Publications by authors named "Maaike H Nauta"

73 Publications

Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults.

J Am Acad Child Adolesc Psychiatry 2022 May 2. Epub 2022 May 2.

Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, the Netherlands. Electronic address:

Objective: Depression and anxiety cause a high burden of disease and have high relapse rates (39%-72%). This meta-analysis systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted.

Method: PubMed, PsycInfo, Embase, Cochrane, and ERIC databases were searched up to June 15, 2021. Eligible studies compared relapse prevention strategies to control conditions among youth (mean age 13-25 years) who were previously depressed or anxious or with ≥30% improvement in symptoms. Two reviewers independently assessed titles, abstracts, and full texts; extracted study data; and assessed risk of bias and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models were used for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO ID: CRD42020149326).

Results: Of 10 randomized controlled trials (RCTs) that examined depression, 9 were eligible for analysis: 4 included psychological interventions (n = 370), 3 included antidepressants (n = 80), and 2 included combinations (n = 132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared with care as usual conditions (k = 6; odds ratio 0.56, 95% CI 0.31 to 1.00). Sensitivity analyses including only studies with ≥50 participants (k = 3), showed similar results. Over 6 to 12 months, relapse was less likely in youth receiving antidepressants compared with youth receiving pill placebo (k = 3; OR 0.29, 95% CI 0.10 to 0.82). Quality of studies was suboptimal.

Conclusion: Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high-quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.
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http://dx.doi.org/10.1016/j.jaac.2022.04.014DOI Listing
May 2022

Treating Speech Anxiety in Youth: A Randomized Controlled Microtrial Testing the Efficacy of Exposure Only Versus Exposure Combined With Anxiety Management Strategies.

Behav Ther 2021 11 6;52(6):1377-1394. Epub 2021 Apr 6.

University of Groningen.

CBT for anxious youth usually combines anxiety management strategies (AMS) with exposure, with exposure assumed to be critical for treatment success. To limit therapy time while retaining effectiveness, one might optimize CBT by restricting treatment to necessary components. This study tested whether devoting all sessions to exposure is more effective in reducing speech anxiety in youth than devoting half to AMS including cognitive or relaxation strategies and half to exposure. After a 6-week waitlist period, adolescents with speech anxiety (N = 65; age 12-15; 42 girls) were randomized to a 5-session in-school group-based CBT training consisting of either (1) exposure-only (EXP+EXP) or (2) cognitive strategies followed by exposure (COG+EXP) or (3) relaxation strategies followed by exposure (REL+EXP). Clinical interviews, speech tests, and self-report measures were assessed at pretest, posttest, and follow-up. For all conditions (a) the intervention period resulted in a stronger decline of speech anxiety than waitlist period; (b) there was a large sized reduction of speech anxiety that was maintained at six-week follow-up; (c) there was no meaningful difference in the efficacy of EXP+EXP versus COG+EXP or REL+EXP. These findings suggest that devoting all sessions to exposure is not more effective than combining exposure with AMS. AMS appeared neither necessary for CBT to be effective, nor necessary for youth to tolerate exposure. This indicates that CBT can be optimized by restricting treatment to exposure.
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http://dx.doi.org/10.1016/j.beth.2021.03.010DOI Listing
November 2021

Youth Psychopathology in Daily Life: Systematically Reviewed Characteristics and Potentials of Ecological Momentary Assessment Applications.

Child Psychiatry Hum Dev 2021 Jun 1. Epub 2021 Jun 1.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.

Traditionally, symptoms of youth psychopathology are assessed with questionnaires, clinical interviews, or laboratory observations. Ecological Momentary Assessment (EMA) could be a particularly valuable additional methodology, since EMA enables examining the daily lives of youths near real-time, considering fluctuations and specific contexts of symptoms. This systematic review aimed to review the characteristics of current EMA applications and to provide a synthesis of their potential in studying youth psychopathology. Following a systematic search in PsycInfo and Medline, we identified 50 studies in clinical samples. Most studies used EMA to examine fluctuations in symptoms, affect, and behavior, and the relation with contextual factors. EMA was also used to investigate interactions between parents and their children over time, and to monitor and predict treatment response. EMA appeared feasible in youth and could provide valuable insights that contribute to understanding youth psychopathology. Benefits, gaps, and suggestions for future research and clinical practice are discussed.
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http://dx.doi.org/10.1007/s10578-021-01177-8DOI Listing
June 2021

Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders.

