Importance  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.

Objective  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.

Results  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.

重要性 据  我们所知，尚未进行系统评价或荟萃分析来评估针对不同人群的焦虑的预防性心理和/或教育干预措施的有效性。

目的  评估预防性心理和/或教育干预措施对不同人群类型焦虑的有效性。

数据来源  根据 MEDLINE、PsycINFO、Web of Science、EMBASE、OpenGrey、Cochrane 对照试验中央注册库和其他来源的文献检索，从开始至 2017 年 3 月 7 日进行了系统回顾和荟萃分析。

研究选择  对随机临床试验进行了检索，评估预防性心理和/或教育干预措施对不同人群中焦虑症的有效性，这些人群在基线时没有焦虑，使用经过验证的仪器进行测量。没有设置或语言限制。资格标准评估由我们 2 人进行。

数据提取和综合  数据提取和偏倚风险评估（Cochrane Collaboration 的工具）由我们两个人完成。使用随机效应模型计算汇总标准化平均差（SMD）。通过随机效应元回归探讨异质性。

主要成果和措施  通过经过验证的仪器测量，焦虑症新病例的发生率或焦虑症状的减少。

结果  在审查的 3273 篇摘要中，选择了 131 篇进行全文审查，其中 29 篇符合纳入标准，代表来自 4 大洲 11 个国家的 10 430 名患者。荟萃分析计算基于 36 项比较。合并的 SMD 为 -0.31（95% CI，-0.40 至 -0.21；P  < .001），异质性很大（I ²  = 61.1%；95% CI，44% 至 73%）。有证据表明存在发表偏倚，但调整后效应大小几乎没有变化（SMD，-0.27；95% CI，-0.37 至 -0.17；P  < .001）。敏感性分析证实了效应量结果的稳健性。包含 5 个变量的元回归解释了 99.6% 的研究间变异，揭示了较高 SMD 与等待名单（比较）之间的关联（β = -0.33 [95% CI，-0.55 至 -0.11]；P = .005  ）样本量较小 (lg)（β = 0.15 [95% CI，0.06 至 0.23]；P  = .001）。没有观察到偏倚风险、家庭医生提供干预以及使用标准化访谈作为结果之间的关联。

结论和相关性  心理和/或教育干预对于所有评估人群的焦虑预防具有微小但具有统计学意义的益处。尽管需要进行更多更大样本和积极比较的研究，但这些发现表明应进一步制定和实施焦虑预防计划。