[!Cite] Kösters, M. P., Chinapaw, M. J. M., Zwaanswijk, M., Van Der Wal, M. F., & Koot, H. M. (2015). Indicated Prevention of Childhood Anxiety and Depression: Results From a Practice-Based Study up to 12 Months After Intervention. American Journal of Public Health, 105(10), 2005–2013. https://doi.org/10.2105/AJPH.2015.302742

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[!md] FirstAuthor:: Kösters, Mia P.  

Author:: Chinapaw, Mai J. M.   Author:: Zwaanswijk, Marieke   Author:: Van Der Wal, Marcel F.   Author:: Koot, Hans M.   ~     Title:: Indicated Prevention of Childhood Anxiety and Depression: Results From a Practice-Based Study up to 12 Months After Intervention Year:: 2015 Citekey:: kostersIndicatedPreventionChildhood2015 itemType:: journalArticle Journal:: American Journal of Public Health Volume:: 105 Issue:: 10 Pages:: 2005-2013 DOI:: 10.2105/AJPH.2015.302742

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[!Abstract]

Objectives. We investigated whether intervention effects of FRIENDS for Life, a school-based prevention program for children with anxiety or depression symptoms, were maintained over a period of 12 months after the intervention in a naturalistic setting. Methods. We used a quasi-experimental design, with 339 children in the intervention group and 157 in the control group (aged 8–13 years) in schools in Amsterdam, the Netherlands. We collected self-, teacher, and peer reports of anxiety and depression scores before and after intervention, and 6 and 12 months after intervention, from 2010 to 2012. Results. Intervention-group children reported a continuing and significant decrease in anxiety and depression scores compared with the control group. Twelve months after the intervention, participants’ anxiety and depression levels were comparable to those of the general population. Girls reported a stronger decrease in anxiety scores than did boys. Teacher reports suggested no effects. Although classmates reported increased internalizing problems in intervention-group children immediately after intervention, these effects disappeared over time. Conclusions. FRIENDS for Life, an indicated prevention program, yielded long-lasting and continuing reduction in anxiety and depression problems when implemented in daily school practice. (Am J Public Health. 2015;105:2005–2013. doi:10.2105/AJPH.2015.302742) .  

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The program teaches children how to recognize symptoms of anxiety or depression, how to relax, how to act when a problem arises, positive self-talk, graduated exposure to feared situations, and to reward oneself after trying rather than focusing on succeeding.

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This is important, because effects found in randomized controlled trials under controlled conditions are not necessarily transferred into practice

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In the current trial, we found that children in the intervention group self-reported significantly lower anxiety and depression scores than did children in the control group immediately after intervention (M. P. Kösters, written communication, February 2, 2015). Teachers, however, reported no differences between treatment conditions in postintervention scores, whereas classmates reported increased scores in intervention-group children, suggesting both positive and negative intervention effects

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In addition, we explored the potential moderating effects of child gender, age, ethnicity, initial severity of problems, comorbid externalizing problems, and peer rejection on program effects.

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We chose a quasi-experimental design as the intervention had become part of the existing curriculum in several schools and we therefore could not randomize schools to treatment conditions

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The RCADS consists of an anxiety scale (sum of 37 anxiety items, Likert scale 0---3) and a depression scale (sum of 10 depression items, Likert scale 0---3).27 Children rate how often each item applies to them (never, sometimes, often, always).

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We performed longitudinal linear regression analyses with a 4-level hierarchical structure (time, individual, class, school)

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Over time, children in the intervention group had significantly lower anxiety (B = –9.0; 95% confidence interval [CI] = ---12.1, –5.9; P < .001) and depression (B = –2.5; 95% CI = ---3.3, –1.7; P < .001) scores than children in the control group.

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We did not find other significant moderator effects.

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Peer reports indicated that, over time, children in the intervention group showed more internalizing problems than children in the control group (B = 0.06; 95% CI = 0.2, 0.10; P < .01). Differences between treatment conditions were significant at T2 and T3 in favor of the control group (Table 2)

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Differences between treatment conditions became smaller at T3, and at T4 no significant differences between the groups existed any more

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As this result contrasted with children’s self-report, and with children’s positive appraisal of the usefulness of the program (M. P. Kösters, written communication, November 27, 2014), we may conclude that teachers cannot adequately identify children’s internalizing problems, which is in concordance with previous research.37

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The initial increase in peer-reported internalizing problems in the intervention group may be ascribed to peers’ increased attention for the internalizing problems of the FRIENDS for Life participants, as they saw their classmates leave the classroom to attend a program targeting anxiety and depression. The decrease of these peerreported internalizing problems in the intervention group after T2 may indicate that this awareness faded over time.

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However, we found no significant baseline differences between treatment conditions, except for a more ethnically diverse and lower-SES intervention group. To account for this, we adjusted our analyses for ethnicity and SES.

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Second, we did not compare the treatment condition to a placebo or an attention-only condition.

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A third limitation was attrition at the T3 and T4 measurements, where especially older children and—for RCADS data—control and general population children dropped o

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