针对儿童焦虑问题的“筛查-干预”路径结合常规学校实践，对比仅采用常规学校实践
针对儿童焦虑问题的“筛查-干预”路径结合常规学校实践，对比仅采用常规学校实践（iCATSi2i）：一项在英格兰小学开展的整群随机对照试验
Screening-to-intervention pathway for child anxiety problems alongside usual school practice versus usual school practice only (iCATSi2i): a cluster-randomised, controlled trial in primary schools in England
——《柳叶刀/精神病学》第13卷，第5期，2026年5月——
【摘要】背景：在小学开展焦虑问题筛查，并针对筛查阳性的儿童家庭，通过在线和电话支持提供由家长主导的认知行为疗法（CBT），有助于克服针对某些最常见的儿童心理障碍进行有效早期干预所面临的关键障碍。本研究旨在评估一种“筛查-干预”一体化路径的成效——该路径在学校常规服务的基础上实施，并与仅提供评估及学校常规服务的对照组进行比较。方法：iCATSi2i 是一项务实、平行组、优效性、整群随机对照试验，在英格兰地区的84 所小学和初中开展，入选学校均至少设有两个四年级班级。参与班级中年龄在8至9岁的儿童，若其家长未明确表示拒绝（即未选择退出），即符合参与资格。完成基线评估后，各学校（整群单位）被按 1:1 的比例随机分配至两个组别：一是“筛查、反馈及干预”组（在学校常规服务基础上实施，即干预组）；二是仅提供“评估及学校常规服务”组（即对照组）。随机分配时采用了基于学校层面社会经济剥夺程度的分层策略。在正式分配前，各学校依据其在基线筛查中焦虑问题呈阳性的儿童数量（即目标人群数量）进行了排序。本试验采用了区组随机化方法，区组大小分别为2和4。试验统计学家在数据集准备好进行最终分析之前，对各学校所属的组别分配情况保持盲态。在干预组学校中，所有抽样班级的家长均受邀在基线阶段填写一份包含两个条目的筛查问卷（iCATS-2），并在随机分配完成后收到关于筛查结果的反馈；对于筛查结果显示存在焦虑问题的儿童（即目标人群），其家长将获邀接受由家长主导的 CBT 辅导，该辅导通过“儿童焦虑在线支持与干预”（OSI）平台提供在线及电话支持（其他家庭如有需求也可申请使用）；此外，学校还为全班学生提供了一次关于识别与应对恐惧及担忧情绪的专题辅导课。在两个组别中，均按计划完成了各项评估（包括筛查问卷的填写），且学校继续照常提供常规教育服务。主要结局指标为：在12个月随访时，目标人群中焦虑问题筛查结果呈阴性（家长填写的iCATS-2得分为0–2分）与呈阳性（得分为3–6分）的比例对比。主要统计分析在“意向治疗人群”（ITT 人群）中进行，缺失数据采用了相应的填补方法进行处理。试验全程对不良事件进行了监测与记录。本试验已在ISRCTN注册中心注册（注册号：ISRCTN76119074），且研究现已完成。研究管理小组的成员中包含了具有相关亲身经历的人士。研究结果：我们在2022年1月6日至11月30日期间招募了参与者并完成了基线评估。共有1459名儿童的家长（占参与班级中5335名儿童总数的27%）填写了筛查问卷，其中409名儿童筛查结果呈阳性（即目标人群）。根据家长填报的信息，在408名筛查结果呈阳性的儿童中，222名（54%）为女性，185名（45%）为男性，另有1名（<1%）家长选择不报告儿童性别。在384名儿童中，有325名（85%）由学校方面报告为白人。参与儿童的平均年龄为8.8岁（标准差 [SD] 0.3）。共有42所学校被随机分配至干预组（目标人群：205名儿童），另有42所学校被分配至对照组（目标人群：204名儿童）。在为期12个月的随访时点上，目标人群中筛查结果显示无焦虑问题的儿童比例，干预组（145名儿童中有89名 [61%]）高于对照组（163名儿童中有62名 [38%]）；基于填补数据进行的主要分析显示，其调整后的优势比（Odds Ratio）为2.32（95%置信区间 [CI] 1.41–3.81；p=0.0009）。本试验未收到任何与试验流程或干预措施相关的严重不良事件报告，亦未收到任何与干预措施相关的一般不良事件报告。研究解读：针对小学阶段儿童焦虑问题所建立的“筛查—干预一体化”路径，与仅提供常规评估及服务（即对照组）的做法相比，能够有效减少家长所报告的儿童焦虑问题；这为提升儿童获得有效早期干预服务的可及性，提供了一种极具前景的途径。
[Summary] Background: Screening for anxiety problems in primary schools and offering parent-led cognitive behavioural therapy (CBT) via online and telephone support for those who screen positive could address key barriers to effective early intervention for some of the most prevalent child mental disorders. We aimed to evaluate outcomes from a screening-to-intervention pathway for child anxiety problems alongside usual school provision compared with assessment and usual school provision only. Methods: iCATSi2i was a pragmatic, parallel-group, superiority, cluster-randomised, controlled trial in 84 primary and junior schools in England with at least two year-4 classes. Children aged 8–9 years in participating classes who were not opted out by their parent were eligible to participate. After baseline assessments, schools (clusters) were randomly assigned (1:1) to screening, feedback, and intervention, alongside usual school practice (intervention group) or assessment and usual school practice only (control group), stratified by school-level deprivation. Before allocation, schools were ordered by the number of children who screened positive for anxiety problems at baseline (target population). Block randomisation was used with block sizes of two and