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Jenniskens K, Rasing S, Popma A, Creemers D, Ghalit C, van Vuuren L, Mérelle S, Spijker J, van Nassau F. Development of an implementation plan for a school-based multimodal approach for depression and suicide prevention in adolescents. Front Public Health 2024; 12:1386031. [PMID: 38799678 PMCID: PMC11122015 DOI: 10.3389/fpubh.2024.1386031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/12/2024] [Indexed: 05/29/2024] Open
Abstract
Strong Teens and Resilient Minds (STORM) is a multimodal, school-based approach for depression and suicide prevention in adolescents that is currently implemented in a region in the Netherlands. The STORM approach will be implemented in new regions in the coming years. This study used the implementation mapping protocol to report on the development of the STORM implementation plan. First, a needs assessment was conducted through semi-structured interviews with stakeholders and brainstorming sessions with regional programme leaders in the two regions that started implementing STORM in 2023. This led to the identification of six main barriers to implementation: high level of demands for schools, insufficient understanding of the programme content, insufficient network collaboration, no perceived relative advantage of STORM by stakeholders, lack of attention to sustainability, and high work pressure. Second, performance and change objectives were formulated based on these barriers. For example, a performance objective for potential providers was that they felt supported by STORM. Third, implementation strategies were selected from theory and translated into practical applications through brainstorming sessions with programme leaders. The following strategies were included in the implementation plan: collaborate with similar initiatives within the region, free up time for STORM tasks, tailor strategies, identify and prepare STORM champions, and promote network weaving. Last, a plan to evaluate the implementation of STORM and the application of the STORM implementation plan was formulated. Planned evaluation research will provide more insight into the usefulness and impact of the STORM implementation plan.
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Affiliation(s)
- Kristel Jenniskens
- GGZ Oost Brabant, Boekel, Netherlands
- 113 Suicide Prevention, Amsterdam, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Sanne Rasing
- GGZ Oost Brabant, Boekel, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, Netherlands
| | - Daan Creemers
- GGZ Oost Brabant, Boekel, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Chaimae Ghalit
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | | | | | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Pro Persona, Nijmegen, Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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IJsselhof R, Hintjens A, Pelzer A, Nieuwenhuis E. Position Paper: fragmented youth healthcare services in the Netherlands endanger treatment of teenage boys with psychiatric disorders. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02378-x. [PMID: 38363390 DOI: 10.1007/s00787-024-02378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
For children who show strongly deviant behaviour in the Netherlands, a distinction is made between behavioural problems and psychiatric problems. As a result, two different domains have emerged over time, each with its own legal frameworks and inclusion and exclusion criteria. Consequently, there is no well-organized, coherent system for youth mental health care in the Netherlands. This strong dichotomy raises the question whether patients are being admitted to facilities where they are receiving appropriate care. In addition, referral bias can arise, because the type of complaint with which a young person presents is often dependent on the type of coping of the individual and thus, in turn, the gender of the patient. In this Position Paper, we examined the gender distribution at a youth psychiatric high and intensive care (HIC-Y) and other streams of youth care in the Netherlands to explore possible inequities in access to psychiatric care among children and adolescents. Results show that girls are significantly more likely than boys to be admitted to the HIC-Y for suicidal thoughts, self-harm and emotional dysregulation. In fact, girls account for 80% of all admissions, while boys account for only 20%. In contrast, regional and national reports from youth services and probation show a majority of boys being admitted (56-89%). The way care is organized (lack of cross-domain collaboration and the interplay between gender-dependent coping and exclusion criteria) seems to play a role in the underrepresentation of boys in acute psychiatry and their overrepresentation in secure youth care. Based on our research results, the concern is raised whether boys have a greater chance of undertreatment for psychiatric problems. Further research is needed to better understand the underlying factors that contribute to gender bias in psychiatric admissions, and to develop interventions that promote gender equality in healthcare.
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Affiliation(s)
- Rinske IJsselhof
- Department of Primary and Long-Term Care, University Medical Center Groningen, Zwolle, The Netherlands.
- Department of Child and Adolescent Psychiatry, Reinier Van Arkel, Herlaarhof, Vught, The Netherlands.
| | - Amy Hintjens
- University College Roosevelt, Middelburg, The Netherlands
| | - Anne Pelzer
- Department of Child and Adolescent Psychiatry, Reinier Van Arkel, Herlaarhof, Vught, The Netherlands
| | - Edward Nieuwenhuis
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Braam MWG, Rasing SPA, Heijs DAM, Lokkerbol J, van Bergen DD, Creemers DHM, Spijker J. Closing the gap between screening and depression prevention: a qualitative study on barriers and facilitators from the perspective of public health professionals in a school-based prevention approach. BMC Public Health 2023; 23:884. [PMID: 37173740 PMCID: PMC10176867 DOI: 10.1186/s12889-023-15705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The prevalence of depression has increased among adolescents in western countries. Prevention is needed to reduce the number of adolescents who experience depression and to avoid negative consequences, including suicide. Several preventive interventions are found to be promising, especially multi-modal approaches, for example combining screening and preventive intervention. However, an important bottleneck arises during the implementation of preventive intervention. Only a small percentage of adolescents who are eligible for participation actually participate in the intervention. To ensure that more adolescents can benefit from prevention, we need to close the gap between detection and preventive intervention. We investigated the barriers and facilitators from the perspective of public health professionals in screening for depressive and suicidal symptoms and depression prevention referral in a school-based setting. METHODS We conducted 13 semi-structured interviews with public health professionals, who execute screening and depression prevention referral within the Strong Teens and Resilient Minds (STORM) approach. The interviews were recorded, transcribed verbatim, and coded in several cycles using ATLAS.ti Web. RESULTS Three main themes of barriers and facilitators emerged from the interviews, namely "professional capabilities," "organization and collaboration," and "beliefs about depressive and suicidal symptoms and participation in prevention". The interviews revealed that professionals do not always feel sufficiently equipped in terms of knowledge, skills and supporting networks. Consequently, they do not always feel well able to execute the process of screening and prevention referral. In addition, a lack of knowledge and support in schools and other cooperating organizationorganizations was seen to hinder the process. Last, the beliefs of public health professionals, school staff, adolescents, and parents -especially stigma and taboo-were found to make the screening and prevention referral process more challenging. CONCLUSIONS To further improve the process of screening and prevention referral in a school-based setting, enhancing professional competence and a holding work environment for professionals, a strong collaboration and a joint approach with schools and other cooperating organizations and society wide education about depressive and suicidal symptoms and preventive intervention are suggested. Future research should determine whether these recommendations actually lead to closing the gap between detection and prevention.
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Affiliation(s)
- Marloes W G Braam
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
- GGZ Oost Brabant, Oss, the Netherlands.
| | - Sanne P A Rasing
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | | | | | | | - Daan H M Creemers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Pro Persona, Nijmegen, the Netherlands
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Chang K, Kuhlman KR. Adolescent-onset depression is associated with altered social functioning into middle adulthood. Sci Rep 2022; 12:17320. [PMID: 36243725 PMCID: PMC9569380 DOI: 10.1038/s41598-022-22131-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/10/2022] [Indexed: 01/10/2023] Open
Abstract
Depression during sensitive periods of social development may have consequences that extend well beyond mental health, and far into adulthood. This study compared the social functioning of adults with adolescent-onset depression (ages 10-20) to those with adult-onset depression (ages 21+). Participants were 3,360 adults (67.2% female; ages 42 ± 15) who had experienced major depression. Adult functional outcomes were marital status, divorce, number of children, years of education, employment status, household income, dependency on welfare, and obesity. Participants with depression during adolescence were less likely to get married, have children, and more likely to have lower household incomes. Depression during adolescence may be associated with broader functional outcomes that impact individuals and society, and may be mitigated through intervention and effective policy.
