Evaluation of FunFRIENDS program in prevention of anxiety in Brazilian children: a randomized controlled pilot trial

Rivero, Lina Maria Herrera Nunez; Andrade, André Luiz Monezi; Figueredo, Larissa Zeggio Perez; Pinheiro, Bruno de Oliveira; Micheli, Denise De

doi:10.1590/1413-812320202511.33072018

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ARTICLE • Ciênc. saúde coletiva 25 (11) • Nov 2020 • https://doi.org/10.1590/1413-812320202511.33072018 copy

Evaluation of FunFRIENDS program in prevention of anxiety in Brazilian children: a randomized controlled pilot trial

Avaliação do programa FunFRIENDS na prevenção da ansiedade em crianças brasileiras: um estudo piloto randomizado controlado

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to evaluate the effects of the FunFRIENDS protocol on anxiety symptoms, internalizing problems and prosocial behavior in 4- to 5-year old children. Participated of this study 43 children with an allocation ratio of 1:1 between groups (Intervention Group [IG], N = 21; Control Group [CG], N = 22) from a public school in the city of Sao Paulo participated in the study. Behaviors were evaluated by using standardized questionnaires (PAS, CBCL, SDQ, SCBE) assessing the behavioral profile of the children at three different periods; baseline (T⁰), one month (T¹) and three months (T²) after the intervention. It was observed a reduction in the intensity of anxiety symptoms in the IG after the intervention but with no significant effect. Overall, there were no significant differences between the IG and the CG in most behaviors on all periods evaluated. On both Intention-to-Treat analyses also it was not detected significant effects of the intervention. This is the first Brazilian study evaluating the effects of FunFRIENDS program and the implications of these findings are discussed and its significance for future research.

Key words
Anxiety; Cognitive therapy; Health promotion; Primary prevention

	Intervention Group						Control Group						Test F	p	Effect
	T₀		T₁		T₂		T₀		T₁		T₂
	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
PAS
Social anxiety	8.50	3.76	8.25	4.91	6.87	4.37	9.93	3.56	8.60	3.99	8.13	3.31	0.26	0.77	0.01
Separation anxiety	8.73	2.93	7.86	2.69	5.33	1.63	8.50	4.63	6.68	4.37	5.68	3.73	0.40	0.67	0.02
Total scores	41.18	16.86	36.62	17.25	31.0	17.19	40.93	12.26	33.40	11.04	30.30	9.50	0.11	0.89	0.00
SDQ
Emotional symptoms	3.18	2.04	2.50	2.03	2.25	1.84	2.20	1.87	1.80	1.32	1.53	1.18	0.34	0.67	0.01
Peer Problems	2.37	1.58	2.87	1.92	1.87	1.82	1.86	1.59	1.66	1.54	1.33	1.29	0.94	0.40	0.03
Prosocial behavior	7.75	2.14	7.75	2.17	7.75	1.94	8.0	1.69	8.20	1.97	7.80	1.37	0.26	0.77	0.01
Total scores	11.13	4.89	9.60	4.13	8.93	4.92	14.0	5.31	14.0	5.37	11.87	5.48	0.92	0.41	0.03
CBCL (1½ - 5)
Anxiety/depression	4.62	2.68	4.56	2.42	3.75	2.35	4.06	2.76	3.60	1.91	3.13	1.18	0.12	0.89	0.00
Somatic symptoms	2.06	2.51	2.06	2.37	2.18	2.22	2.06	1.62	1.60	1.35	1.33	1.29	0.69	0.51	0.03
Internalizing symptoms	14.31	8.03	13.56	7.81	13.43	7.42	11.0	6.95	10.0	5.89	8.33	4.41	0.48	0.62	0.02
Anxiety problems	6.06	3.64	5.50	3.2	4.68	3.60	5.60	2.99	4.86	2.19	3.73	2.43	0.28	0.76	0.01
Affective problems	4.43	3.16	3.87	2.47	4.12	2.75	2.80	2.11	3.33	2.76	2.06	2.08	3.15	0.05	0.10
Total scores	51.12	24.3	44.87	21.23	45.87	21.60	37.4	18.89	36.53	18.46	28.4	16.09	2.67	0.08	0.09
SCBE
Anxiety	1.48	0.58	1.62	0.65	1.54	0.57	1.50	0.56	1.36	0.47	1.24	0.36	1.46	0.24	0.05
Prosocial behaviors	4.65	1.60	4.01	1.30	5.04	1.17	4.24	0.89	3.78	0.74	4.68	0.70	0.08	0.89	0.00

