PhD defence W.H. (Marieke) van den Heuvel

Summary:

In the Netherlands, in a class of 25 secondary school students, an average of one student has a depressive disorder and five students have a subclinical depression. A subclinical depression can be a precursor to a depressive disorder. Therefore, it is important to detect adolescents with these symptoms early and target prevention programs accordingly. The goal of my dissertation was to improve the effectiveness and efficiency of depression prevention in adolescents, specifically Cognitive Behavioral Therapy (CBT).  First, we found that there are differences in how adolescents cope with a stressful event. We distinguished four profiles. One profile stood out in particular, namely maladaptive regulators (adolescents who use few helping and many non-helping strategies). They reported more depressive symptoms relative to the other profiles. This shows which youths are particularly at risk for depression.
Next, we found that the social costs of adolescents with subclinical depression exceed 42 million euros per year in the Netherlands. Major cost items are school absenteeism, mental health care and homework assistance. The magnitude of the costs justifies structural government funding for depression prevention. Finally, we examined the relative effectiveness of four commonly used CBT elements (cognitive restructuring, behavioral activation, problem solving, relaxation) and variations in their sequencing in indicated depression prevention. We found no differences in effect after 3 sessions, at post-measurement and 6-month follow-up. We also found no differences in what works for whom (gender, age and symptom level). This allows trainers to tailor the sequence of elements to adolescents' preferences.