Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents: A Cluster-Randomized Microtrial.

OBJECTIVE: Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules' relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. METHOD: We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. RESULTS: None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. CONCLUSIONS: Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. ABBREVIATIONS: CDI-2:F: Children's Depression Inventory-2 Full-length version; CDI-2:S: Children's Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.

Evaluating Effect Moderators in Cognitive Versus Behavioral Based CBT-Modules and Sequences Towards Preventing Adolescent Depression.

OBJECTIVE: The aim of this study was to investigate age group, gender, and baseline depressive symptom severity as possible effect moderators in (1) cognitive versus behavioral based CBT-modules and (2) sequences of modules that started either with cognitive or behavioral modules in indicated depression prevention in adolescents. METHOD: We conducted a pragmatic cluster-randomized trial under four parallel conditions. Each condition consisted of four CBT-modules of three sessions (cognitive restructuring, problem solving, behavioral activation, relaxation), but the sequencing of modules differed. The CBT-modules and sequences were clustered into more cognitive versus more behavioral based approaches. The sample involved 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). Assessments were conducted at baseline, after three sessions, at post-intervention and 6-month follow-up with self-reported depressive symptoms as the primary outcome. RESULTS: We found no evidence for substantial moderation effects. Age group, gender, and depressive symptom severity level at baseline did not moderate the effects of cognitive versus behavioral modules after three sessions. No evidence was also found that these characteristics moderated the effectiveness of sequences of modules that started either with cognitive or behavioral modules at post-intervention and 6-month follow-up. CONCLUSION: Cognitive and behavioral based modules and sequences in the prevention of depression in adolescents might apply to a relatively wide range of adolescents in terms of age group, gender, and severity levels of depressive symptoms.Abbreviation: CDI-2:F: Children's Depression Inventory-2 Full-length version; CDI-2:S: Children's Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax, and repeat.

Societal costs of subclinical depressive symptoms in Dutch adolescents: a cost-of-illness study.

BACKGROUND: Subclinical depressive symptoms are highly prevalent among adolescents and are associated with negative consequences, which may pose an economic burden for society. We conducted a prevalence-based cost-of-illness study using a societal perspective to investigate the cost-of-illness of subclinical depressive symptoms among adolescents. METHODS: Using a bottom-up approach, cost questionnaires were assessed to measure costs from 237 Dutch families with an adolescent aged 11-18 with subclinical depressive symptoms (of which 34 met the criteria of a depressive disorder). The study is registered in the Dutch Trial Register (Trial NL5584/NTR6176; www.trialregister.nl/trial/5584). RESULTS: Our calculations show that adolescents with subclinical depressive symptoms cost the Dutch society more than €42 million annually, expressed in costs related to depressive symptoms. Secondary analyses were performed to test the reliability and stability of the costs. When costs related to psychological problems were considered, the annual costs amounted to €67 million. The total societal costs related to physical problems amounted to approximately €126 million. All costs combined (depressive, psychological, behavioural and physical problems and other reasons) amounted to a €243 million. Total costs were highest for physical-related problems of the adolescent (52% of the total costs), followed by psychological (28%), depressive (17%) and behavioural problems (1%). Using an international prevalence rate, societal costs related to depressive symptoms resulted in €54 million a year. CONCLUSIONS: Cost-effective prevention programmes seem warranted given the high societal costs and risk of future costs as subclinical depressive symptoms could be a precursor of clinical depression later in life.

The degree of consistency of applying parental dietary and sedentary behavior rules as indicators for overweight in children: a cross-sectional study.

BACKGROUND: Review studies increasingly emphasize the importance of the role of parenting in interventions for preventing overweight in children. The aim of this study was to examine typologies regarding how consistently parents apply energy-balance related behavior rules, and the association between these typologies and socio-demographic characteristics, energy balance-related behaviors among school age children, and the prevalence of being overweight. METHODS: For this cross-sectional study, we had access to a database managed by a Municipal Health Service Department in the Netherlands. In total, 4,865 parents with children 4-12 years of age participated in this survey and completed a standardized questionnaire. Parents classified their consistency of applying rules as "strict", "indulgent", or "no rules". Typologies were identified using latent class analyses. We used regression analyses to examine how the typologies differed with respect to the covariates socio-demographic characteristics, children's energy balance-related behaviors, and weight status. RESULTS: We identified four stable, distinct parental typologies with respect to applying dietary and sedentary behavior rules. Overall, we found that parents who apply "overall strict EBRB rules" had the highest level of education and that their children practiced healthier behaviors compared to the children of parents in the other three classes. In addition, we found that parents who apply "indulgent dietary rules and no sedentary rules" had the lowest level of education and the highest percentage of non-Caucasians; in addition, their children 8-12 years of age had the highest likelihood of being overweight compared to children of parents with "no dietary rules". CONCLUSIONS: Parents' consistency in applying rules regarding dietary and sedentary behaviors was associated with parents' level of education and ethnic background, as well as with children's dietary and sedentary behaviors and their likelihood of becoming overweight. Our results may contribute to helping make healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight, as well as the importance of encouraging parents to apply strict dietary and sedentary behavior rules. These results can serve as a starting point for developing effective strategies to prevent overweight among children.

