OBJECTIVES

: Interventions to prevent children and young adults from developing mental health conditions have the potential to benefit society through improved short- and long-term outcomes. With increasing numbers presenting with mental ill health, many complex interventions incorporating multiple components have been developed. However, little is known about the cost implications of such interventions. This study aims to assess current knowledge of the costs and cost-effectiveness of interventions for preventing anxiety, depression and conduct disorder in children and young people.

METHODS

: Studies describing randomised controlled trials (RCTs) of school-based interventions to prevent anxiety, depression and conduct disorder in children and adolescents were systematically identified using the MEDLINE, Embase, CENTRAL and PsycINFO databases. Economic evaluations of relevant interventions were sought by further restricting the results using relevant cost-effectiveness terms, and by extending the searches to the NHS Economic Evaluation Database. Data including the condition, population, economic study type and conclusions were extracted, and incorporated into a narrative review.

RESULTS

: Following screening of abstracts and titles (n=434), full texts were obtained for 36 articles, of which only 6 were deemed to meet the inclusion criteria. The included interventions were designed to prevent depression (n=3), conduct disorder (n=2) and anxiety (n=1). The economic evaluations were based on both RCTs (n=4) and decision models (n=2). Interventions were delivered in primary school (n=1), secondary school (n=3) or both (n=2). Varying conclusions on cost-effectiveness were reached with studies suggesting the intervention was cost-effective (n=2), not cost-effective (n=3) or cost-effective in a post-hoc sub-group analysis (n=1).

CONCLUSIONS

: This review highlights the paucity of published economic analyses concerning school-based mental ill health prevention. Furthermore, the included studies cover a range of interventions and economic analyses, and reach inconsistent conclusions, illustrating the heterogeneity of the research. Gathering economic data should be a priority to improve development and implementation of suitable interventions in future.