Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents

__Background:__ Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR. __Methods:__ We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated. __Discussion:__ The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs

Effectiveness of Cognitive Behaviours Therapy (CBT), in clinically depressed adolescents versus Treatment As Usual (TAU)

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Angst en angststoornissen bij meisjes

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Multiproblem families referred to youth mental health: What's in a name?

Contains fulltext : 155887.pdf (publisher's version ) (Closed access)The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut-off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut-off scores were established for various questionnaires. Finally, three types of families were found: (1) community-problem families, (2) multiproblem families, and (3) child-focused mild-problem families. This paper looks to advance an evidence-based definition and assessment of "multiproblem families" suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments.17 p

ACT voor ouders van kinderen met ontwikkelings- en/of psychische problemen

Item does not contain fulltextIn dit hoofdstuk wordt een therapeutische vorm van ouderbegeleiding beschreven, die ouders helpt bij het veranderen van hun eigen gedrag met als doel het stimuleren van de ontwikkeling van hun kinderen: ACTief opvoeden. Er wordt beschreven wat de aanleiding is om een nieuw aanbod voor ouders te ontwikkelen, hoe het aanbod is opgebouwd en welke technieken er worden gebruikt. Daarna wordt het therapeutisch proces beschreven en de accenten die gelegd worden. Er volgt een beschrijving van de therapeutische rol en de valkuilen die er voor therapeuten zijn. Het hoofdstuk wordt afgesloten met de beschrijving van een casus en er wordt gekeken naar de effecten van ACTief opvoeden

Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU)

Contains fulltext : 130148.pdf (publisher's version ) (Open Access)Background: Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions. Method/Design: CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted. Discussion: This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment.10 p

Societal burden of adolescent depression, an overview and cost-of-illness study

Background Depression in adolescents is a serious problem to society because of the high prevalence rate, the high subjective burden of illness and negative (economic) consequences. Information regarding the economic burden of adolescent depression is scarce. The goal of this study is twofold. First, an overview of the literature on prevalence, burden of disease, and costs related to adult and adolescent depression is given. Second, a prevalence-based cost-of-illness study is being conducted. Methods In this study a cost-of-illness study using a societal perspective was conducted using data of 56 clinically depressed Dutch adolescents aged 12–21. Bottom-up acquired costs were measured by means of cost questionnaires. Results The calculations showed that clinically depressed adolescents referred to treatment cost the Dutch society €37.7 million a year. The calculated costs were higher when a more recent prevalence rate was used in a secondary analysis. Limitations Limitations of this study are that only older Dutch prevalence rates were available, a relatively small sample size was used and no long term costs could be calculated. Conclusion Even though the sample size is small, the calculated costs are indicative for the societal costs of adolescents with depression. Cost-effective prevention and intervention methods seem warranted to reduce these enormous costs

Factors associated with the referral of anxious children to mental health care: The influence of family functioning, parenting, parental anxiety and child impairment

Contains fulltext : 140333-free.pdf (publisher's version ) (Open Access)This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age =10.28, standard deviation (SD) =1.35], 176 non-referred anxious children recruited in primary schools (M age =9.94, SD =1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment.12 p