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Affiliation(s)
- Katherine Chang
- grid.266093.80000 0001 0668 7243Department of Psychological Science, School of Social Ecology, University of California, Irvine, 4546 Social & Behavioral Sciences Gateway, Irvine, CA 92697 USA
| | - Kate Ryan Kuhlman
- grid.266093.80000 0001 0668 7243Department of Psychological Science, School of Social Ecology, University of California, Irvine, 4546 Social & Behavioral Sciences Gateway, Irvine, CA 92697 USA ,grid.19006.3e0000 0000 9632 6718Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Development, University of California, Los Angeles, Los Angeles, CA USA
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Gijzen M, Rasing S, van den Boogaart R, Rongen W, van der Steen T, Creemers D, Engels R, Smit F. Feasibility of a serious game coupled with a contact-based session led by lived experience workers for depression prevention in high-school students. PLoS One 2021; 16:e0260224. [PMID: 34847158 PMCID: PMC8631635 DOI: 10.1371/journal.pone.0260224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained. METHODS Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed. RESULTS Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers' stories and shared their own experiences with depression. CONCLUSIONS Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms. TRIAL REGISTRATION The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).
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Affiliation(s)
- Mandy Gijzen
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- GGZ Oost Brabant, Boekel, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sanne Rasing
- GGZ Oost Brabant, Boekel, The Netherlands
- Anxiety, Compulsion & Phobia Foundation; National Patient Organization, Driebergen-Rijsenburg, The Netherlands
| | | | | | - Twan van der Steen
- Anxiety, Compulsion & Phobia Foundation; National Patient Organization, Driebergen-Rijsenburg, The Netherlands
| | - Daan Creemers
- GGZ Oost Brabant, Boekel, The Netherlands
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rutger Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology and Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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7
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van den Heuvel MWH, Bodden DHM, Smit F, Stikkelbroek Y, Weisz JR, Moerbeek M, Engels RCME. Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents: A Cluster-Randomized Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021:1-16. [PMID: 34644218 DOI: 10.1080/15374416.2021.1978296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules' relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. METHOD We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. RESULTS None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. CONCLUSIONS Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. ABBREVIATIONS CDI-2:F: Children's Depression Inventory-2 Full-length version; CDI-2:S: Children's Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.
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Affiliation(s)
- Marieke W H van den Heuvel
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam.,Department of Mental Health and Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction
| | - Denise H M Bodden
- Child and Adolescent Studies, Utrecht University.,Altrecht, Child and Youth Psychiatry
| | - Filip Smit
- Department of Mental Health and Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction.,Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers.,Department of Clinical, Neuro and Developmental Psychology, VU University
| | - Yvonne Stikkelbroek
- Child and Adolescent Studies, Utrecht University.,GGZ Oost Brabant, Depression Expertise Center, Youth Psychiatry
| | | | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam
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School-based depression and anxiety prevention programs: An updated systematic review and meta-analysis. Clin Psychol Rev 2021; 89:102079. [PMID: 34571372 DOI: 10.1016/j.cpr.2021.102079] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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10
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Méndez J, Sánchez-Hernández Ó, Garber J, Espada JP, Orgilés M. Psychological Treatments for Depression in Adolescents: More Than Three Decades Later. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094600. [PMID: 33926111 PMCID: PMC8123571 DOI: 10.3390/ijerph18094600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/29/2022]
Abstract
Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.
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Affiliation(s)
- Javier Méndez
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, 30100 Murcia, Spain
- Correspondence:
| | - Óscar Sánchez-Hernández
- Department of Developmental and Educational Psychology, University of Murcia, 30100 Murcia, Spain;
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37302, USA;
| | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
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11
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de Jonge-Heesen KWJ, Rasing SPA, Vermulst AA, Scholte RHJ, van Ettekoven KM, Engels RCME, Creemers DHM. Secondary Outcomes of Implemented Depression Prevention in Adolescents: A Randomized Controlled Trial. Front Psychiatry 2021; 12:643632. [PMID: 33708150 PMCID: PMC7940696 DOI: 10.3389/fpsyt.2021.643632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Our most recent RCT provides evidence that indicated depression prevention is effective in reducing depressive symptoms in adolescents when implemented in the school community. In the present study we further test the potential effects of this prevention approach on symptoms related to depression: anxiety, suicidality, somatic symptoms, and perfectionism. We conducted exploratory analyses in 130 adolescents with elevated depressive symptoms aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) who were randomly assigned to the experimental (OVK 2.0) or active control condition (psycho-education). Self-reported anxiety, suicidality, somatic symptoms, and perfectionism were assessed at pretest, post intervention, as well as 6- and 12-months follow-up. Latent growth curve analyses revealed that there was a significant decrease in anxiety in both conditions and that this decrease was significantly larger in the intervention condition than in the control condition. Somatic symptoms and socially prescribed perfectionism decreased significantly in the intervention condition and suicidality decreased significantly in the control condition. Yet there was no difference in decrease in suicidality, somatic symptoms, and perfectionism between the two conditions. This study suggest that screening on depressive symptoms and providing a CBT depression prevention program for adolescents with elevated depressive symptoms, can decrease comorbid symptoms of anxiety and therefore ensure better outcomes. We discuss the clinical implications as well suggestions for future research. Clinical Trial Registration: The study is registered in the Dutch Trial Register for RCTs (NTR5725). Date registered: 11th of March 2016.
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Affiliation(s)
- Karlijn W J de Jonge-Heesen
- GGZ Oost Brabant, Boekel, Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Sanne P A Rasing
- GGZ Oost Brabant, Boekel, Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Ron H J Scholte
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Praktikon, Nijmegen, Netherlands
| | - Kim M van Ettekoven
- GGZ Oost Brabant, Boekel, Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Daan H M Creemers
- GGZ Oost Brabant, Boekel, Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
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12
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Speksnijder CM, Lankhorst PJM, de Bree R, de Haan AFJ, Koole R, Merkx MAW. Depression and related factors after oral oncological treatment: a 5-year prospective cohort study. Support Care Cancer 2020; 29:2907-2916. [PMID: 33001267 PMCID: PMC8062368 DOI: 10.1007/s00520-020-05795-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSES Being diagnosed with oral cancer is a life-threatening life event. It often induces social, emotional and psychological consequences and may cause depressive disorders. The primary aim of this study was to identify and quantify the personal and clinical characteristics involved in depression for patients who have been treated for oral cavity malignancies, with a 5-year follow-up period after treatment. The secondary aim of this study was to identify the clinical factors that increase a patient's risk of experiencing depression 5 years after treatment. METHODS Patients with primary oral cancer were assessed for up to 5 years after primary treatment. A mixed-model analysis was performed, with depression measured by the Center for Epidemiologic Studies Depression Scale as outcome measure. RESULTS A total of 141 patients were included in the study. Factors associated with depression were gender, tumour location and having an emotion-oriented coping style. The occurrence of depression within 5 years after treatment could be reliably predicted by a patient's gender, the location of their tumour and the extent to which they had an emotion-oriented coping style. CONCLUSIONS This study revealed that being female, having a maxillary tumour and having an emotion-oriented coping style are associated with higher levels of depressive symptoms in patients treated for oral cancer up to 5 years post-treatment. A substantial proportion of the patients with oral cancer experienced high levels of depression both before and after their treatment, suggesting that adequate diagnostics and care are needed to try to prevent severe depression in these patients.
