Abstract
BackgroundAnxiety and mood disorders are highly prevalent and pose a huge burden on patients. Their offspring is at increased risk of developing these disorders as well, indicating a clear need for prevention of psychopathology in this group. Given high comorbidity and non-specificity of intergenerational transmission of disorders, prevention programs should target both anxiety and depression. Further, while the indication for preventive interventions is often elevated symptoms, offspring with other high risk profiles may also benefit from resilience-based prevention programs.Method/designThe current STERK-study (Screening and Training: Enhancing Resilience in Kids) is a randomized controlled clinical trial combining selected and indicated prevention: it is targeted at both high risk individuals without symptoms and at those with subsyndromal symptoms. Individuals without symptoms meet two of three criteria of the High Risk Index (HRI; female gender, both parents affected, history of a parental suicide (attempt). This index was developed in an earlier study and corresponds with elevated risk in offspring of depressed patients. Children aged 8–17 years (n = 204) with subthreshold symptoms or meeting the criteria on the HRI are randomised to one of two treatment conditions, namely (a) 10 weekly individual child CBT sessions and 2 parent sessions or (b) minimal information. Assessments are held at pre-test, post-test and at 12 and 24 months follow-up. Primary outcome is the time to onset of a mood or anxiety disorder in the offspring. Secondary outcome measures include number of days with depression or anxiety, child and parent symptom levels, quality of life, and cost-effectiveness. Based on models of aetiology of mood and anxiety disorders as well as mechanisms of change during interventions, we selected potential mediators and moderators of treatment outcome, namely coping, parent–child interaction, self-associations, optimism/pessimism, temperament, and emotion processing.DiscussionThe current intervention trial aims to significantly reduce the risk of intergenerational transmission of mood and anxiety disorders with a short and well targeted intervention that is directed at strengthening the resilience in potentially vulnerable children. We plan to evaluate the effectiveness and cost-effectiveness of such an intervention and to identify mechanisms of change.Trial registrationNTR2888
Highlights
Anxiety and mood disorders are highly prevalent and pose a huge burden on patients
The current intervention trial aims to significantly reduce the risk of intergenerational transmission of mood and anxiety disorders with a short and well targeted intervention that is directed at strengthening the resilience in potentially vulnerable children
The current study builds upon these studies, while adding to them in a variety of ways: (1) we use additional risk factors to select ultra high risk individuals among offspring of patients with a mood or anxiety disorder; (2) we focus on both depression and anxiety; (3) we aim at symptom reduction as well as at increasing strengths and resilience; (4) we include mediators and moderators of change; (5) we include short and longterm cost-effectiveness analyses
Summary
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). Developing prevention studies, getting funding, gaining ethical approval, and including participants is a timeconsuming trajectory. 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. 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.
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