Send to

Choose Destination
JAMA Psychiatry. 2017 Oct 1;74(10):1021-1029. doi: 10.1001/jamapsychiatry.2017.2509.

Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression.

Author information

Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain.
Prevention and Health Promotion Research Network, Málaga, Spain.
Institute of Biomedical Research in Málaga, Málaga, Spain.
Sant Joan de Déu Research Foundation, Barcelona, Spain.
Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain.
School of Pharmacy, University of Barcelona, Barcelona, Spain.
Service of Community Health, Public Health Agency of Barcelona, Barcelona, Spain.
Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Málaga, Spain.
Department of Psychology, University Loyola Andalucía, Seville, Spain.
Department of Biostatistics, University of Granada, Granada, Spain.
Primary Care Center of Marquesado, Área Nordeste de Granada, Granada, Spain.
Primary Care Center of San José, Linares, Jaén, Spain.
Primary Care Center of Federico del Castillo, Jaén, Spain.
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain.
Primary Care Center of El Palo, Málaga, Spain.
Department of Preventive Medicine, Public Health and Psychiatry, University of Málaga, Málaga, Spain.



To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations.


To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types.

Data Sources:

A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017.

Study Selection:

A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us.

Data Extraction and Synthesis:

Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression.

Main Outcomes and Measures:

Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments.


Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (β = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes.

Conclusions and Relevance:

Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center