Int J Environ Res Public Health 2021 03 17;18(6). Epub 2021 Mar 17.

Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands.

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13-22 ( = 16.60, = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.
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http://dx.doi.org/10.3390/ijerph18063102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002752PMC
March 2021

Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents: a randomized controlled trial.

Sci Rep 2020 09 9;10(1):14815. Epub 2020 Sep 9.

Child and Adolescent Studies, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands.

We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care. This multisite Randomized controlled trail included 88 clinically depressed adolescents (aged 12-21 years) randomly assigned to CBT or TAU. Multiple assessments (pre-, post treatment and six-month follow-up) were done using semi-structured interviews, questionnaires and ratings and multiple informants. The primary outcome was depressive or dysthymic disorder based on the KSADS. Completers, CBT (n = 19) and TAU (n = 26), showed a significant reduction of affective diagnoses at post treatment (76% versus 76%) and after six months (90% versus 79%). Intention-to-treat analyses on depressive symptoms showed that 41.6% within CBT and 31.8% within the TAU condition was below clinical cut-off at post treatment and after six-months, respectively 61.4% and 47.7%. No significant differences in self-reported depressive symptoms between CBT and TAU were found. No prediction or moderation effects were found for age, gender, child/parent educational level, suicidal criteria, comorbidity, and severity of depression. We conclude that CBT did not outperform TAU in clinical practice in the Netherlands. Both treatments were found to be suitable to treat clinically referred depressed adolescents. CBT needs further improvement to decrease symptom levels below the clinical cut-off at post treatment.
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http://dx.doi.org/10.1038/s41598-020-71160-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481792PMC
September 2020

Application of Latent Class Analysis to Identify Subgroups of Children with Autism Spectrum Disorders who Benefit from Social Skills Training.

J Autism Dev Disord 2021 Jun;51(6):2004-2018

Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

With Latent Class Analysis applied on data of 98 children with autism spectrum disorder (ASD) (9-12 years; 17 girls) participating in social skills training (SST) in a randomized controlled trial (Dekker et al. 2019), four subgroups were detected, based on social-communicative skills before, and response patterns to training. Two subgroups improved after SST. Characterizing the subgroups based on participant and intervention characteristics showed that improvement was related to lower parent-reported perceived difficulty of social-communicative skills at start, higher verbal ability, younger age and milder symptoms of ASD and anxiety. The lowest performing non-improving subgroup participated more often in SST without parent/teacher involvement, compared to all other subgroups. Response to SST in ASD seems to vary depending on participant characteristics.
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http://dx.doi.org/10.1007/s10803-020-04678-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124042PMC
June 2021

Research Review: Recommendations for reporting on treatment trials for child and adolescent anxiety disorders - an international consensus statement.

J Child Psychol Psychiatry 2021 03 19;62(3):255-269. Epub 2020 Jul 19.

Department of Psychology, Temple University, Philadelphia, PA, USA.

Background: Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships).

Methods: To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people.

Results And Conclusions: This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.
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http://dx.doi.org/10.1111/jcpp.13283DOI Listing
March 2021

Therapists' characteristics associated with the (non-)use of exposure in the treatment of anxiety disorders in youth: A survey among Dutch-speaking mental health practitioners.

J Anxiety Disord 2020 06 11;73:102230. Epub 2020 May 11.

University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands. Electronic address:

Introduction: Although there is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Previous research pointed to therapists' beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists' own anxiety as important factors in the underusage of exposure in the treatment of adult anxiety disorders. This study examined what therapist characteristics may be involved in the (non-)use of exposure in treating childhood anxiety disorders.

Methods: An internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists' beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists' own anxiety, depression and stress.

Results: The current survey showed that therapists used exposure in about half of their cases of childhood anxiety and that the non-use was independently associated with the relatively strong negative beliefs about exposure, therapists' age, and non-CBT orientation.