Brain responses and approach bias to social alcohol cues and their association with drinking in a social setting in young adult males.

Alcohol is mainly consumed in social settings, in which people often adapt their drinking behaviour to that of others, also called imitation of drinking. Yet, it remains unclear what drives this drinking in a social setting. In this study, we expected to see stronger brain and behavioural responses to social compared to non-social alcohol cues, and these responses to be associated with drinking in a social setting. The sample consisted of 153 beer-drinking males, aged 18-25 years. Brain responses to social alcohol cues were measured during an alcohol cue-exposure task performed in an fMRI scanner. Behavioural responses to social alcohol cues were measured using a stimulus-response compatibility task, providing an index of approach bias towards these cues. Drinking in a social setting was measured in a laboratory mimicking a bar environment. Specific brain responses to social alcohol cues were observed in the bilateral superior temporal sulcus and the left inferior parietal lobe. There was no approach bias towards social alcohol cues specifically; however, we did find an approach bias towards alcohol (versus soda) cues in general. Brain responses and approach bias towards social alcohol cues were unrelated and not associated with actual drinking. Thus, we found no support for a relation between drinking in a social setting on the one hand, and brain cue-reactivity or behavioural approach biases to social alcohol cues on the other hand. This suggests that, in contrast to our hypothesis, drinking in a social setting may not be driven by brain or behavioural responses to social alcohol cues.

Randomized control trial testing the effectiveness of implemented depression prevention in high-risk adolescents.

BACKGROUND: Adolescent depression is a global mental health concern. Identification and effective prevention in an early stage are necessary. The present randomized, controlled trial aimed to examine the effectiveness of Cognitive Behavioral Therapy (CBT)-based depression prevention in adolescents with elevated depressive symptoms. This prevention approach is implemented in school communities, which allows to examine effects under real-life circumstances. METHODS: A total of 5222 adolescents were screened for elevated depressive symptoms in the second grade of secondary schools; 130 adolescents aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) were randomly assigned to the experimental (OVK 2.0) or control condition (psycho-education). Self- and parent-reported depressive symptoms were assessed at pretest and post intervention, as well as 6- and 12-months follow-up. Clinical assessment of depression was assessed at pretest and 6-months follow-up. RESULTS: Intent-to-treat analyses revealed that the decrease in adolescent-rated depressive symptoms was significantly larger in the intervention condition than in the control condition. There was no significant difference in decrease of parent-rated depressive symptoms between both conditions. CONCLUSIONS: Based on the findings, we recommend the implementation of screening and prevention in schools, according the basics of this study design. Since this is a new step forward, we discuss the clinical impact and challenges, as well possibilities for future research. TRIAL REGISTRATION: The study is registered in the Dutch Trial Register for RCT's ( NTR5725 ). Date registered: 11 March 2016.

Brain responses to anticipating and receiving beer: Comparing light, at-risk, and dependent alcohol users.

Impaired brain processing of alcohol-related rewards has been suggested to play a central role in alcohol use disorder. Yet, evidence remains inconsistent and mainly originates from studies in which participants passively observe alcohol cues or taste alcohol. Here, we designed a protocol in which beer consumption was predicted by incentive cues and contingent on instrumental action closer to real life situations. We predicted that anticipating and receiving beer (compared with water) would elicit activity in the brain reward network and that this activity would correlate with drinking level across participants. The sample consisted of 150 beer-drinking males, aged 18 to 25 years. Three groups were defined based on alcohol use disorders identification test (AUDIT) scores: light drinkers (n = 39), at-risk drinkers (n = 64), and dependent drinkers (n = 47). fMRI measures were obtained while participants engaged in the beer incentive delay task involving beer- and water-predicting cues followed by real sips of beer or water. During anticipation, outcome notification and delivery of beer compared with water, higher activity was found in a reward-related brain network including the dorsal medial prefrontal cortex, orbitofrontal cortex, and amygdala. Yet, no activity was observed in the striatum, and no differences were found between the groups. Our results reveal that anticipating, obtaining, and tasting beer activates parts of the brain reward network, but that these brain responses do not differentiate between different drinking levels.

Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial.

BACKGROUND: Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR. METHODS: We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated. DISCUSSION: The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs. TRIAL REGISTRATION: The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.

Everyday life situations in which mothers experience difficulty stimulating healthy energy balance-related behavior in their school-age children: a focus group study.

BACKGROUND: Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children. METHODS: We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6. RESULTS: Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult. CONCLUSIONS: We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.

Depressive Symptoms Amplify Emotional Reactivity to Daily Perceptions of Peer Rejection in Adolescence.

During adolescence, interpersonal stressors such as peer rejection pose challenges to emotion regulation. Yet, very little is known about how these transactional processes unfold in adolescents' daily lives. This study investigated adolescents' (a) emotional reactivity to daily perceptions of peer rejection, which concerns concurrent changes in negative and positive emotions, and (b) emotional recovery from daily perceptions of peer rejection, which concerns subsequent changes in negative and positive emotions. Because depressive symptoms can compromise effectiveness of emotion regulation, it was investigated as a moderator for emotional reactivity and recovery to daily perceptions of peer rejection. The sample consisted of 303 adolescents (59% girls; Mage = 14.20, SD = 0.54; range 13-16 years) who reported depressive symptoms at baseline and completed ecological momentary assessments of emotions and perceived peer rejection at nine random time-points per day for six consecutive days. Results from multi-level modeling analyses showed that perceived peer rejection was related to emotional reactivity (i.e., higher levels of negative emotions and lower levels of positive emotions). This effect was stronger for those with higher depressive symptoms. For emotional recovery, perceived peer rejection had lasting effects on adolescents' negative emotions, but was not related to positive emotions. Depressive symptoms did not moderate effects of perceived peer rejection on emotional recovery. This study provides a more nuanced understanding of how depressive symptoms amplify the emotional impact of perceived peer rejection in adolescents' day-to-day lives.

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial.

BACKGROUND: Since 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously. METHODS: We will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes. DISCUSSION: If the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale. TRIAL REGISTRATION: The study is registered in the Dutch Trial Register ( NTR6622 ).

Trait and State Levels of Loneliness in Early and Late Adolescents: Examining the Differential Reactivity Hypothesis.

According to the differential reactivity hypothesis, lonely individuals respond differently to their environment compared to nonlonely individuals, which may sustain their loneliness levels. However, this interesting hypothesis has not yet been explored in daily life: Do lonely individuals feel lonely all the time, or do they feel more or less lonely in specific social contexts? The main aim of the present study was to test the differential reactivity hypothesis in daily life by examining in three samples whether trait levels of loneliness affected the levels of state loneliness in different social contexts. We used baseline questionnaires to measure trait loneliness and the Experience Sampling Method to collect data on state loneliness, in early adolescents (N = 269, Mage = 14.49, 59% female) and late adolescents (N = 223, Mage = 19.60, 91% female) from the Netherlands and late adolescents from the United States (N = 126, Mage = 19.20, 51% female). Results provided evidence for the differential reactivity hypothesis in the total sample, as high lonely adolescents experienced higher levels of state loneliness in situations in which they were alone than low lonely adolescents, but also benefited more from being with intimate company than low lonely adolescents. In sum, the present study provided evidence for the differential reactivity hypothesis and showed that the experience of loneliness in daily life was remarkably similar across age and culture. Our findings provide important insights into the daily experiences of trait lonely people, which may provide starting points for interventions.

Effectiveness of a Cognitive Behavioral Therapy-Based Indicated Prevention Program for Children with Elevated Anxiety Levels: a Randomized Controlled Trial.

Childhood anxiety is a problem not only because of its negative consequences on the well-being of children but also because of its adverse effects on society and its role in mental disorders later in life. Adequate prevention might be the key in tackling this problem. The effectiveness of Coping Cat, as an indicated CBT-based prevention program in Dutch primary school children, was assessed by means of a randomized controlled trial. In total, 141 children aged 7-13 with elevated levels of anxiety and their mothers were included and randomly assigned to an intervention group and a waiting list control group. After screening, all participants completed baseline, post-intervention, and 3-month follow-up assessments. The results showed that Coping Cat, as an indicated prevention program, reduces children's self-reported anxiety symptoms, with Cohen's effect size d of 0.66 at the 3-month follow-up. A moderating effect was found for baseline anxiety level; specifically, children with high levels of baseline anxiety who received the Coping Cat program had lower anxiety levels at follow-up compared to children with high levels of anxiety in the control condition. No moderating effects of gender or age were found. An unexpected decline in anxiety levels from screening to pre-assessment was found in both groups, and this decline was stronger in the experimental group. These promising results warrant the implementation of Coping Cat as an indicated prevention program.