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Affiliation(s)
- Caroline M Speksnijder
- Cancer Center, Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85.500, 3508, GA, Utrecht, The Netherlands.
| | - Petra J M Lankhorst
- Department of Medical Oncology, Deventer Hospital, Deventer, The Netherlands
| | - Remco de Bree
- Cancer Center, Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anton F J de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ron Koole
- Department of Medical Oncology, Deventer Hospital, Deventer, The Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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de Jonge-Heesen KWJ, Rasing SPA, Vermulst AA, Scholte RHJ, van Ettekoven KM, Engels RCME, Creemers DHM. Randomized control trial testing the effectiveness of implemented depression prevention in high-risk adolescents. BMC Med 2020; 18:188. [PMID: 32703288 PMCID: PMC7379355 DOI: 10.1186/s12916-020-01656-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adolescent depression is a global mental health concern. Identification and effective prevention in an early stage are necessary. The present randomized, controlled trial aimed to examine the effectiveness of Cognitive Behavioral Therapy (CBT)-based depression prevention in adolescents with elevated depressive symptoms. This prevention approach is implemented in school communities, which allows to examine effects under real-life circumstances. METHODS A total of 5222 adolescents were screened for elevated depressive symptoms in the second grade of secondary schools; 130 adolescents aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) were randomly assigned to the experimental (OVK 2.0) or control condition (psycho-education). Self- and parent-reported depressive symptoms were assessed at pretest and post intervention, as well as 6- and 12-months follow-up. Clinical assessment of depression was assessed at pretest and 6-months follow-up. RESULTS Intent-to-treat analyses revealed that the decrease in adolescent-rated depressive symptoms was significantly larger in the intervention condition than in the control condition. There was no significant difference in decrease of parent-rated depressive symptoms between both conditions. CONCLUSIONS Based on the findings, we recommend the implementation of screening and prevention in schools, according the basics of this study design. Since this is a new step forward, we discuss the clinical impact and challenges, as well possibilities for future research. TRIAL REGISTRATION The study is registered in the Dutch Trial Register for RCT's ( NTR5725 ). Date registered: 11 March 2016.
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Affiliation(s)
- Karlijn W. J. de Jonge-Heesen
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Sanne P. A. Rasing
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
- Child and Adolescent Studies, Utrecht University, P.O. Box 80125, 3508 TC Utrecht, The Netherlands
| | - Ad A. Vermulst
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Ron H. J. Scholte
- Praktikon, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Kim M. van Ettekoven
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Rutger C. M. E. Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Daan H. M. Creemers
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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14
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Gee B, Reynolds S, Carroll B, Orchard F, Clarke T, Martin D, Wilson J, Pass L. Practitioner Review: Effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review. J Child Psychol Psychiatry 2020; 61:739-756. [PMID: 32250447 DOI: 10.1111/jcpp.13209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. METHODS Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. RESULTS Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = .34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD = -.49, 95% CI -0.79, -0.19) immediately postintervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤ 12) or long-term (>12-month) follow-up. Reductions in anxiety symptoms were not maintained at any follow-up. CONCLUSIONS Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately postintervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence base. Further high-quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety.
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Affiliation(s)
- Brioney Gee
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Ben Carroll
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Clarke
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Martin
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jon Wilson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Norwich Medical School, University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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15
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Ma L, Zhang Y, Huang C, Cui Z. Resilience-oriented cognitive behavioral interventions for depressive symptoms in children and adolescents: A meta-analytic review. J Affect Disord 2020; 270:150-164. [PMID: 32339107 DOI: 10.1016/j.jad.2020.03.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/07/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The study aimed to evaluate whether resilience-oriented cognitive behavioral interventions (CBIs) which teach cognitive, problem-solving, and social skills are effective for addressing depressive symptoms in the school setting and to investigate factors that could moderate the intervention effects. METHOD Electronic databases Medline, PsycINFO and Cochrane Central were searched to identify potentially relevant trials. The difference of change from baseline in depressive symptoms between intervention and control condition was assessed. Mean effect sizes (Hedges'g) were calculated using random-effects models. Study-specific characteristics relevant to participant demographics (age, gender, and risk status), intervention conditions (program type, intervention duration, group leader type, and use of homework), and study features (sample size, and methodological quality) were evaluated as potential moderators of the effect size. RESULTS 38 controlled studies were identified, including 24,135 individuals. At post-intervention, the mean effect size was considered significantly small (Hedges'g = 0.13) and subgroup analyses revealed significant effect sizes for programs administered to both universal and targeted samples, programs both with and without homework, and programs led by school personnel. The mean effect size was largely maintained at 6 months follow-up and subgroup analyses indicated significant effect sizes for programs administered to targeted samples, programs based on Penn Resiliency Program, programs with homework, and programs led by professional interventionists. CONCLUSION This study reinforces the efficacy of resilience-oriented CBIs for addressing depressive symptoms in the school setting. Although more research is needed to confirm and extend the findings of this study, our findings suggest a range of directions in particular for further investigation.
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Affiliation(s)
- Liang Ma
- The First Hospital of China Medical University, Shenyang, China.
| | - Yingnan Zhang
- The First Hospital of China Medical University, Shenyang, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China; Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Zeshi Cui
- School of Pharmacy, China Medical University, Shenyang, China
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16
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Saw JA, Tam CL, Thanzami V, Bonn G. Contextualized School-Based Cognitive Behavioral Therapy (CBT) Intervention for Malaysian Secondary School Students. Front Psychiatry 2020; 11:565896. [PMID: 33408652 PMCID: PMC7779468 DOI: 10.3389/fpsyt.2020.565896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
This study investigates the effectiveness of the school-based Shine Through Any Roadblocks (STAR) CBT intervention, by a screening conducted on 634 students from eight secondary schools in Malaysia. Participants (n = 85) who fulfilled the eligibility criteria were assigned randomly to either the intervention group (n = 42) or the assessment-only waitlist control group (n = 43). The intervention consisted of eight group-based sessions over a period of 2 months. Sessions were 60-min each and conducted according to the STAR module. Outcome measures (depressive symptoms and automatic negative thoughts) were administered at five intervals: baseline/pre-intervention, mid-intervention, post-intervention, 1-month after intervention, and 3-months after intervention. Results showed significant and lasting lower levels of depressive symptoms and automatic negative thoughts in the intervention group, indicating that the STAR intervention could be an effective means of reducing depressive symptomatology among adolescents. Clinical implications for the Malaysian secondary school context are further discussed.
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Affiliation(s)
- Jo Anne Saw
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia.,Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Malaysia
| | - Cai Lian Tam
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Malaysia.,GA21 Multidisciplinary Platform & Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Malaysia
| | - Vanlal Thanzami
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Malaysia
| | - Gregory Bonn
- The Chicago School of Professional Psychology, Chicago, IL, United States
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17
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Spiro-Levitt C, Gallop R, Young JF. Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative. J Affect Disord 2019; 253:176-183. [PMID: 31051322 PMCID: PMC6620130 DOI: 10.1016/j.jad.2019.04.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the prevalence and consequences of adolescent depression, depression prevention has become an important area of research. While prevention programs like Interpersonal Psychotherapy - Adolescent Skills Training (IPT-AST) have demonstrated effectiveness, little research to date has studied the relationship between maternal depression and adolescent outcomes in these programs. METHOD The current study investigated the relationship between maternal and adolescent depressive symptoms in 167 mother-adolescent dyads who were enrolled in the Depression Prevention Initiative (DPI), a randomized controlled trial that compared IPT-AST to group counseling (GC). First, the study examined the relationship between initial levels of adolescent and maternal depressive symptoms. The study then investigated whether maternal depressive symptoms improved over the two-year study period. Finally, the study assessed whether maternal and adolescent symptoms changed concurrently across time. RESULTS Results indicated that initial levels of maternal and adolescent symptoms were positively associated. Additionally, maternal symptoms improved across the two-year period. Maternal and adolescent outcomes were related across time: as adolescents improved in our study, their mothers also improved. LIMITATIONS The study utilized self-report data only and did not allow for the testing of causality in the relationship between mother-youth depression. CONCLUSIONS These findings add to the literature demonstrating that as one part of the mother-child dyad improves, the other improves as well. These findings extend the current understanding of the relationship between maternal and adolescent depressive symptom outcomes, and have important implications for the prevention and treatment of depression.
