The 'FRIENDS for Life' emotional health programme: Differential impact for those at risk.

Background: Evidence suggests that FRIENDS, a universal cognitive behavioural programme for schools, can improve children's emotional health, yet debate persists regarding its efficacy with respect to prevention versus treatment, particularly for children at risk of anxiety disorders.

Aim: To examine the impact of FRIENDS across different risk categories by assessing: (a) changes in risk status resulting from intervention and (b) treatment effects within specific risk groups.

Sample and methods: Secondary analysis of data from a cluster randomized trial (ISRCTN13721202) conducted between 2016 and 2018 involving approximately 3000 pupils (aged 9-10) from 79 schools. Self-reported anxiety, depression and worry measures were collected at pre- and post-test. Risk categories were established using baseline anxiety and depression scores.

Results: FRIENDS did not significantly change risk status, neither reducing risk (χ² (1) = 1.667; p =.797) nor preventing progression to higher risk categories (χ² (1) = .44; p =.507). Within risk categories, significant effects appeared only in the clinical risk group (β = 1.83 (SE = .14), d = .67), with no significant effects for borderline (β = 1.03 (SE = .98), d = .18) or normal (β = .03 (SE = .33), d < .01) categories.

Conclusion: While FRIENDS did not alter risk status, there appears treatment effects specifically for children within the clinical range for anxiety and depression. Findings provide a more nuanced understanding of who benefits from universal school-based interventions. Findings inform health and education professionals in balancing FRIENDS' treatment effects against factors like availability of alternative services, relative costs and sustainability.