	Intervention Group						Control Group						Test F	p	Effect
	T₀		T₁		T₂		T₀		T₁		T₂
	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
PAS
Social anxiety	8.71	3.70	8.52	4.81	7.47	4.30	8.86	3.97	8.13	4.12	7.72	3.57	0.22	0.79	0.00
Separation anxiety	8.0	4.79	6.71	4.02	6.02	4.57	7.77	4.63	7.0	3.19	7.13	2.74	0.68	0.50	0.01
Total scores	41.04	15.65	36.61	15.37	31.95	16.32	36.86	3.76	33.27	11.73	29.77	10.13	0.14	0.86	0.00
SDQ
Emotional symptoms	3.76	2.16	3.09	2.21	2.76	2.11	2.09	1.63	1.95	1.36	1.86	1.67	1.08	0.33	0.02
Peer problems	2.47	1.56	2.95	1.71	1.85	1.71	1.81	1.70	1.54	1.37	1.54	1.62	1.92	0.15	0.04
Prosocial behavior	7.09	1.78	7.52	2.24	7.23	2.13	6.81	1.78	7.54	2.38	7.31	1.78	0.14	0.86	0.00
Total scores	13.33	5.25	13.85	4.73	11.19	5.81	9.59	5.0	9.50	4.28	9.45	5.69	1.79	0.18	0.04
CBCL (1½ - 5)
Anxiety/depression	4.85	2.47	4.80	2.29	4.19	2.31	4.0	2.58	3.54	2.01	3.22	1.60	0.26	0.76	0.00
Somatic symptoms	2.71	2.98	2.28	2.34	2.76	2.79	2.0	1.60	1.63	1.43	1.50	1.40	0.71	0.49	0.01
Internalizing symptoms	15.47	8.35	14.38	7.89	13.80	7.07	11.18	6.35	11.18	5.11	9.36	4.84	0.32	0.72	0.00
Anxiety problems	6.09	3.20	4.76	2.79	5.04	3.24	5.45	3.06	3.77	2.91	4.18	2.78	0.09	0.88	0.00
Affective problems	4.57	2.97	4.0	2.25	4.09	2.44	2.72	1.88	2.95	2.49	2.22	1.87	1.42	0.24	0.03
Total scores	52.19	23.23	46.28	19.93	46.38	21.14	39.54	19.30	38.31	18.42	33.40	18.52	1.01	0.36	0.02
SCBE
Anxiety	1.46	0.53	1.55	0.59	1.59	0.69	1.48	0.50	1.33	0.42	1.29	0.33	2.75	0.06	0.06
Prosocial behavior	4.62	1.50	3.90	1.16	4.98	1.12	4.15	0.90	3.71	0.71	4.54	0.78	0.36	0.65	0.00

	Intervention Group						Control Group						Test F	p	Effect
	T₀		T₁		T₂		T₀		T₁		T₂
	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
PAS
Social anxiety	8.71	3.70	8.07	4.56	6.87	3.79	8.86	3.97	8.35	3.56	8.17	2.71	0.61	0.54	0.01
Separation anxiety	8.0	4.79	6.87	3.97	6.06	3.85	7.77	3.19	7.11	3.19	6.86	2.57	0.48	0.61	0.01
Total scores	41.04	15.65	36.46	15.25	29.66	11.37	36.86	13.76	33.57	10.32	29.86	7.60	0.70	0.47	0.01
SDQ
Emotional symptoms	3.76	2.16	2.90	2.15	2.52	1.98	2.09	1.63	1.83	1.24	1.87	1.46	1.68	0.19	0.03
Peer problems	2.47	1.56	2.94	1.68	1.78	1.62	1.81	1.70	1.63	1.31	1.45	1.19	1.49	0.23	0.03
Prosocial behavior	7.09	1.78	7.54	2.20	7.38	2.38	6.81	1.78	7.98	1.94	7.71	1.18	0.05	0.59	0.01
Total scores	13.33	5.25	13.90	4.13	11.30	5.41	9.59	5.0	9.17	3.84	9.48	4.77	1.85	0.17	0.04
CBCL (1½ - 5)
Anxiety/depression	4.85	2.47	4.80	2.29	4.19	2.31	4.0	2.58	4.85	2.47	3.22	1.60	0.26	0.76	0.00
Somatic symptoms	2.71	2.98	2.28	2.34	2.76	2.79	2.0	1.60	2.28	2.34	1.50	1.40	0.71	0.49	0.01
Internalizing symptoms	15.47	8.35	14.38	7.89	13.80	7.73	11.18	6.35	11.19	5.61	9.36	4.84	0.32	0.72	0.00
Anxiety problem	6.09	3.20	4.76	2.79	4.18	2.78	5.45	3.06	3.77	2.91	4.18	2.78	0.09	0.88	0.00
Affective problem	4.57	2.97	4.0	2.25	4.09	2.44	2.72	1.88	2.95	2.49	2.22	1.87	1.42	0.24	0.03
Total scores	52.19	23.23	46.28	19.93	46.38	21.14	39.54	19.03	38.31	18.42	33.40	18.52	1.01	0.36	0.02
SCBE
Anxiety	1.46	0.53	1.55	0.69	1.59	0.79	1.48	0.50	1.32	0.41	1.23	0.30	3.01	0.06	0.06
Prosocial behavior	4.62	1.50	3.95	1.16	4.98	1.12	4.15	0.90	3.72	0.67	4.63	0.69	0.33	0.65	0.00

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[1] Collaborations

LMHN Rivero, LZP Figueiredo, ALM Andrade and D De Micheli were responsible for the study concept and design. LMHN Rivero and BO Pinheiro contributed to the acquisition of data. All authors assisted with data analysis and the interpretation of findings and provided a critical revision of the manuscript for important intellectual content. All authors reviewed the content and approved the final version.