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Affiliation(s)
- Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at New York University Langone, United States.
| | - Robert Gallop
- Department of Mathematics, West Chester University, United States
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, United States
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18
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Saw JA, Tam CL, Bonn G. Development and validation of a school-based cognitive-behavioural therapy (CBT) intervention for Malaysian high school students with depressive symptoms. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2019. [DOI: 10.1080/21507686.2019.1629973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jo Anne Saw
- Discipline of Psychological and Behavioral Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
- Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Cai Lian Tam
- Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Gregory Bonn
- Department of Global and Social Studies, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
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19
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van der Meulen H, McCashin D, O'Reilly G, Coyle D. Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study. JMIR Ment Health 2019; 6:e12430. [PMID: 31094346 PMCID: PMC6707559 DOI: 10.2196/12430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/21/2019] [Accepted: 04/04/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings. OBJECTIVE This paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings. METHODS Pesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data. RESULTS A total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists' reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model. CONCLUSIONS This study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use.
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Affiliation(s)
| | - Darragh McCashin
- University College Dublin, School of Psychology, Dublin, Ireland
| | - Gary O'Reilly
- University College Dublin, School of Psychology, Dublin, Ireland
| | - David Coyle
- University College Dublin, School of Computer Science, Dublin, Ireland
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20
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Oud M, de Winter L, Vermeulen-Smit E, Bodden D, Nauta M, Stone L, van den Heuvel M, Taher RA, de Graaf I, Kendall T, Engels R, Stikkelbroek Y. Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. Eur Psychiatry 2019; 57:33-45. [DOI: 10.1016/j.eurpsy.2018.12.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/19/2022] Open
Abstract
AbstractBackground:Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.Methods:A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.Results:We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.Conclusions:There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
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Ssegonja R, Nystrand C, Feldman I, Sarkadi A, Langenskiöld S, Jonsson U. Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression. Prev Med 2019; 118:7-15. [PMID: 30287331 DOI: 10.1016/j.ypmed.2018.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/22/2018] [Accepted: 09/30/2018] [Indexed: 01/08/2023]
Abstract
Depression contributes about 2% to the global burden of disease. A first onset of depressive disorder or subsyndromal depressive symptoms is common in adolescence, indicating that early prevention is a priority. However, trials of preventive interventions for depression in youths show conflicting results. This systematic review and meta-analysis investigated the effectiveness of group-based cognitive behavioral therapy (GB-CBT) as a preventive intervention targeting subsyndromal depression in children and adolescents. In addition, the impact of different covariates (type of comparator and use of booster sessions) was assessed. Relevant articles were identified from previous systematic reviews, and supplemented with an electronic search spanning from 01/09/2014 to 28/02/2018. The retrieved articles were assessed for eligibility and risk of bias. Relevant data were extracted. Intervention effectiveness was pooled using a random-effects model and the impact of covariates assessed using meta-regression. 38 eligible articles (34 trials) were obtained. The analysis showed GB-CBT to significantly reduce the incidence (relative risk 0.43, 95% CI 0.21-0.87) and symptoms (Cohen's d -0.22, 95% CI -0.32 to -0.11) of depression at post-test compared to all controls. Comparisons with passive comparators suggested that the effect decayed over time. However, compared to active controls, a significant intervention effect was evident only after 12 month or more. Our results suggest that the preventive effect of GB-CBT wears off, but still lasts longer than the effect of active comparators. Only a few studies included booster sessions, precluding firm conclusions. Future studies should clarify to what extent maintenance strategies can prolong the preventive effect of GB-CBT.
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Affiliation(s)
- Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.
| | - Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala University, Sweden; Department of Women's and Children's Health, Uppsala University, Sweden
| | - Sophie Langenskiöld
- Department of Public Health and Caring Sciences, Uppsala University, Sweden; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden
| | - Ulf Jonsson
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health at Karolinska Institutet, Sweden; Child and Adolescent Psychiatry, BUP-KIND, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden
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22
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Brunwasser SM, Freres DR, Gillham JE. Youth Cognitive-Behavioral Depression Prevention: Testing Theory in a Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2018; 42:468-482. [PMID: 30057434 PMCID: PMC6059657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study tested the plausibility of a theoretical model of change for the Penn Resiliency Program (PRP), a cognitive-behavioral (CB) depression prevention program for adolescents. Middle school students (N = 697) were randomized to PRP, an assessment-only control condition (CON), or a placebo-control condition (PLA). Explanatory style and depressive symptoms were evaluated over 24 months of follow-up. Relative to both CON and PLA, there were significant indirect effects of PRP on 12-month levels of depressive symptoms through improvements in explanatory style in two of three participating schools. Within a third school, where PRP was not effective in targeting depressive symptoms (Gillham et al., 2007), there was no evidence of group differences in growth in explanatory style or indirect effects. When effective, PRP's CB training provides incremental value over non-specific components and there are indirect effects on depressive symptoms through improvements in explanatory style.
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Affiliation(s)
- Steven M Brunwasser
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Derek R Freres
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jane E Gillham
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, Swarthmore College, Swarthmore, PA, USA
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23
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Outcomes of a Randomized Controlled Trial on the Effectiveness of Depression and Anxiety Prevention for Adolescents with a High Familial Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071457. [PMID: 29996542 PMCID: PMC6069229 DOI: 10.3390/ijerph15071457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 01/04/2023]
Abstract
A randomized controlled trail was conducted to examine the effectiveness of a depression and anxiety prevention program ‘Een Sprong Vooruit’ (A Leap Forward) among adolescent girls with a high familial risk (N = 142). The results showed neither effects of the prevention program directly after the intervention, nor at 6 or 12 months follow-up on depression and anxiety symptoms. Further, latent growth curve modeling (LGCM) was used to examine whether the growth functions for the intervention and the control condition were different. The slope representing the change in depression symptoms was not significantly different between the intervention and the control condition. For anxiety symptoms, the difference between slopes was also not significant. Based on these results, we suggested that these high-risk adolescent girls might benefit more from a more intensive prevention program.
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Gijzen MWM, Creemers DHM, Rasing SPA, Smit F, Engels RCME. Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial. BMC Psychiatry 2018; 18:124. [PMID: 29747618 PMCID: PMC5946540 DOI: 10.1186/s12888-018-1710-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously. METHODS We will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes. DISCUSSION If the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale. TRIAL REGISTRATION The study is registered in the Dutch Trial Register ( NTR6622 ).
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Affiliation(s)
- Mandy W. M. Gijzen
- 0000 0001 0835 8259grid.416017.5Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands ,0000000092621349grid.6906.9Erasmus School of Social and Behavioural Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands ,0000 0004 0377 6226grid.476319.eGGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Daan H. M. Creemers
- 0000 0004 0377 6226grid.476319.eGGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,0000000122931605grid.5590.9Behavioral Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Sanne P. A. Rasing
- 0000 0004 0377 6226grid.476319.eGGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,0000000120346234grid.5477.1Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| | - Filip Smit
- 0000 0001 0835 8259grid.416017.5Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Clinical, Neuro and Developmental Psychology and Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Rutger C. M. E. Engels
- 0000000092621349grid.6906.9Erasmus School of Social and Behavioural Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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25
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Youth Cognitive-Behavioral Depression Prevention: Testing Theory in a Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9897-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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van Starrenburg MLA, Kuijpers RCMW, Kleinjan M, Hutschemaekers GJM, Engels RCME. Effectiveness of a Cognitive Behavioral Therapy-Based Indicated Prevention Program for Children with Elevated Anxiety Levels: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:31-39. [PMID: 27822663 PMCID: PMC5236072 DOI: 10.1007/s11121-016-0725-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Childhood anxiety is a problem not only because of its negative consequences on the well-being of children but also because of its adverse effects on society and its role in mental disorders later in life. Adequate prevention might be the key in tackling this problem. The effectiveness of Coping Cat, as an indicated CBT-based prevention program in Dutch primary school children, was assessed by means of a randomized controlled trial. In total, 141 children aged 7–13 with elevated levels of anxiety and their mothers were included and randomly assigned to an intervention group and a waiting list control group. After screening, all participants completed baseline, post-intervention, and 3-month follow-up assessments. The results showed that Coping Cat, as an indicated prevention program, reduces children’s self-reported anxiety symptoms, with Cohen’s effect size d of 0.66 at the 3-month follow-up. A moderating effect was found for baseline anxiety level; specifically, children with high levels of baseline anxiety who received the Coping Cat program had lower anxiety levels at follow-up compared to children with high levels of anxiety in the control condition. No moderating effects of gender or age were found. An unexpected decline in anxiety levels from screening to pre-assessment was found in both groups, and this decline was stronger in the experimental group. These promising results warrant the implementation of Coping Cat as an indicated prevention program.
