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Background <p>Mental health problems in children and young people have become an important public health challenge, especially among high-risk populations. While studies have confirmed the effectiveness of school-based cognitive behavioral therapy (CBT), the exact effectiveness is unclear due to multiple limitations. Our study aimed to determine the effectiveness of school-based CBT on depression and anxiety in a high-risk population and to explore the potential effect of different variables.</p> Methods <p>A systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo was conducted from the start of the build to November 2024 to identify randomized controlled trials (RCTs) of the effects of school-based CBT on depression and anxiety in at-risk populations. Pairwise and regression meta-analyses of these results were conducted using Bayesian stratified models based on random effects.</p> Results <p>A total of 41 randomized controlled trials (RCTs) involving 8,527 children and young people were included. The school-based CBT intervention significantly reduced participants’ depression (Standardized Mean Difference [SMD]: -0.20, 95% Credible Interval [CrI]: -0.24 to -0.17) and anxiety (SMD: -0.15, 95%CrI: -0.19 to -0.12) compared to the control group, though the overall effect sizes were small. Meta-regression indicated that for depression, a longer intervention duration diminished the therapeutic effect, while a higher proportion of female participants enhanced it. For anxiety, the improvement effect decreased with older participant age. Furthermore, subgroup analysis revealed that the intervention was effective for students in primary and secondary schools, but the effect was not statistically significant for university students.</p> Conclusion <p>This study is the first to use Bayesian multilevel modeling to explore the effects of school-based CBT on high-risk children and young people. The study found that school-based CBT significantly reduced depression and anxiety, but the effect was small. Future research should focus on the duration of the intervention, gender and age differences, and emphasize the importance of tailoring school mental health programs to the needs of students.</p>

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Effectiveness of School-Based Cognitive Behavioral Therapy in Alleviating Anxiety and Depression Among High-Risk Child and Young People: A Bayesian Meta-Analysis with Meta-Regression

  • 期刊论文

  • 发表日期：

    2025年10月29日

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  • Xiangying Zhang,
  • Zhide Liang,
  • Yunju Kim

摘要

Background

Mental health problems in children and young people have become an important public health challenge, especially among high-risk populations. While studies have confirmed the effectiveness of school-based cognitive behavioral therapy (CBT), the exact effectiveness is unclear due to multiple limitations. Our study aimed to determine the effectiveness of school-based CBT on depression and anxiety in a high-risk population and to explore the potential effect of different variables.

Methods

A systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo was conducted from the start of the build to November 2024 to identify randomized controlled trials (RCTs) of the effects of school-based CBT on depression and anxiety in at-risk populations. Pairwise and regression meta-analyses of these results were conducted using Bayesian stratified models based on random effects.

Results

A total of 41 randomized controlled trials (RCTs) involving 8,527 children and young people were included. The school-based CBT intervention significantly reduced participants’ depression (Standardized Mean Difference [SMD]: -0.20, 95% Credible Interval [CrI]: -0.24 to -0.17) and anxiety (SMD: -0.15, 95%CrI: -0.19 to -0.12) compared to the control group, though the overall effect sizes were small. Meta-regression indicated that for depression, a longer intervention duration diminished the therapeutic effect, while a higher proportion of female participants enhanced it. For anxiety, the improvement effect decreased with older participant age. Furthermore, subgroup analysis revealed that the intervention was effective for students in primary and secondary schools, but the effect was not statistically significant for university students.

Conclusion

This study is the first to use Bayesian multilevel modeling to explore the effects of school-based CBT on high-risk children and young people. The study found that school-based CBT significantly reduced depression and anxiety, but the effect was small. Future research should focus on the duration of the intervention, gender and age differences, and emphasize the importance of tailoring school mental health programs to the needs of students.