Universal Anxiety Interventions in United States Schools: A Systematic Review

Abstract

Recognized as the nation’s most prevalent mental health burden, anxiety represents the most common reason for referral to mental healthcare teams.1-3Among youth, anxiety may lead to concentration and attention problems, difficulties with problem-solving (cognitive impairments), emotional dysregulation, excessive worry, and task avoidance.4 Anxiety disorders are highly comorbid with a range of psychiatric diagnoses, and have been associated with heightened risk for depression and substance abuse (self-medication), and academic underachievement.1,5 A growing body of literature recognizes the relationship between adverse childhood experiences (ACEs), anxiety, and health outcomes later in life.6 Unresolved stressors drive and compound levels of anxiety experienced across the lifespan, repeatedly triggering activation of the central nervous system (stress response), known to change neurobiology, alter physiology and immunity, and produce behavior patterns that may manifest as one or more comorbid conditions.7-11 Increasing rates of anxiety and associated emotional and mental health difficulties, including lifelong implications on successful functioning and health outcomes, have long been a call for primary prevention through population-based public health interventions in community settings and schools.12 Evidence for universal, whole school approaches to mental health promotion has grown.12-14 Universal whole school strategies can be essential, as children who experience anxiety do not always receive ser-