Cool or Fool? The Association Between Drinker Prototypes and Alcohol Consumption Using Multiple Time-Point Diary Assessments in Adolescent Males.

OBJECTIVES: There is still limited understanding of how different kinds of drinker prototypes are associated with adolescent drinking. This study uses the strengths of multiple time-point diary measures (enhanced validity of alcohol use measurement) to test the predictive value of abstainer, moderate and heavy drinker prototypes in social situations. We examined whether the favorability of these prototypes (i.e., "prototype evaluation"), the perceived similarity of these prototypes to one's self-image (i.e., "prototype similarity") assessed at baseline, and their interaction predict alcohol use assessed in social situations. METHODS: Drinker prototypes were assessed in a baseline sample of 599 adolescents. Subsequently, a sample of 77 alcohol-using 16 to 18-year-old males reported their Friday and Saturday evening drinking behavior the next day during eight weeks (resulting in 495 daily measures). Alcohol use was assessed in the company of peers. RESULTS: The more adolescents perceived themselves as similar to heavy drinker prototypes the higher their alcohol consumption in social situations. The more adolescents held favorable abstainer prototypes, the lower their alcohol consumption. The interaction between prototype evaluation and similarity was not significant. CONCLUSIONS: By using a more reliable and valid method to assess adolescents' alcohol use, the present study showed that more "extreme" drinker prototypes (i.e., heavy drinker and abstainer prototypes) are most predictive of adolescent alcohol use in social situations. Increasing the perceived dissimilarity to heavy drinker prototypes and the favorability of abstainer prototypes may therefore be important targets in interventions aimed at reducing adolescents' alcohol consumption.

The Prospective Associations between Self-Efficacy and Depressive Symptoms from Early to Middle Adolescence: A Cross-Lagged Model.

Over the course of adolescence, an increasing number of adolescents experience depression. In order to effectively target depression, identifying risk factors for depressive symptoms is pivotal. Since low levels of self-efficacy were associated with higher levels of depressive symptoms in previous studies, the current study investigated the bidirectional and prospective associations between depressive symptoms and academic, social and emotional self-efficacy from early to mid adolescence in a cross-lagged path model. The sample consisted of 1,341 adolescents (47 % girls) with a mean age of 14 years, SD = 0.56. Depressive symptoms and self-efficacy levels were assessed every 6 months over a period of 2.5 years. Depressive symptoms predicted subsequent levels of academic and emotional self-efficacy on all time points, and social self-efficacy on one time point. Self-efficacy did not predict subsequent levels of depressive symptoms. There was no evidence of sex differences in the cross-lagged associations between depressive symptoms and self-efficacy levels. Implications of the findings are discussed.

Video Gaming and Children's Psychosocial Wellbeing: A Longitudinal Study.

The effects of video games on children's psychosocial development remain the focus of debate. At two timepoints, 1 year apart, 194 children (7.27-11.43 years old; male = 98) reported their gaming frequency, and their tendencies to play violent video games, and to game (a) cooperatively and (b) competitively; likewise, parents reported their children's psychosocial health. Gaming at time one was associated with increases in emotion problems. Violent gaming was not associated with psychosocial changes. Cooperative gaming was not associated with changes in prosocial behavior. Finally, competitive gaming was associated with decreases in prosocial behavior, but only among children who played video games with high frequency. Thus, gaming frequency was related to increases in internalizing but not externalizing, attention, or peer problems, violent gaming was not associated with increases in externalizing problems, and for children playing approximately 8 h or more per week, frequent competitive gaming may be a risk factor for decreasing prosocial behavior. We argue that replication is needed and that future research should better distinguish between different forms of gaming for more nuanced and generalizable insight.

The Role of Executive Control and Readiness to Change in Problematic Drinkers with Mild to Borderline Intellectual Disability.

BACKGROUND: Problematic alcohol use is associated with neuropsychological consequences, including cognitive biases. The goal of the study was to explore the moderating role of executive control and readiness to change on the relationship between alcohol use and cognitive biases in light and problematic drinkers with and without mild to borderline intellectual disability (MBID). METHOD: Participants (N = 112) performed the visual dot probe task to measure the strength of the cognitive biases. Executive control was measured using two computerised tasks for working memory capacity (Corsi block-tapping task) and inhibitory control (Go/No-go task). Readiness to change was measured using the Readiness to Change Questionnaire. RESULTS: No cognitive biases or executive dysfunctions were found in problematic drinkers. Working memory capacity and inhibitory control were impaired among individuals with MBID, irrespective of severity of alcohol use-related problems. Executive control and readiness to change did not moderate the relationship between alcohol use and cognitive biases. CONCLUSION: The results fail to support the dual-process models of addiction, but results need to be treated with caution given the problematic psychometric qualities of the visual dot probe task. Implementing a neurocognitive assessment and protocols in the treatment of substance use disorders seems premature.

