likely to receive psychological assistance (Cunningham & Frieman, 1996; Kazdin & Mazurick, 1994; Kazdin & Wassell, 1999; Misfud & Rapee, 2005), and face significant barriers to accessing the treatment they require (Owens et al., 2002). Despite the greater risk of anxiety faced by children living within socioeconomically disadvantaged communities, there is a paucity of research investigating the prevention of childhood anxiety disorders specifically within disadvantaged populations. The primary objective of this thesis was to evaluate the effectiveness of a well-validated cognitive-behavioural intervention for childhood anxiety, the FRIENDS for Life program, when delivered as a universal school-based intervention within a socioeconomically disadvantaged region. The study involved a cohort of 963 children from Grades 5, 6, and 7, who were enrolled at one of three primary schools within this region. Children from all schools participated in a teacher-led, manualised 12-session intervention for anxiety, delivered during regular classroom time within one regular school term. All participants completed a package of self-report measures assessing levels of anxiety and depressive symptomatology, as well as self-esteem, coping skills, and psychosocial difficulties, prior to commencing the intervention. These measures were readministered at the completion of the intervention, and again at 12 months post-intervention to participants in Grades 6 and 7 (children from Grades 5 and 6 during the intervention year) only. Results indicated significant reductions in anxiety and depressive symptomatology from pre to post-intervention, with these gains maintained at 12 months follow-up. Peer problems and conduct problems were significantly lower both at post-intervention and again at 12-months follow-up. Use of cognitive avoidance and behavioural avoidance strategies also significantly decreased, whilst self-esteem and cognitive behavioural problem-solving increased significantly over time. The findings further validate the FRIENDS for Life program, and demonstrate it’s effectiveness as a universal school-based intervention for children within socioeconomically disadvantaged populations. Clinical implications of these results are discussed, along with limitations and directions for future research