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Affiliation(s)
- Manon L A van Starrenburg
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands. .,Ambulatorium KJJ, Toernooiveld 5, Postbus 6909, 6503 GK, Nijmegen, The Netherlands.
| | - Rowella C M W Kuijpers
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.,Ambulatorium KJJ, Toernooiveld 5, Postbus 6909, 6503 GK, Nijmegen, The Netherlands
| | | | - Giel J M Hutschemaekers
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.,Pro Persona, Tarweweg 2, 6534 AM, Nijmegen, The Netherlands
| | - Rutger C M E Engels
- Trimbos, Da Costakade 45, 3521 VS, Utrecht, The Netherlands.,Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
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27
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Fréchette-Simard C, Plante I, Bluteau J. Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review. Cogn Behav Ther 2017; 47:263-285. [PMID: 29103355 DOI: 10.1080/16506073.2017.1388275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label "CBT" encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.
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Affiliation(s)
- Catherine Fréchette-Simard
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
| | - Isabelle Plante
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
| | - Jonathan Bluteau
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
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28
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Rasing SPA, Creemers DHM, Janssens JMAM, Scholte RHJ. Depression and Anxiety Prevention Based on Cognitive Behavioral Therapy for At-Risk Adolescents: A Meta-Analytic Review. Front Psychol 2017; 8:1066. [PMID: 28701980 PMCID: PMC5487592 DOI: 10.3389/fpsyg.2017.01066] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/09/2017] [Indexed: 01/04/2023] Open
Abstract
Depression and anxiety disorders are among the most common mental disorders during adolescence. During this life phase, the incidence of these clinical disorders rises dramatically, and even more adolescents suffer from symptoms of depression or anxiety that are just below the clinical threshold. Both clinical and subclinical levels of depression or anxiety symptoms are related to decreased functioning in various areas, such as social and academic functioning. Prevention of depression and anxiety in adolescents is therefore imperative. We conducted a meta-analytic review of the effects of school-based and community-based prevention programs that are based on cognitive behavioral therapy with the primary goal preventing depression, anxiety, or both in high risk adolescents. Articles were obtained by searching databases and hand searching reference lists of relevant articles and reviews. The selection process yielded 32 articles in the meta-analyses. One article reported on two studies and three articles reported on both depression and anxiety. This resulted in a total of 36 studies, 23 on depression and 13 on anxiety. For depression prevention aimed at high risk adolescents, meta-analysis showed a small effect of prevention programs directly after the intervention, but no effect at 3-6 months and at 12 months follow-up. For anxiety prevention aimed at high risk adolescents, no short-term effect was found, nor at 12 months follow-up. Three to six months after the preventive intervention, symptoms of anxiety were significantly decreased. Although effects on depression and anxiety symptoms were small and temporary, current findings cautiously suggest that depression and anxiety prevention programs based on CBT might have small effects on mental health of adolescents. However, it also indicates that there is still much to be gained for prevention programs. Current findings and possibilities for future research are discussed in order to further improve the effectiveness of targeted prevention on internalizing disorders.
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Affiliation(s)
- Sanne P. A. Rasing
- Behavioural Science Institute, Radboud UniversityNijmegen, Netherlands
- GGZ Oost BrabantBoekel, Netherlands
| | - Daan H. M. Creemers
- Behavioural Science Institute, Radboud UniversityNijmegen, Netherlands
- GGZ Oost BrabantBoekel, Netherlands
| | | | - Ron H. J. Scholte
- Behavioural Science Institute, Radboud UniversityNijmegen, Netherlands
- PraktikonNijmegen, Netherlands
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Silverstone PH, Bercov M, Suen VYM, Allen A, Cribben I, Goodrick J, Henry S, Pryce C, Langstraat P, Rittenbach K, Chakraborty S, Engles RC, McCabe C. Long-term Results from the Empowering a Multimodal Pathway Toward Healthy Youth Program, a Multimodal School-Based Approach, Show Marked Reductions in Suicidality, Depression, and Anxiety in 6,227 Students in Grades 6-12 (Aged 11-18). Front Psychiatry 2017; 8:81. [PMID: 28555115 PMCID: PMC5430037 DOI: 10.3389/fpsyt.2017.00081] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/24/2017] [Indexed: 11/13/2022] Open
Abstract
Here, we report on findings from a 15-month follow-up of a school-based program called Empowering a Multimodal Pathway Toward Healthy Youth (EMPATHY). This was primarily intended to reduce suicidal thinking in pre-teens, adolescents, and youth students aged 11-18 in middle schools (Grades 6-8) and high SCHOOLS (Grades 9-12). It also aimed to reduce depression and anxiety. The EMPATHY multimodal program consisted of repeated data collection, identification of a high-risk group, a rapid intervention for this high-risk group including offering supervised online cognitive behavioral therapy (CBT) program, a universal CBT intervention for those in Grades 6-8, a variety of interactions with trained staff ("Resiliency Coaches"), and referral to external medical and psychiatric services where appropriate. There were four time-points at which assessments were made: baseline, 3, 7, and 15 months. Here, we report cross-sectional findings over 15 months in a total of 6,227 students who were assessed at least once during the study period. Additionally, we report longitudinal findings from the 1,884 students who completed all 4 assessments. Our results found highly statistically significant decreases in suicidality rates, with the percentage of the total school population who were actively suicidal decreasing from 4.4% at baseline (n = 143 of 3,244) to 2.8% at 15 months (n = 125 of 4,496) (p < 0.001). There were also highly statistically significant reductions in depression and anxiety scores at each time-point. Thus, Mean Depression scores at baseline for the entire student population were 3.73 ± 3.87 (n = 3,244) at baseline and decreased to 3.22 ± 3.52 (n = 4,496) (p < 0.001). Since most students were not depressed, whole population changes such as this may indicate impact in many areas. In the longitudinal analysis of students who completed all four assessments, there were also highly statistically significant improvements in depression and anxiety scores at all time-points. For example, depression scores decreased from a mean of 3.43 ± 3.67 (n = 1,884) at baseline to 2.95 ± 3.53 (n = 1,884) at 15-months (p < 0.001), while the number who were actively suicidal decreased from 69 to 37. These results suggest that school-based multimodal programs, utilizing a combination of interventions, can have meaningful benefits across entire school populations.
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Affiliation(s)
- Peter H. Silverstone
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Business, Department of Finance and Statistical Analysis, University of Alberta, Edmonton, AB, Canada
| | - Marni Bercov
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Victoria Y. M. Suen
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrea Allen
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Ivor Cribben
- Faculty of Business, Department of Finance and Statistical Analysis, University of Alberta, Edmonton, AB, Canada
| | | | - Stu Henry
- Red Deer Public Schools, Red Deer, AB, Canada
| | - Catherine Pryce
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | | | - Katherine Rittenbach
- Strategic Clinical Network for Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Christopher McCabe
- Department of Emergency Medicine and Public Health, Edmonton, AB, Canada
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30
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Werner-Seidler A, Perry Y, Calear AL, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clin Psychol Rev 2017; 51:30-47. [DOI: 10.1016/j.cpr.2016.10.005] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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31
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Weersing VR, Jeffreys M, Do MCT, Schwartz KTG, Bolano C. Evidence Base Update of Psychosocial Treatments for Child and Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:11-43. [PMID: 27870579 DOI: 10.1080/15374416.2016.1220310] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.