Discussion: Findings point to the importance of addressing negative beliefs about exposure in therapists' training and supervision to resolve therapy drift away from exposure, and consequently improve utilization and delivery of exposure-based therapy for childhood anxiety disorders.
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http://dx.doi.org/10.1016/j.janxdis.2020.102230DOI Listing
June 2020

Guided internet interventions for depression: impact of sociodemographic factors on treatment outcome in Indonesia.

Behav Res Ther 2020 07 4;130:103589. Epub 2020 Mar 4.

Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.

Depression is the leading cause of disability worldwide, but an alarming treatment gap exists, especially in lower- and middle income countries (LMIC), where people are exposed to many societal and sociodemographic risk factors. As internet access increases in LMIC, online interventions could decrease this gap, especially when shown suitable for all demographics, including vulnerable groups with low socioeconomic status (SES). We used mixed-model analysis to explore moderating effects of sociodemographic factors (age, sex, education level, SES and urbanicity) on treatment effect in a recent trial in Indonesia, comparing guided online behavioral activation versus online psychoeducation only for depression, in 313 participants from (sub)urban areas. Outcome measures were self-reported Patient Health Questionnaire 9 (PHQ-9) and Inventory of Depressive Symptomatology (IDS-SR). Without correction for multiple testing, we found urbanicity to moderate treatment effect, with stronger treatment effect in suburban relative to urban participants (IDS-SR 24 weeks past baseline, p = 0.04) and a trend towards moderation by SES, with stronger treatment effect in low SES groups (PHQ-9 10 weeks past baseline, p = 0.07). These exploratory results suggest online treatments are a promising mental health intervention for all demographics in a (sub)urban LMIC setting, but hypothesis-testing studies including rural participants are warranted.
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http://dx.doi.org/10.1016/j.brat.2020.103589DOI Listing
July 2020

A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial.

Int J Methods Psychiatr Res 2020 06 17;29(2):e1820. Epub 2020 Feb 17.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.

Objectives: Despite the gains made by current first-line interventions for major depressive disorder (MDD), modest rates of treatment response and high relapse indicate the need to augment existing interventions. Following theory and initial research indicating the promise of mindful yoga interventions (MYIs), this study examines mindful yoga as a treatment of MDD.

Methods/design: This randomized controlled trial uses a sample of young females (18-34 years) to examine the efficacy and cost-effectiveness of a 9-week manualized MYI added to treatment as usual (TAU) versus TAU alone. Primary outcome measures consist of clinician-administered (Hamilton Depression Rating Scale) and self-report (Depression-Anxiety-Stress Scales) measures of depression. Underlying mechanisms will be examined, including rumination, negative self-evaluation, intolerance of uncertainty, interoceptive awareness, and dispositional mindfulness. Assessments were conducted at preintervention and will be conducted at postintervention, 6-, and 12-month follow up.

Results: The baseline sample consists of 171 females (88 were randomized into the MYI), reporting a baseline M = 25.08 years (SD = 4.64), M = 18.39 (SD = 6.00), and a M = 21.02 (SD = 9.36).

Conclusion: This trial will provide important information regarding the benefits of adding yoga-based interventions to TAU for young women with MDD and the mechanisms through which such benefits may occur.
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http://dx.doi.org/10.1002/mpr.1820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301287PMC
June 2020

Self-directed or therapist-led parent training for children with attention deficit hyperactivity disorder? A randomized controlled non-inferiority pilot trial.

Internet Interv 2019 Dec 8;18:100262. Epub 2019 Aug 8.

University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Lübeckweg 2, 9723 HE Groningen, the Netherlands.

Background And Objectives: Therapist-led behavioral parent training is a well-established treatment for behavior problems in children with attention-deficit/hyperactivity disorder (ADHD). However, parental attrition is high; self-directed forms of parent training may be a promising alternative. To date, no studies have compared these two forms of parent training in referred children with ADHD. The objectives of this pilot study were to examine the non-inferiority of a blended parent training (i.e. online program + supportive therapist contact) in comparison to its therapist-led equivalent (i.e. face-to-face parent training) regarding effects on behavioral problems, and to compare attrition rates, parental satisfaction, and therapist-time between both treatments.

