About the project
The Intervention EMOTION, Coping Kids, A Program for Managing Anxiety and Depression (Kendall et. al, 2013) was developed to reduce symptoms of anxiety and depression in youth at risk aged 8 to 12. The intervention is based on cognitive behavioral theory and integrates core components of empirically supported treatments for anxiety and for depression in youth: the Coping cat program (Kendall & Hedtke, 2006) and the Taking ACTION program (Stark, Streusand, Prerna, & Patel, 2012).
The current study will build on the TIM study: a cluster randomized controlled study which examined the effectiveness of the indicated preventive EMOTION intervention (Kendall et al., 2013; Martinsen et al., 2019). Thirty-six schools covering both rural and urban areas in Norway participated and were randomized to treatment as usual or intervention condition. Children aged 8 – 12 years were screened for participation using well established questionnaires (March, 1997) and SMFQ (Angold, Costello, Messer, & Pickles, 1995) to identify those with elevated levels of anxious or depressive symptoms. High-scorers were invited to participate in the study (N = 795) either attending a 10-week EMOTION group during school hours or getting the care normally provided (e.g., talking to the school health nurse). Parents participated in parent groups learning the same coping skills as the children plus specific coping skills for the parents. The participating children and parents reported on the child symptoms at three timepoints: screening (T1), post-intervention (T2) and 1-year follow-up (T3). This study follows up 5 years after the intervention (T4).
Objectives
To enhance our understanding of prevention and the trajectories of anxiety and depression in youth.
Research Question
The purpose of the research project is to investigate whether a preventive intervention aimed at anxious and sad children aged 8 to 12 years when the study was conducted in 2013 - 2017 can prevent and reduce the occurrence of mental disorders in the long term. The research questions are the following:
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Do children who participated in the EMOTION intervention have lower prevalence of anxiety and depression, higher quality of life and lower level of emotional symptoms than children in the control condition 5 years after the intervention?
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What subgroups of children (high/low scorers on one or both of the secondary outcome measures) have had most effect of this preventive intervention in the long run?
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How did children and parents experience the participation in the TIM study? What kind of support did the youth receive from the parents and the school during and after the intervention? What services have they used after the study, and do they experience the services as coordinated?
Background
Early intervention targeting anxiety and depression is important as these disorders are highly prevalent in youth (Merikangas et al., 2010), and impairing (Beesdo, Knappe, & Pine, 2009), leading to academic, social, and family problems and lower quality of life. In addition to causing distress in childhood, such symptoms are significant risk factors for a negative trajectory later in life, especially since few of these children and adolescents receive the services they need. Early intervention can combat this development, as research shows positive effects post-intervention.
Reseach on the long-term effects of preventive interventions is however scarce, and a recent meta-analysis by Rith-Najarian et al. (2019) highlights the need for more knowledge regarding the lasting impact of preventive interventions. Knowledge regarding the long-term effects of interventions as well as their cost-effectiveness are of great importance when influencing priorities in local government.
Financing
Funding is provided by «Stiftelsen Dam»
Cooperation
Done in collaboration with reserachers from RBUP Eastern and Southern Norway (Simon-Peter Neumer) and RKBU Mid (Ass. Professor Jo Magne Ingul), and RKBU North (Ass. Professor Frode Adolfsen).
Gro Janne Wergeland, MD, PhD, specialist in child and adolescent psychiatry conducted the training in the ADIS manual.
Prof. Silverman at Yale School of Medicine, USA, is part of our expert team as she is the developer of the main outcome measure; the ADIS interview. An expert in longitudinal studies: prof. Røysamb at University of Oslo will also be in the expert team together with our long-standing international partner: Prof. Philip C. Kendall. Dr. Kendall is one of the leading experts in this field of emotional disorders, diagnostics, and co-creator of the intervention. He will be an expert advisor to the project in all phases of the project.
An important goal in the study is to collect the user perspective on participation in a preventive intervention and experiences with and need for high quality and coordinated services and support. Representatives from the different users are recruited through the organization Voksne for Barn (youth, parents, and employees from the organization) and representatives from the services from Ullern municipality in Oslo. In addition to this, the user organizations have assisted in creating the interview guide for qualitative interviews.
Tools
We have contact information for the parents of 594 children. Taking dropout rates into account, we aim to include 70% to answer the questionaires, which would be 415 children. All participants, both children and parents, will answer the same quantitative questionnaires as they did in the original study.
A selection of participants, approximately 200, both parents and children, will be invited to undergo a structured diagnostic interview using the ADIS manual.
A smaller sample, approximately 10 children and 10 parents, who participated in the intervention group will be invited to participate in a qualitative interview. They will be asked about their recollection of the intervention, the coping strategies they have found helpful, and the extent to which they have utilized healthcare services after the intervention.
Ethical considerations
To comply with the requirements in the Health Research Act (2015), information letters to the youth (separate letters for youth above and below 16) and their parents will be carefully prepared in collaboration with user representatives. It will be emphasized that participation is voluntary and that participants may withdraw from the study at any time. Parents have provided informed consent to be contacted for a new follow-up study and youth 16 years or older provide informed consent on their own behalf.
The original project description of the TIM study has been revised for T4 and is approved by The Regional Committees for Medical and Health Research Ethics (2013/1909/REK South East). The study will be carried out in accordance with prevailing ethical and data security standards, and according to the host institutions policies. The study is registered at www.clinicaltrials.gov.