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Affiliation(s)
- V Robin Weersing
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology.,b Department of Psychology , San Diego State University
| | - Megan Jeffreys
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Minh-Chau T Do
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Carl Bolano
- b Department of Psychology , San Diego State University
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32
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de Jonge-Heesen KWJ, van Ettekoven KM, Rasing SPA, Liempd FHJOV, Vermulst AA, Engels RCME, Creemers DHM. Evaluation of a school-based depression prevention program among adolescents with elevated depressive symptoms: study protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:402. [PMID: 27852295 PMCID: PMC5112661 DOI: 10.1186/s12888-016-1119-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Adolescents are at risk of developing depressive symptoms. Given the prevalence, recurrence and negative consequences of adolescent depression, it is crucial to implement prevention programs for high-risk adolescents. Prevention programs at an indicated level have shown to be successful in reducing depressive symptoms in adolescents. This study will evaluate the (cost)effectiveness of the prevention program 'Op Volle Kracht (OVK 2.0)' for adolescents with elevated depressive symptoms. METHODS We will perform a Randomized Controlled Trial (RCT) with an intervention and control condition to test the effectiveness of an indicated prevention program aimed at depression in adolescents. Adolescents in their second year of secondary education (11-15 year) will be screened for depressive symptoms. Those with heightened levels of depressive symptoms (CDI-2 ≥ 14) will be randomly assigned to the intervention (N = 80) or control group (N = 80). The participants in the intervention condition will receive a prevention program comprising eight meetings of 60 min each. The participants in the control condition will receive psycho-educational information. All participants and their parents will complete assessment at baseline, post-intervention, and 6-, 12- and 24- month follow-up. Primary outcome will be depressive symptoms. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of OVK 2.0 on secondary outcomes. DISCUSSION This paper describes a study designed to screen adolescents for depressive symptoms and offer them a prevention program to prevent the onset of depressive symptomatology. Adolescents in the intervention condition are expected to show lower levels of depressive symptoms at 12 month follow-up compared to adolescents in the control condition. If OVK 2.0 proves to be effective, the screening and intervention program could be implemented in schools on a large scale. TRIAL REGISTRATION Dutch Trial Register NTR5725 . Date registered: 11th of March 2016.
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Affiliation(s)
- Karlijn W. J. de Jonge-Heesen
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,Utrecht University, P.O. Box 80125, 3508 TC Utrecht, The Netherlands
| | - Kim M. van Ettekoven
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,Utrecht University, P.O. Box 80125, 3508 TC Utrecht, The Netherlands
| | - Sanne P. A. Rasing
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | | | - Ad A. Vermulst
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Rutger C. M. E. Engels
- Utrecht University, P.O. Box 80125, 3508 TC Utrecht, The Netherlands ,Trimbos Institute, P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Daan H. M. Creemers
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands ,Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Brunwasser SM, Garber J. Programs for the Prevention of Youth Depression: Evaluation of Efficacy, Effectiveness, and Readiness for Dissemination. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:763-783. [PMID: 25933173 PMCID: PMC5176361 DOI: 10.1080/15374416.2015.1020541] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective of this study was to evaluate the current state of evidence of the effectiveness of depression prevention programs for youth, assess the degree to which current evidence supports broad implementation, and outline additional steps needed to close the gap between effectiveness and dissemination. We used the Society for Prevention Research's Standards of Evidence (Flay et al., 2005 ) to evaluate the degree to which existing depression prevention programs have established intervention efficacy, effectiveness, and readiness for dissemination. We reviewed all depression prevention programs for youth that have been evaluated in at least two published, randomized controlled trials in which the intervention was compared to a no-intervention control group. A total of 37 studies evaluating 11 different programs were reviewed with regard to depressive symptoms and diagnoses at postintervention and follow-up (at least 6 months). Eight programs demonstrated significant main effects on depressive symptoms relative to controls in multiple randomized controlled trials; 5 programs had at least 1 trial with significant main effects present at least 1 year postintervention. Two programs demonstrated efficacy for both depressive symptoms and depressive episodes across multiple independent trials. Regarding effectiveness, 6 programs had at least 1 study showing significant effects when delivered by endogenous service providers; 4 programs had significant effects in studies conducted independently of the program developers. Several programs have demonstrated promise in terms of efficacy, but no depression prevention program for children or adolescents as yet has garnered sufficient evidence of effectiveness under real-world conditions to warrant widespread dissemination at this time.
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Affiliation(s)
| | - Judy Garber
- a Department of Psychology & Human Development , Vanderbilt University
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Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 2016:CD003380. [PMID: 27501438 PMCID: PMC8407360 DOI: 10.1002/14651858.cd003380.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. OBJECTIVES To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. SEARCH METHODS We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. MAIN RESULTS We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. AUTHORS' CONCLUSIONS Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.
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Affiliation(s)
- Sarah E Hetrick
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Georgina R Cox
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | | - Julliet J Bir
- University of AucklandDepartment of PsychiatryPrivate Bag 92109AucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
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Tak YR, Lichtwarck-Aschoff A, Gillham JE, Van Zundert RMP, Engels RCME. Universal School-Based Depression Prevention 'Op Volle Kracht': a Longitudinal Cluster Randomized Controlled Trial. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:949-61. [PMID: 26404640 PMCID: PMC4893378 DOI: 10.1007/s10802-015-0080-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The longitudinal effectiveness of a universal, adolescent school-based depression prevention program Op Volle Kracht (OVK) was evaluated by means of a cluster randomized controlled trial with intervention and control condition (school as usual). OVK was based on the Penn Resiliency Program (PRP) (Gillham et al. Psychological Science, 6, 343-351, 1995). Depressive symptoms were assessed with the Child Depression Inventory (Kovacs 2001). In total, 1341 adolescents participated, Mage = 13.91, SD = 0.55, 47.3 % girls, 83.1 % Dutch ethnicity; intervention group n = 655, four schools; control group n = 735, five schools. Intent-to-treat analyses revealed that OVK did not prevent depressive symptoms, β = -0.01, SE = 0.05, p = .829, Cohen's d = 0.02, and the prevalence of an elevated level of depressive symptoms was not different between groups at 1 year follow-up, OR = 1.00, 95 % CI = 0.60-1.65, p = .992, NNT = 188. Latent Growth Curve Modeling over the 2 year follow-up period showed that OVK did not predict differences in depressive symptoms immediately following intervention, intercept: β = 0.02, p = .642, or changes in depressive symptoms, slope: β = -0.01, p = .919. No moderation by gender or baseline depressive symptoms was found. To conclude, OVK was not effective in preventing depressive symptoms across the 2 year follow-up. The implications of these findings are discussed.