Methods: 21 school-aged children with ADHD and behavioral problems, who had been referred to an outpatient mental health clinic, were randomized to blended ( = 11) or face-to-face ( = 10) parent training. Behavior problems were measured with the Child Behavior Checklist. Treatment completers and dropouts were included in the analyses.

Results And Conclusions: Blended parent training was not found to be non-inferior to face-to-face parent training in the reduction of behavior problems. Parents in the blended condition dropped out of treatment significantly earlier than parents in the face-to-face condition and were less satisfied. Therapists in the blended condition spent significantly less time on parent training than therapists in the face-to-face condition.
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http://dx.doi.org/10.1016/j.invent.2019.100262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926327PMC
December 2019

Are parental changes related to improvements in preschool children's disruptive behaviours?

Clin Psychol Psychother 2020 Jan 4;27(1):24-33. Epub 2019 Dec 4.

Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Objective: To investigate whether changes in parenting after behavioural parent training in routine clinical care are associated with improvements in preschool children's disruptive behaviours.

Method: We evaluated changes after parent training in maternal and paternal self-reports of parental discipline practices parenting sense of competence, and parents' ratings of child disruptive behaviours in parents of 63 children, with a one group pretest-posttest design. We also compared parenting parameters in this clinical sample with a nonclinical sample (n = 121).

Results: Mothers' self-reports of parental discipline practices and parenting sense of competence significantly improved after behavioural parent training. Less over-reactivity in both mothers and fathers was associated with fewer disruptive behaviours in children. After parent training, mothers' ratings of their discipline techniques did not differ anymore from those in the nonclinical sample.

Conclusion: Positive changes in parental discipline practices, particularly less over-reactive parental behaviours, were related to a decrease of disruptive child behaviours.
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http://dx.doi.org/10.1002/cpp.2402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027841PMC
January 2020

Effectiveness and Cost-Effectiveness of Blended Cognitive Behavioral Therapy in Clinically Depressed Adolescents: Protocol for a Pragmatic Quasi-Experimental Controlled Trial.

JMIR Res Protoc 2019 Oct 7;8(10):e13434. Epub 2019 Oct 7.

Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands.

Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk.

Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents.

Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups.

Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT.

Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.

Trial Registration: Dutch Trial Register (NTR6759); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6759.

International Registered Report Identifier (irrid): DERR1-10.2196/13434 RR1-10.2196/12654.
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http://dx.doi.org/10.2196/13434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803889PMC
October 2019

The Longitudinal Association Between Preadolescent Facial Emotion Identification and Family Factors, and Psychotic Experiences in Adolescence (The TRAILS Study).

Child Psychiatry Hum Dev 2020 04;51(2):187-199

Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.

The current study examines whether facial emotion identification and family factors at preadolescence (age 11) predict psychotic experiences 5 years later during adolescence (age 16) and whether family factors may mediate the association between facial emotion identification and psychotic experiences. Data was obtained from the epidemiological cohort TRAILS (N = 2059). At preadolescence, a facial emotion identification test and three questionnaires to assess family functioning, perceived parenting styles and parenting stress, were administered. At adolescence, a questionnaire on psychotic experiences was administered. Facial emotion identification at preadolescence was not associated with psychotic experiences at adolescence, and the mediational role of family functioning was not further explored. However, increased overprotective parenting at preadolescence was associated with a higher frequency of psychotic experiences and delusions at adolescence. Future research may examine the mechanism behind the role of overprotective parenting on psychotic experiences during adolescence.
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http://dx.doi.org/10.1007/s10578-019-00922-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067727PMC
April 2020

Homesickness in social context: An ecological momentary assessment study among 1st-year university students.

Int J Psychol 2020 Jun 26;55(3):392-397. Epub 2019 May 26.

Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands.

Homesickness is common among university students and associated with mental health problems. Most previous studies assessed homesickness as a summary of the past weeks. However, there may be significant fluctuations across situations. At the current residence, homesickness may especially be triggered during (phone) interactions with attachment figures. Dutch and international 1st-year students (n = 92) completed the Utrecht Homesickness Scale and subsequently used a smartphone application to record social interactions for 14 days (ecological momentary assessment [EMA]). For each interaction they reported the social context (e.g. location, contact type) and their affective state, including homesickness. Homesickness in the past weeks and momentary homesickness were both higher in international students than in Dutch students. Feeling homesick was highest at participants' current residency, when interacting with parents, or when using video-chat. When participants felt more homesick, they reported less pleasant and more unpleasant affect. In conclusion, EMA provided insight in cross-situational variations in homesickness.
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http://dx.doi.org/10.1002/ijop.12586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318594PMC
June 2020

The development, validity, and reliability of the auditory vocal hallucination rating scale questionnaire (AVHRS-Q).