four. Trial statisticians were masked to group allocation until datasets were ready for final analysis. In schools in the intervention group all parents in sampled classes were invited to complete a two-item screening questionnaire (iCATS-2) at baseline and received feedback on the screening outcome (after randomisation); parents of children who screened positive for anxiety problems (target population) were offered parent-led CBT delivered via online and telephone support, using the Online Support and Intervention for Child Anxiety (OSI) platform (and this was available for other families on request); a single whole-class session on identifying and managing fears and worries was also provided. In both groups, assessments (including the screening questionnaire) were completed and schools continued with usual provision. The primary outcome was screen-negative for anxiety problems (score 0–2 on the parent-reported iCATS-2) versus screen-positive (score 3–6) in the target population at 12 months. Primary analyses were conducted in the intention-to-treat population, with missing data imputed. Adverse events were monitored and recorded throughout. The trial was registered with the ISRCTN registry, ISRCTN76119074, and the study is complete. The study management group included individuals with relevant lived experience. Findings: We recruited participants and collected baseline assessments between Jan 6, and Nov 30, 2022. Parents of 1459 children (27% of 5335 children in participating classes) completed the screening questionnaire, and 409 screened positive (target population). On the basis of parent report, 222 (54%) of 408 children who screened positive were female, 185 (45%) were male, and one (<1%) preferred not to report child gender. 325 (85%) of 384 children were reported by the school as White. The mean age was 8·8 years (SD 0·3). 42 schools were randomly assigned to the intervention group (target population: 205 children) and 42 to the control group (target population: 204 children). In the target population at 12 months, more children screened negative for anxiety problems in the intervention group (89 [61%] of 145 children) than the control group (62 [38%] of 163 children), with an adjusted odds ratio of 2·32 (95% CI 1·41–3·81; p=0·0009) in the primary analysis based on imputed data. No serious adverse events related to trial procedures or the intervention or adverse events related to the intervention were reported. Interpretation: An integrated screening-to-intervention pathway for child anxiety problems in primary schools reduced parent-reported child anxiety problems compared with assessment and usual provision only, providing a promising way to improve access to effective early intervention.
论文原文：Tessa Reardon, Obioha C Ukoumunne, Lucy Taylor, et al. (2026). Screening-to-intervention pathway for child anxiety problems alongside usual school practice versus usual school practice only (iCATSi2i): a cluster-randomised, controlled trial in primary schools in England. The Lancet / Psychiatry, Volume 13, Issue 5, Pages 396-412. May 2026.
https://doi.org/10.1016/S2215-0366(26)00064-7
（翻译兼责任编辑：MARY）
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