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Affiliation(s)
- Yuli R Tak
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands.
| | - Anna Lichtwarck-Aschoff
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Jane E Gillham
- Psychology Department, Swarthmore College, 500 College Avenue, Swarthmore, PA, 19081, USA
- The Penn Resiliency Project, Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rutger C M E Engels
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- Trimbos-Institute, P.O. Box 725, 3500, AS, Utrecht, The Netherlands
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A randomized controlled trial comparing two cognitive-behavioral programs for adolescent girls with subclinical depression: A school-based program (Op Volle Kracht) and a computerized program (SPARX). Behav Res Ther 2016; 80:33-42. [DOI: 10.1016/j.brat.2016.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 03/07/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
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Young JF, Benas JS, Schueler CM, Gallop R, Gillham JE, Mufson L. A Randomized Depression Prevention Trial Comparing Interpersonal Psychotherapy--Adolescent Skills Training to Group Counseling in Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:314-24. [PMID: 26638219 PMCID: PMC5467441 DOI: 10.1007/s11121-015-0620-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the rise in depression disorders in adolescence, it is important to develop and study depression prevention programs for this age group. The current study examined the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a group prevention program for adolescent depression, in comparison to group programs that are typically delivered in school settings. In this indicated prevention trial, 186 adolescents with elevated depression symptoms were randomized to receive IPT-AST delivered by research staff or group counseling (GC) delivered by school counselors. Hierarchical linear modeling examined differences in rates of change in depressive symptoms and overall functioning from baseline to the 6-month follow-up assessment. Cox regression compared rates of depression diagnoses. Adolescents in IPT-AST showed significantly greater improvements in self-reported depressive symptoms and evaluator-rated overall functioning than GC adolescents from baseline to the 6-month follow-up. However, there were no significant differences between the two conditions in onset of depression diagnoses. Although both intervention conditions demonstrated significant improvements in depressive symptoms and overall functioning, results indicate that IPT-AST has modest benefits over groups run by school counselors which were matched on frequency and duration of sessions. In particular, IPT-AST outperformed GC in reduction of depressive symptoms and improvements in overall functioning. These findings point to the clinical utility of this depression prevention program, at least in the short-term. Additional follow-up is needed to determine the long-term effects of IPT-AST, relative to GC, particularly in preventing depression onset.
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Affiliation(s)
| | | | | | | | | | - Laura Mufson
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Scholten H, Malmberg M, Lobel A, Engels RCME, Granic I. A Randomized Controlled Trial to Test the Effectiveness of an Immersive 3D Video Game for Anxiety Prevention among Adolescents. PLoS One 2016; 11:e0147763. [PMID: 26816292 PMCID: PMC4729475 DOI: 10.1371/journal.pone.0147763] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
Adolescent anxiety is debilitating, the most frequently diagnosed adolescent mental health problem, and leads to substantial long-term problems. A randomized controlled trial (n = 138) was conducted to test the effectiveness of a biofeedback video game (Dojo) for adolescents with elevated levels of anxiety. Adolescents (11–15 years old) were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Initial screening for anxiety was done on 1,347 adolescents in five high schools; only adolescents who scored above the “at-risk” cut-off on the Spence Children Anxiety Survey were eligible. Adolescents’ anxiety levels were assessed at pre-test, post-test, and at three month follow-up to examine the extent to which playing Dojo decreased adolescents’ anxiety. The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms (not of total anxiety symptoms) in the Dojo condition compared to the control condition. Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants’ expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.
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Affiliation(s)
- Hanneke Scholten
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- * E-mail:
| | - Monique Malmberg
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Adam Lobel
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Rutger C. M. E. Engels
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Isabela Granic
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Nardi B, Massei M, Arimatea E, Moltedo-Perfetti A. Effectiveness of group CBT in treating adolescents with depression symptoms: a critical review. Int J Adolesc Med Health 2016; 29:/j/ijamh.2017.29.issue-3/ijamh-2015-0080/ijamh-2015-0080.xml. [PMID: 26812765 DOI: 10.1515/ijamh-2015-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022]
Abstract
Depression is among the most common psychological disorders of adolescents. Its management is based on pharmacological treatment, psychological therapy, or a combination thereof. Cognitive behavioral therapy (CBT) is the most extensively tested intervention for adolescent depression. A PubMed search was conducted for randomized controlled trials (RCT) of the efficacy of CBT in treating adolescents with depressive symptoms published in 2005-2015. Keywords were "cognitive behavioral therapy", "group therapy", "depression" and "adolescent". Of the 23 papers that were retrieved, only six met all inclusion criteria. Three of them reported a significant reduction in depressive symptom severity after either individual or group (G)-CBT compared with the control group, even with a small number of CBT sessions (six rather than 10-12), with a medium or medium-to-large effect size. One study reported improved self-awareness and a significantly greater increase in perceived friend social support compared with bibliotherapy and check with brochure. Two studies reported clinical symptom reduction without significant differences compared with the control group (activity contrast). This review highlighted primarily that very few RCT have applied CBT in adolescents; moreover, it confirmed the effectiveness of G-CBT, especially as psychotherapy, although it was not always superior to other interventions (e.g. other activities in prevention programs). Comparison showed that G-CBT and group interpersonal psychotherapy were both effective in reducing depressive symptoms. Successful G-CBT outcomes were related to the presence of peers, who were an important source of feedback and support to observe, learn, and practice new skills to manage depressive symptoms and improve social-relational skills.
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Weeland MM, Nijhof KS, Vermaes I, Engels RCME, Buitelaar JK. Study protocol: a randomised controlled trial testing the effectiveness of 'Op Volle Kracht' in Dutch residential care. BMC Psychiatry 2015; 15:161. [PMID: 26194791 PMCID: PMC4509693 DOI: 10.1186/s12888-015-0498-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although adolescents are often referred to residential treatment centres because of severe externalizing behaviours, a vast majority demonstrated comorbid symptoms of depression and anxiety. Covert internalizing symptoms in these adolescents might be easily unrecognized and therefore untreated. Adolescents with mild intellectual disability (MID) are overrepresented among youth with both externalizing and internalizing problems. There are yet few treatment programs available for adolescents with both externalizing and internalizing problems. METHODS/DESIGN The CBT-based resiliency program, Op Volle Kracht (OVK), which is based on the US Penn Resiliency Program (PRP), was adapted to suit the needs of adolescents with both externalizing and internalizing problems, either with or without MID, in Dutch residential treatment centres. The effectiveness of this group intervention program of eight sessions will be tested in a randomised controlled trial (RCT) with N = 182 adolescents aged 12-16, allocated to either the target intervention plus treatment as usual (OVK + TAU) or treatment as usual only (TAU). The main outcome variables include depressive symptoms (primary), anxiety, behavioural problems, and group therapeutic climate. Cognitive styles and coping styles will be included as possible mediators. Assessments take place at baseline (T1), one week before the start of the program (T2), immediately after the program (T3), and at three months follow-up (T4). DISCUSSION The program assets include its wide implementation possibilities due to low costs, the short duration of the program and the delivery by group care workers, and its suitability for adolescents with MID. Further strengths of the present study design include its robust method (RCT), the ecological validity, and the inclusion of possible mediators of treatment effect. The program emphasizes individual risk factors for depression rather than social and family factors. Implications for practice and future research are discussed. TRIAL REGISTRATION Dutch Trial Register NTR4836.
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Affiliation(s)
- Martine M Weeland
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen, HE, 6500, The Netherlands.
- Pluryn, P.O. Box 53, Nijmegen, AB, 6500, The Netherlands.
- Karakter Child and Adolescent Psychiatry, P.O. Box 68, Ede, BB, 6710, The Netherlands.
| | - Karin S Nijhof
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen, HE, 6500, The Netherlands.
- Pluryn, P.O. Box 53, Nijmegen, AB, 6500, The Netherlands.
| | - Ignace Vermaes
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen, HE, 6500, The Netherlands.
- Pluryn, P.O. Box 53, Nijmegen, AB, 6500, The Netherlands.
| | - Rutger C M E Engels
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen, HE, 6500, The Netherlands.
- Trimbos, Utrecht, The Netherlands.
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry, P.O. Box 68, Ede, BB, 6710, The Netherlands.