Soc Psychiatry Psychiatr Epidemiol 2019 Aug 22;54(8):927-935. Epub 2019 Mar 22.

University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, University of Groningen, Hanzeplein 1 (CC72), 9713 GZ, Groningen, The Netherlands.

Purpose: The Auditory Vocal Hallucination Rating Scale Questionnaire (AVHRS-Q) is a short self-report measure assessing several characteristics of auditory vocal hallucinations (AVH) that was derived from a validated clinical interview (the auditory vocal hallucination rating scale; AVHRS). This study investigated the internal reliability, convergent validity, and divergent validity of the AVHRS-Q using two clinical samples.

Methods: In sample I, 32 psychiatric patients with AVH were recruited from an academic hospital service and assessed with the AVHRS and the AVHRS-Q. Data for sample II were retrospectively retrieved from a pseudonymised Routine Outcome Monitoring (ROM) database collected in the context of mental healthcare at the same academic hospital service. Data from 82 psychiatric patients with AVH were retrieved, who completed the AVHRS-Q, and measures of psychological distress (the Outcome Questionnaire; OQ-45, and the Symptom Checklist; SCL-90) and quality of life (the Manchester Short Assessment of Quality of Life; MANSA).

Results: The AVHRS-Q showed good internal consistency in both samples. Severity scores of the AVHRS-Q were strongly correlated to the severity scores of the AVHRS (r = 0.90, p < 0.01). The AVHRS-Q and AVHRS did not differ in the identification of mild and severe voice-hearers [X (1, N = 32) = 15.71]. AVHRS-Q severity scores had moderate correlations with measures of psychological distress (OQ-45, r = 0.43, p < 0.01; SCL-90, r = 0.50, p < 0.05) and quality of life (MANSA, r = - 0.22, p < 0.01).

Conclusions: The AVHRS-Q demonstrated good reliability, convergent validity, and divergent validity, suggesting it can be applied in both clinical and research settings for a quick and reliable assessment of AVH.
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http://dx.doi.org/10.1007/s00127-019-01692-zDOI Listing
August 2019

Childhood theory of mind does not predict psychotic experiences and social functioning in a general population sample of adolescents.

PLoS One 2019 28;14(2):e0213165. Epub 2019 Feb 28.

Rob Giel Research center, University Center for Psychiatry Groningen, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Aims: Theory of Mind (ToM) is often impaired in early and chronic phases of psychosis and it is often suggested that poor ToM is a trait vulnerability for psychosis. The aim of this study was to examine in an adolescent sample whether childhood ToM abilities can predict psychotic experiences over a period of six years and whether this is mediated by social functioning. To examine whether ToM is a specific predictor for psychosis, symptoms of depression and anxiety were also examined.

Materials And Methods: A baseline case-control sample (T0: age 7-8 years) with and without auditory vocal hallucinations (AVH) in the general population was assessed after five years (T1: age 12-13 years) on ToM ability (ToM Storybook Frank), and after eleven years (T2: age 18-19 years) on psychotic experiences (Community Assessment of Psychic Experiences; CAPE), depressive and anxiety symptoms (Depression Anxiety and Stress Scale; DASS-21), and social functioning (Groningen Questionnaire on Social Behaviour; GSVG-45). Analyses were conducted on a subsample of 157 adolescents aged 18-19 years (T2) who had data available on ToM ability at T1.

Results: ToM at T1 was not predictive of psychotic experiences after six years (from age 12-13 to age 18-19) and social functioning was also not a mediator. ToM was not associated with psychopathology in general (depressive and anxiety symptoms) over six years (from age 12-13 to age 18-19).

Conclusions: The current study found no evidence for a longitudinal association between ToM ability and psychotic experiences, social functioning, and symptoms of depression and anxiety, in adolescence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213165PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394971PMC
December 2019

Trajectories and predictors of response in youth anxiety CBT: Integrative data analysis.

