Commentary: Why treatment is the best choice for childhood mental disorders – a commentary on Roest et al. (2022)

An important question in mental healthcare for children is whether treatments are effective and safe in the long run. Here, we comment on a recent editorial perspective by Roest et al. (2022), who argue, based on an overview of systematic reviews, ‘that there is no convincing evidence that interventions for the most common childhood disorders are beneficial in the long term’. We believe that the available evidence does not justify this conclusion and express our concern regarding the harmful effects of their message. We show that there is evidence to suggest beneficial longer term treatment effects for each of the disorders and explain why evidence-based treatment should be offered to children with mental disorders

Turning depression inside out : Life events, cognitive emotion regulation and treatment in adolescents

In view of the large burden of disease for the depressed adolescents, their families and society as a whole, studies on risk factors and mechanisms for development of a depression, as well as effect studies concerning specific treatment procedures for adolescents with depression, are definitely needed. This thesis combines several research questions targeting different concepts in relation to depression, namely risk factors and development of adolescent depression and the treatment of adolescent depression. This dissertation focuses on three important themes related to the development and treatment of depressive symptoms in adolescents, namely life events, cognitive emotion regulation and CBT. Life events were studied as risk factors for adolescent depression, cognitive emotion regulation was examined as a mediating mechanism between risk factors and adolescent depression and the effectiveness of CBT was investigated as a treatment for adolescent depression in clinical practice and compared to TAU. Different samples were used, including two large community samples, as well as a sample of clinically depressed adolescents. In addition different study designs were used, including a large longitudinal adult population study (NEMESIS), a longitudinal study following adolescents from 12 to 20 years of age (TRAILS) and a randomized controlled trial (RCT) studying the effectiveness of CBT (‘Doepressie’). Important results were found clarifying the relationships between depressive symptoms in adolescents and invasive life events, cognitive emotion regulation strategies and different forms of treatment. Looking into the role of life events in adolescent depression, the first study focused on the consequences of family bereavement. It was found that the devastating experience of the death of a parent during childhood was not associated with increased psychiatric diagnoses during adulthood. Most children seemed to cope well after family-bereavement and handled their emotions without developing internalizing problems. A small number of family-bereaved adolescents was found to be at risk for severe internalizing problems. Next, we identified that elevated levels of internalizing problems before bereavement, formed a risk factor for internalizing problems after bereavement. Another important risk factor that was found to increase the vulnerability in adolescents to develop depression was stressful relational life events, like conflicts between the adolescent and his/her parents or friends. In addition, in a clinical sample, it was found that depressed adolescents who experienced stressful health threats like serious illness of themselves, parents or sibling had more depressive symptoms than depressed adolescents without a health threating life event. Another focus of this thesis is on processes that contribute to the actual development of depressive symptom after the occurrence of severe life events, namely cognitive emotion regulation strategies. Maladaptive strategies, like rumination, as well as adaptive strategies, like positive reappraisal, were found to be related to elevated depressive symptoms. Maladaptive strategies were identified as mediators of depressive symptoms after stressful life events but adaptive strategies were not. Therefore it seems that stressful relational life events, put adolescents at risk for depression, and even more so when they use maladaptive cognitive emotion regulation strategies. Regarding treatment of adolescents that had a clinical diagnosis of depression, it was found that both groups that were either treated with CBT or TAU, improved significantly. CBT did not outperform TAU. However, half of the treated adolescents still experienced elevated levels of depressive symptoms by the end of the treatment. Although it was feasible to use a manualized treatment in the CBT group in routine mental health, it was also found that discontinuation of treatment in the CBT group was higher than in TAU, which resulted in new ideas that could improve CBT for depressed adolescents. This thesis covers these three themes

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

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Depressieve adolescenten, een zorg op zich

In Nederland zijn ieder jaar 37.000 jongeren depressief. De zorg voor deze patiënten is versnipperd georganiseerd en wordt bovendien niet altijd volgens de richtlijn aangeboden. Met vroegsignalering, preventie, goede behandelingen en terugvalpreventie in de regio groeit de effectiviteit van de hele zorgketen

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

Depressieve adolescenten, een zorg op zich

In Nederland zijn ieder jaar 37.000 jongeren depressief. De zorg voor deze patiënten is versnipperd georganiseerd en wordt bovendien niet altijd volgens de richtlijn aangeboden. Met vroegsignalering, preventie, goede behandelingen en terugvalpreventie in de regio groeit de effectiviteit van de hele zorgketen

Depressie en suïcide

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De beste behandeling voor depressie is vroegsignalering en preventie bij jeugdigen [The best intervention for depression is early detection and prevention in youth]

Achtergrond Een focus op een preventieve en proactieve aanpak binnen en buiten de jeugd-ggz kan eraan bijdragen om de ernst van psychische problemen bij jongeren minder groot te laten worden en de kans op therapieresistentie te verkleinen. Doel De mogelijkheden laten zien om de jeugd-ggz proactiever te organiseren. Methode Bespreken van nieuwe benaderingen in de bestaande literatuur en voorbeelden uit de praktijk. Resultaten Het is essentieel dat jongeren eerder interventies ontvangen die passen bij de ernst van de problematiek. Vroegsignalering en preventie kunnen systematisch uitgevoerd worden in samenwerking tussen ggz, GGD en onderwijs. Daarnaast is het noodzakelijk dat jongeren op basis van hun prognose de juiste (specialistische) zorg ontvangen. Conclusie De zorg voor jongeren met (sub)klinische depressieve klachten kan proactiever worden ingericht. Daarbij zijn er mogelijkheden op het gebied van preventie en behandeling en op termijn in het gepersonaliseerd aanbieden van behandeling