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Initial Findings from a Novel School-Based Program, EMPATHY, Which May Help Reduce Depression and Suicidality in Youth. PLoS One 2015; 10:e0125527. [PMID: 25974146 PMCID: PMC4431804 DOI: 10.1371/journal.pone.0125527] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/10/2015] [Indexed: 11/21/2022] Open
Abstract
We describe initial pilot findings from a novel school-based approach to reduce youth depression and suicidality, the Empowering a Multimodal Pathway Towards Healthy Youth (EMPATHY) program. Here we present the findings from the pilot cohort of 3,244 youth aged 11–18 (Grades 6-12). They were screened for depression, suicidality, anxiety, use of drugs, alcohol, or tobacco (DAT), quality-of-life, and self-esteem. Additionally, all students in Grades 7 and 8 (mean ages 12.3 and 13.3 respectively) also received an 8-session cognitive-behavioural therapy (CBT) based program designed to increase resiliency to depression. Following screening there were rapid interventions for the 125 students (3.9%) who were identified as being actively suicidal, as well as for another 378 students (11.7%) who were felt to be at higher-risk of self-harm based on a combination of scores from all the scales. The intervention consisted of an interview with the student and their family followed by offering a guided internet-based CBT program. Results from the 2,790 students who completed scales at both baseline and 12-week follow-up showed significant decreases in depression and suicidality. Importantly, there was a marked decrease in the number of students who were actively suicidal (from n=125 at baseline to n=30 at 12-weeks). Of the 503 students offered the CBT program 163 (32%) took part, and this group had significantly lower depression scores compared to those who didn’t take part. There were no improvements in self-esteem, quality-of-life, or the number of students using DAT. Only 60 students (2% of total screened) required external referral during the 24-weeks following study initiation. These results suggest that a multimodal school-based program may provide an effective and pragmatic approach to help reduce youth depression and suicidality. Further research is required to determine longer-term efficacy, reproducibility, and key program elements.
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Tak YR, Kleinjan M, Lichtwarck-Aschoff A, Engels RCME. Secondary outcomes of a school-based universal resiliency training for adolescents: a cluster randomized controlled trial. BMC Public Health 2014; 14:1171. [PMID: 25404142 PMCID: PMC4247712 DOI: 10.1186/1471-2458-14-1171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study investigated the long-term effectiveness of the adolescent cognitive behavioral resiliency training Op Volle Kracht (OVK) on the secondary outcomes: anxiety symptoms, hopelessness, happiness, life satisfaction, optimism, coping, self-efficacy, and school functioning. In addition, the study analyzed whether the secondary outcomes moderated the intervention effect on depressive symptoms. METHODS A two-condition (intervention and control) cluster randomized controlled trial was conducted. All adolescents in the 8th grade were eligible to participate, unless they, or their parents, declined their participation. Schools were the unit of randomization. Missing data were imputed and intent to treat analyses were conducted. The results were analyzed using Latent Growth Curve Modeling across the 24-months follow-up period. RESULTS The total sample consisted of 1341 adolescents (Mage = 13.91, SD =0.55, 47.3% girls, 83.1% Dutch ethnicity). The intervention and control condition consisted of 634 adolescents from 4 schools and 707 adolescents from 5 schools, respectively. OVK did not have an effect on depression, anxiety, hopelessness, happiness, and life satisfaction, but promoted cognitive coping over the course of the follow-up period. OVK showed small iatrogenic effects on optimism, active coping, social self-efficacy and school grades directly post intervention, but these effects disappeared during the follow-up period. Finally, none of the outcome variables moderated the intervention effect on depressive symptoms. CONCLUSIONS The universal resiliency training OVK was not effective in this Dutch sample. Implications for research and practice were discussed. TRIAL REGISTRATION NUMBER NTR2879.
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Affiliation(s)
- Yuli R Tak
- />Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Marloes Kleinjan
- />Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- />Trimbos-Institute, P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Anna Lichtwarck-Aschoff
- />Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Rutger CME Engels
- />Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- />Trimbos-Institute, P.O. Box 725, 3500 AS Utrecht, The Netherlands
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Kindt KCM, Kleinjan M, Janssens JMAM, Scholte RHJ. Evaluation of a school-based depression prevention program among adolescents from low-income areas: a randomized controlled effectiveness trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5273-93. [PMID: 24837666 PMCID: PMC4053916 DOI: 10.3390/ijerph110505273] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 01/04/2023]
Abstract
A randomized controlled trial was conducted among a potential high-risk group of 1,343 adolescents from low-income areas in The Netherlands to test the effectiveness of the depression prevention program Op Volle Kracht (OVK) as provided by teachers in a school setting. The results showed no main effect of the program on depressive symptoms at one-year follow-up. A moderation effect was found for parental psychopathology; adolescents who had parents with psychopathology and received the OVK program had less depressive symptoms compared to adolescents with parents with psychopathology in the control condition. No moderating effects on depressive symptoms were found for gender, ethnical background, and level of baseline depressive symptoms. An iatrogenic effect of the intervention was found on the secondary outcome of clinical depressive symptoms. Based on the low level of reported depressive symptoms at baseline, it seems that our sample might not meet the characteristics of a high-risk selective group for depressive symptoms. Therefore, no firm conclusions can be drawn about the selective potential of the OVK depression prevention program. In its current form, the OVK program should not be implemented on a large scale in the natural setting for non-high-risk adolescents. Future research should focus on high-risk participants, such as children of parents with psychopathology.
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Affiliation(s)
- Karlijn C M Kindt
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Marloes Kleinjan
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Jan M A M Janssens
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Ron H J Scholte
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
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Rasing SPA, Creemers DHM, Janssens JMAM, Scholte RHJ. Effectiveness of depression and anxiety prevention in adolescents with high familial risk: study protocol for a randomized controlled trial. BMC Psychiatry 2013; 13:316. [PMID: 24268128 PMCID: PMC3871007 DOI: 10.1186/1471-244x-13-316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Depression and anxiety disorders during adolescence can have detrimental consequences. Both disorders are related to negative outcome in various areas during adolescence and are also predictive of depression and anxiety disorders later in life. Especially parental psychopathology and being female are risk factors that increase the probability of developing one of these disorders during adolescence. Research has shown that prevention programs have promising results, especially for adolescents who have these risk factors. Therefore, in this study, we will focus on the effectiveness of a prevention program 'A jump forward' that has been developed for adolescent girls with a familial risk of depression and/or anxiety. METHODS/DESIGN We designed a randomized controlled trial to test the effectiveness of an indicated and selective prevention program aimed at depression and anxiety in adolescent girls. Adolescents aged between 11 and 15 years old with depressive and/or anxiety symptoms and with parents who show indicators of parental psychopathology will be randomly assigned to the experimental (N = 80) or control groups (N = 80). Participants in the experimental group will follow a preventive intervention, consisting of six sessions of 90 minutes each. All participants will complete baseline, intervention phase 1 (after session 2), intervention phase 2 (after session 4), post-intervention, 6 month follow-up, and 12 month follow-up assessments. Furthermore, parents will be asked to complete assessments at baseline, post-intervention, and 12-month follow-up. Primary outcome will be depressive symptoms. Secondary outcomes will be anxiety symptoms, suicidal ideation, response style, negative cognitive errors, parental emotional support and parental control, parental psychopathology, parenting stress and adolescents' depression and anxiety symptoms according to the parents. DISCUSSION This paper described the study designed to evaluate a program for preventing depression and/or anxiety in high-risk adolescents over a 12-month follow-up period. If the program showed to be effective in reducing symptoms of depression and anxiety and preventing adolescents from developing clinical levels of these disorders, our results would be relevant to practice. Thus, the intervention could be used on a large scale. Moreover, this study aims to contribute to the evidence-based prevention of depression and anxiety of adolescents. TRIAL REGISTRATION Dutch Trial Register NTR3720.
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Affiliation(s)
- Sanne PA Rasing
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, Netherlands
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, Netherlands
| | - Daan HM Creemers
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, Netherlands
- GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, Netherlands
| | - Jan MAM Janssens
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, Netherlands
| | - Ron HJ Scholte
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, Netherlands
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