J Consult Clin Psychol 2019 Feb 20;87(2):198-211. Epub 2018 Dec 20.

Department of Statistics and Biostatistics.

Objective: Integrative data analysis was used to combine existing data from nine trials of cognitive-behavioral therapy (CBT) for anxious youth ( = 832) and identify trajectories of symptom change and predictors of trajectories.

Method: Youth- and parent-reported anxiety symptoms were combined using item-response theory models. Growth mixture modeling assessed for trajectories of treatment response across pre-, mid-, and posttreatment and 1-year follow-up. Pretreatment client demographic and clinical traits and treatment modality (individual- and family-based CBT) were examined as predictors of trajectory classes.

Results: Growth mixture modeling supported three trajectory classes based on parent-reported symptoms: steady responders, rapid responders, and delayed improvement. A 4-class model was supported for youth-reported symptoms: steady responders, rapid responders, delayed improvement, and low-symptom responders. Delayed improvement classes were predicted by higher number of diagnoses (parent and youth report). Receiving family CBT predicted membership in the delayed improvement class compared to all other classes and membership in the steady responder class compared with rapid responders (youth report). Rapid responders were predicted by older age (parent report) and higher number of diagnoses (parent report). Low-symptom responders were more likely to be male (youth report).

Conclusions: Integrative data analysis identified distinct patterns of symptom change. Diagnostic complexity, age, gender, and treatment modality differentiated response classes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000367DOI Listing
February 2019

Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis.

PLoS One 2018 1;13(10):e0204925. Epub 2018 Oct 1.

University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.

Background: The aim of this study was to systematically investigate the effectiveness of hatha yoga in treating acute, chronic and/or treatment-resistant mood and anxiety disorders.

Methods: Medline, Cochrane Library, Current Controlled Trials, Clinical Trials.gov, NHR Centre for Reviews and Dissemination, PsycINFO and CINAHL were searched through June 2018. Randomized controlled trials with patients with mood and anxiety disorders were included. Main outcomes were continuous measures of severity of mood and anxiety symptoms. Cohen's d was calculated as a measure of effect size. Meta-analyses using a random effects model was applied to estimate direct comparisons between yoga and control conditions for depression and anxiety outcomes. Publication bias was visually inspected using funnel plots.

Results: Eighteen studies were found, fourteen in acute patients and four in chronic patients. Most studies were of low quality. For depression outcomes, hatha yoga did not show a significant effect when compared to treatment as usual, an overall effect size of Cohen's d -0.64 (95% CI = -1.41, 0.13) or to all active control groups, Cohen's d -0.13 (95% CI = -0.49, 0.22). A sub-analysis showed that yoga had a significant effect on the reduction of depression compared to psychoeducation control groups, Cohen's d -0.52 (95% CI = -0.96, -0.08) but not to other active control groups, Cohen's d 0.28 (95% CI = -0.07, 0.63) For studies using a follow-up of six months or more, hatha yoga had no effect on the reduction of depression compared to active control groups, Cohen's d -0.14 (95% CI = -0.60, 0.33). Regarding anxiety, hatha yoga had no significant effect when compared to active control groups, Cohen's d -0.09 (95% CI = -0.47, 0.30). The I2 and Q-statistic revealed heterogeneity amongst comparisons. Qualitative analyses suggest some promise of hatha yoga for chronic populations.

Conclusions: The ability to draw firm conclusions is limited by the notable heterogeneity and low quality of most of the included studies. With this caveat in mind, the results of the current meta-analysis suggest that hatha yoga does not have effects on acute, chronic and/or treatment-resistant mood and anxiety disorders compared to treatment as usual or active control groups. However, when compared to psychoeducation, hatha yoga showed more reductions in depression. It is clear that more high-quality studies are needed to advance the field.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204925PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166972PMC
March 2019

Acceptability of internet-based interventions for depression in Indonesia.

Internet Interv 2018 Sep 2;13:8-15. Epub 2018 May 2.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.

Background: In Indonesia, internet-based interventions may represent a promising strategy to reduce the mental health gap given that the level of internet usage in the country continues to increase. To check the acceptability of internet-based interventions, this study investigates factors that contribute to the use of internet-based interventions for depression in Indonesia.