Evaluation of a school-based depression prevention program among adolescents with elevated depressive symptoms: study protocol of a randomized controlled trial.

BACKGROUND: Adolescents are at risk of developing depressive symptoms. Given the prevalence, recurrence and negative consequences of adolescent depression, it is crucial to implement prevention programs for high-risk adolescents. Prevention programs at an indicated level have shown to be successful in reducing depressive symptoms in adolescents. This study will evaluate the (cost)effectiveness of the prevention program 'Op Volle Kracht (OVK 2.0)' for adolescents with elevated depressive symptoms. METHODS: We will perform a Randomized Controlled Trial (RCT) with an intervention and control condition to test the effectiveness of an indicated prevention program aimed at depression in adolescents. Adolescents in their second year of secondary education (11-15 year) will be screened for depressive symptoms. Those with heightened levels of depressive symptoms (CDI-2 ≥ 14) will be randomly assigned to the intervention (N = 80) or control group (N = 80). The participants in the intervention condition will receive a prevention program comprising eight meetings of 60 min each. The participants in the control condition will receive psycho-educational information. All participants and their parents will complete assessment at baseline, post-intervention, and 6-, 12- and 24- month follow-up. Primary outcome will be depressive symptoms. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of OVK 2.0 on secondary outcomes. DISCUSSION: This paper describes a study designed to screen adolescents for depressive symptoms and offer them a prevention program to prevent the onset of depressive symptomatology. Adolescents in the intervention condition are expected to show lower levels of depressive symptoms at 12 month follow-up compared to adolescents in the control condition. If OVK 2.0 proves to be effective, the screening and intervention program could be implemented in schools on a large scale. TRIAL REGISTRATION: Dutch Trial Register NTR5725 . Date registered: 11th of March 2016.

Emotional eating as a mediator between depression and weight gain.

Depression is often associated with weight gain but underlying mechanisms are unclear. This study assessed whether three psychological eating styles (emotional eating, external eating and restrained eating) act as mediators between depression and weight gain. We used structural equation modelling to test the hypothesized mediation models in a sample of 298 fathers and 294 mothers by assessing self-reported eating styles (Dutch Eating Behavior Questionnaire), depressive feelings (Depressive Mood List) and body mass index (BMI) at baseline and BMI after five years. In the model with emotional eating we also assessed the moderation effect of 5-HTTLPR genotype in a sub-sample of 520 Caucasians. All analyses were performed separately for the two sexes. Although the overall effect of depression on weight gain was statistically non-significant in both sexes, there was a causal chain between depression, emotional eating and weight gain in the mothers. Depressive symptoms were related to higher emotional eating and emotional eating predicted greater increases in BMI independently of depression. Moreover, the indirect effect (via emotional eating) of depression on BMI change was significant (Beta = 0.18, P = 0.026). This mediation effect was found to be independent of 5-HTTLPR genotype. No such mediation effect was found for the fathers. Further, external eating and restrained eating did not act as mediators between depression and weight gain in either sex. The finding that emotional eating acted as mediator between depression and weight gain in the mothers suggests that obesity interventions should take emotional eating into account.

Friends' drinking norms and male adolescents' alcohol consumption: The moderating role of performance-based peer influence susceptibility.

This study examined whether the relationship between friends' drinking norms and male adolescents' alcohol use is moderated by performance-based peer influence susceptibility. Seventy-three male adolescents (M = 17 years) from three schools in the Netherlands were exposed to the drinking norms of "peers" (electronic confederates) in a chat room experiment. These peers were either popular or unpopular, and conveyed pro- or anti-alcohol norms. Peer influence susceptibility was defined as the change in adolescents' answers before and after exposure to the peer norms. Multilevel regression analyses indicated that the relationship between friends' drinking norms and adolescents' alcohol use (assessed during eight weekends) was moderated by susceptibility to the pro-alcohol norms of popular peers. This relationship was stronger for adolescents who were highly susceptible. These findings suggest that a behavioral measure of peer influence susceptibility could be useful in alcohol prevention programs to select adolescents at risk for negative peer socialization.