School programs targeting stress management in children and adolescents: A meta-analysis

Introduction

This meta-analysis evaluates the effect of school programs targeting stress management or coping skills in school children.

Methods

Articles were selected through a systematic literature search. Only randomized controlled trials or quasi-experimental studies were included. The standardized mean differences (SMDs) between baseline and final measures were computed for experimental and control groups. Experimental groups were groups that either received an intervention of (a) relaxation training, (b) social problem solving, (c) social adjustment and emotional self-control, or (d) a combination of these interventions. If no baseline measurement was available, SMDs were calculated between final measures of the groups. The overall pooled effect size was calculated and the pooled effect sizes of improvement on stress, coping, (social) behavior, and self-efficacy by random effects meta-analysis. The dependence of the results on study characteristics (i.e. methodological quality and type of intervention) was evaluated using meta-regression analysis.

Results

Nineteen publications met the inclusion criteria of controlled trials for class programs, teaching coping skills or stress management. Overall effect size for the programs was − 1.51 [95% confidence interval (CI) − 2.29, − 0.73], indicating a positive effect. However, heterogeneity was significant (p < .001). Sensitivity analyses showed that study quality and type of intervention were sources of heterogeneity influencing the overall result (p values < .001). The heterogeneity in quality may be associated with methodological diversity and differences in outcome assessments, rather than variety in treatment effect. Effect was calculated per intervention type, and positive effects were found for stress symptoms with a pooled effect size of − 0.865 (95% CI: − 1.229, − 0.502) and for coping with a pooled effect size of − 3.493 (95% CI: − 6.711, − 0.275).

Conclusion

It is tentatively concluded that school programs targeting stress management or coping skills are effective in reducing stress symptoms and enhancing coping skills. Future research should use clear quality criteria and strive for less diversity in methodology and outcome assessment.     

Determinants of Citation in Epidemiological Studies on Phthalates: A Citation Analysis

Science and Engineering Ethics - Citing of previous publications is an important factor in knowledge development. Because of the great amount of publications available, only a selection of studies...     

Trajectories and predictors of developmental skills in healthy twins up to 24 months of age

Background

Low birth weight and low 5-min Apgar scores have been associated with developmental delay, while older maternal age is a protective factor. Little is known about trajectories and predictors of developmental skills in infant twins, who are generally born with lower birth weights, lower Apgar scores and to older mothers.

Methods

Developmental skills were assessed at 3, 6, 9, 12, 18 and 24 months using the Ages and Stages Questionnaires in 152 twins from the Birmingham Registry for Twin and Heritability Studies. Multilevel spline and linear regression models (adjusted for gestational age, gender, maternal age) were used to estimate developmental trajectories and the associations between birth weight, maternal age and Apgar scores on developmental skills.

Results

Twins performed worse than singletons on communication, gross motor, fine motor, problem solving and personal-social skills (p < 0.001). Twins caught up around 6 months (score within −1 standard deviation of norm), except on gross motor skills, which did not catch up until after the age of 12 months. A one-year increase in maternal age was significantly associated with decreases in gross motor and personal–social z-scores of up to −0.09, whereas one unit increases in Apgar score increased z-scores up to 0.90 (p < 0.01).

Conclusions

Healthy twins should be considered at a higher risk for developmental delay. Whether these results are comparable to preterm singletons, or whether there are twin-specific issues involved, should be further investigated in a study that uses a matched singleton control group.