Method: The survey was conducted online and had 904 participants recruited from specific social networks on mental health and general social media (Mean age = 27.07, 50.22% females). The three dependent variables were (1) behavioral intention to start using internet-based interventions for depression, (2) preference to use it as a substitute for regular treatments and (3) preference to use it to complement regular treatments. The predictor variables included sociodemographic characteristics, perceived mental health conditions, personal situational characteristics, personal innovativeness toward online services, and depression level.

Results: A large majority reported to be open to using internet-based interventions for depression (73.7%), as well as to use it as a substitution (73.3%) or as a complementary (73%) to regular treatments. Personal innovativeness toward online services was the strongest significant predictor for all types of use, even when corrected for current depression level. When added to the analyses separately, depression level was the second strongest predictive factor for all dependent variables.

Conclusion: The majority of Indonesians showed openness to use internet-based interventions for depression. To increase the adoption of internet-based interventions for depression, it is important to first promote internet usage to more people across the country, especially for those who are currently depressed.
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http://dx.doi.org/10.1016/j.invent.2018.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112096PMC
September 2018

Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group.

Internet Interv 2018 Jun 19;12:1-10. Epub 2018 Feb 19.

Child & Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia, PA, USA.

Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.
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http://dx.doi.org/10.1016/j.invent.2018.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096322PMC
June 2018

Social skills group training in children with autism spectrum disorder: a randomized controlled trial.

Eur Child Adolesc Psychiatry 2019 Mar 21;28(3):415-424. Epub 2018 Jul 21.

Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

In 122 high-functioning children with autism spectrum disorder (ASD; 9-13 years; 19 girls), we investigated the effectiveness of a 15-session social skills group training (SST) with and without parent and teacher involvement (PTI) in a randomized controlled trial with three conditions: SST (n = 47), SST-PTI (n = 51), and care-as-usual (CAU, n = 24). Hierarchical linear modeling was used for immediate and 6-month follow-up analyses. Measures were administered before randomization (blind), post-treatment and at follow-up (not blind). Trial registration: Dutch Trial Register; http://www.trialregister.nl ; NTR2405. At post-treatment, children in both SSTs had improved significantly more than CAU on the primary outcome, Vineland Socialization (SST: Cohen's d = 0.39; 95% CI - 2.23 to 3.11 and SST-PTI: d = 0.43; 95% CI - 2.19 to 3.15) and on the secondary outcome parent-SSRS "Cooperation" (SST: d = 0.43; 95% CI - 0.23 to 1.15 and SST-PTI: d = 0.45; 95% CI - 0.21 to 1.17), with no difference between post-treatment and follow-up. Additionally, children in SST-PTI improved significantly more on the teacher-SSRS than in CAU ["Cooperation" d =0.42 (95% CI - 0.33 to 1.13); "Assertion" d =0.34 (95% CI - 0.39 to 1.11); "Self-Control" d =0.61 (95% CI - 0.08 to 1.34)] and in SST ["Cooperation" d =0.34 (95% CI - 0.37 to 1.05); "Self-Control" d =0.59 (95% CI - 0.13 to 1.32)]. The current study corroborates earlier findings in smaller samples and wider age ranges, with small but statistically significant effects of SST for high-functioning pre-adolescent children with ASD. Parental and teacher involvement intensified treatment, yet did not yield an additional effect relative to SST for children only, as reported by parents. 6 months after training, no further improvement or decline was found.
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http://dx.doi.org/10.1007/s00787-018-1205-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407743PMC
March 2019

Internet-based behavioural activation with lay counsellor support versus online minimal psychoeducation without support for treatment of depression: a randomised controlled trial in Indonesia.

Lancet Psychiatry 2018 09 11;5(9):707-716. Epub 2018 Jul 11.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands; Amsterdam University Medical Centres, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands. Electronic address:

Background: Depression is one of the leading contributors to the global burden of disease. However, treatment availability is often very poor in low-income and middle-income countries. In a randomised clinical trial, we investigated the efficacy of internet-based behavioural activation with lay counsellor support compared with online minimal psychoeducation without support for depression in Indonesia (a middle-income country).

