Preventing Mood and Anxiety Disorders in Youth
Given the high prevalence of anxiety and mood disorders in offspring of adults with these disorders, prevention interventions are needed to prevent internalising mental disorders in children and adolescents. The current STERK-study is a randomised controlled prevention trial in high-risk offspring (aged 8–17 years) of anxious and depressed patients. We select youth on either elevated symptoms or on the basis of the High Risk Index that we developed in an earlier epidemiological offspring study (ARIADNE). The present study is the first to focus on both anxiety and depression, since these disorders are often comorbid, and since epidemiological findings in offspring show that anxious and depressive symptoms are prevalent in offspring of patients with anxiety disorders and just as well in patients suffering from unipolar depression. With this study, we hope to contribute to the prevention of mental disorders in offspring, as well as to the knowledge on mediators and moderators of change.
Developing prevention studies, getting funding, gaining ethical approval, and including participants is a time-consuming trajectory. For the current study/project, the grant application was in 2007, the grant was awarded in 2008, and we received ethical approval by the end of 2009. The inclusion of participants into the project is still ongoing. Due to this timeframe, we have not been able to incorporate some of the most recent findings into our design. In fact, the current design is an adaptation of an earlier design. In the first wave of the study, we only included adult patients that were currently in treatment, and we excluded all children with a history of mental illness. However, we noticed that quite some eligible and interested participants were excluded in this way. In addition, the Garber study got published in 2009, showing that prevention interventions may be only fruitful if parents were remitted in terms of their own mental health problems. Therefore, we decided to broaden the inclusion scope of our trial (approved of by both the governmental funding organization ZonMw and the Medical Ethical Committee).
A preventive intervention of this kind should not be a stand-alone in clinical practice. Many youth departments primarily work on the youth's psychopathology and hardly identify parental psychopathology. Likewise, mental health centers for adult patients often do not consider the mental health status of offspring. During the process of implementing this study, we noticed that therapists are often unaware if the adult patient has children. The electronic patient files usually do not map age or emotional well being of children. It would be helpful in clinical practice to pay attention to the psychopathology in the family as a whole, and to have more cooperation between the youth and adult departments for cross-referrals. In line with Garber's findings it might be helpful to address the emotional well being of the children in the remitted instead of the acute phase of the parent's disorder. The STERK-study may provide valuable tools within such an infrastructure: a way of screening for high-risk children, as well as an intervention aiming at symptom reduction and resilience.
Discussion
Given the high prevalence of anxiety and mood disorders in offspring of adults with these disorders, prevention interventions are needed to prevent internalising mental disorders in children and adolescents. The current STERK-study is a randomised controlled prevention trial in high-risk offspring (aged 8–17 years) of anxious and depressed patients. We select youth on either elevated symptoms or on the basis of the High Risk Index that we developed in an earlier epidemiological offspring study (ARIADNE). The present study is the first to focus on both anxiety and depression, since these disorders are often comorbid, and since epidemiological findings in offspring show that anxious and depressive symptoms are prevalent in offspring of patients with anxiety disorders and just as well in patients suffering from unipolar depression. With this study, we hope to contribute to the prevention of mental disorders in offspring, as well as to the knowledge on mediators and moderators of change.
Developing prevention studies, getting funding, gaining ethical approval, and including participants is a time-consuming trajectory. For the current study/project, the grant application was in 2007, the grant was awarded in 2008, and we received ethical approval by the end of 2009. The inclusion of participants into the project is still ongoing. Due to this timeframe, we have not been able to incorporate some of the most recent findings into our design. In fact, the current design is an adaptation of an earlier design. In the first wave of the study, we only included adult patients that were currently in treatment, and we excluded all children with a history of mental illness. However, we noticed that quite some eligible and interested participants were excluded in this way. In addition, the Garber study got published in 2009, showing that prevention interventions may be only fruitful if parents were remitted in terms of their own mental health problems. Therefore, we decided to broaden the inclusion scope of our trial (approved of by both the governmental funding organization ZonMw and the Medical Ethical Committee).
A preventive intervention of this kind should not be a stand-alone in clinical practice. Many youth departments primarily work on the youth's psychopathology and hardly identify parental psychopathology. Likewise, mental health centers for adult patients often do not consider the mental health status of offspring. During the process of implementing this study, we noticed that therapists are often unaware if the adult patient has children. The electronic patient files usually do not map age or emotional well being of children. It would be helpful in clinical practice to pay attention to the psychopathology in the family as a whole, and to have more cooperation between the youth and adult departments for cross-referrals. In line with Garber's findings it might be helpful to address the emotional well being of the children in the remitted instead of the acute phase of the parent's disorder. The STERK-study may provide valuable tools within such an infrastructure: a way of screening for high-risk children, as well as an intervention aiming at symptom reduction and resilience.
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