Methods: We did a community-based, two-group, randomised controlled trial in Indonesia. Eligible participants were aged 16 years or older, scored 10 or above on the Patient Health Questionnaire 9 (PHQ-9), met the criteria for major depressive disorder or persistent depressive disorder based on the Structured Clinical Interview for DSM-5, were proficient in Bahasa Indonesia, and could use the internet. Participants were randomly allocated (1:1) by a research assistant using a web-based randomisation program to online behavioural activation with lay support (termed Guided Act and Feel Indonesia [GAF-ID]) or online psychoeducation without further support. Randomisation was done within a random permuted block design and was stratified by sex and depression severity (ie, PHQ-9 10-14 vs ≥15). The primary outcome was self-reported PHQ-9 score at 10 weeks from baseline. Research assistants were masked to group allocation until after the assessment of the primary outcome. Interventions were described to participants during the consent procedure and after randomisation, but no indication was given as to which was the intervention of interest and which was the control. Analysis was by intention to treat. The trial was registered in the Netherlands Trial Register, number NTR5920. It is closed to new particpants, and follow-up has been completed.

Findings: Between Sept 6, 2016, and May 1, 2017, 313 participants were enrolled and randomly assigned, 159 to the GAF-ID group and 154 to the online psychoeducation group. At 10 weeks, PHQ-9 scores were significantly lower in the GAF-ID group than in the online psychoeducation group (mean difference -1·26 points [95% CI -2·29 to -0·23]; p=0·017), and participants in the GAF-ID group had a 50% higher chance of remission at 10 weeks (relative risk 1·50 [95% CI 1·19 to 1·88]; p<0·0001). An effect size of 0·24 for the GAF-ID group compared with the control group at 10 weeks was sustained over time (effect size 0·24 at 3 months, and 0·27 at 6 months). No adverse events were reported in either group.

Interpretation: To our knowledge, ours is the first adequately powered randomised clinical trial of an internet-based intervention for depression in a low-income or middle-income country. Online behavioural activation with lay counsellor support efficaciously reduced symptoms of depression, and could help to bridge the mental health gap in low-income and middle-income countries.

Funding: Indonesia Endowment Fund for Education, University of Groningen.
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http://dx.doi.org/10.1016/S2215-0366(18)30223-2DOI Listing
September 2018

Individual Negative Affective Trajectories Can Be Detected during Different Depressive Relapse Prevention Strategies.

Psychother Psychosom 2018 14;87(4):243-245. Epub 2018 May 14.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.

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http://dx.doi.org/10.1159/000489044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159830PMC
November 2018

Imagine your mood: Study design and protocol of a randomized controlled micro-trial using app-based experience sampling methodology to explore processes of change during relapse prevention interventions for recurrent depression.

Contemp Clin Trials Commun 2017 Sep 12;7:172-178. Epub 2017 Jul 12.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS, Groningen, The Netherlands.

Background: Relapse prevention strategies include continuation of antidepressant medication and preventive psychological interventions. This study aims to gain understanding that may inform tailoring of relapse prevention to individual differences, to improve their effects. Such treatment personalization may be based on repeated assessments within one individual, using experience sampling methodology. As a first step towards informing decisions based on this methodology, insight is needed in individual differences in risk of relapse and response to treatment, and how relapse prevention strategies may differentially target vulnerability for relapse.

Methods: The smartphone application 'Imagine your mood' has been developed specifically for this study to assess emotions, imagery, cognitions, and behaviors in daily life. Parallel to the randomized controlled trial 'Disrupting the rhythm of depression', 45 remitted recurrently depressed individuals taking continuation antidepressant medication will be randomly assigned to either continuing antidepressant medication ( = 15), continuing antidepressant medication combined with an eight-session preventive cognitive therapy ( = 15), or tapering of antidepressant medication in combination with preventive cognitive therapy ( = 15). Relapse and return of depressive symptomatology over a 24-month follow-up will be assessed. Additionally, matched never depressed individuals ( = 15) will be recruited as controls.

Discussion: This innovative study combines the strengths of a randomized controlled trial and experience sampling methodology in a micro-trial to explore individual differences in risk of relapse and what works for whom to prevent relapse. Results may ultimately pave the way for therapists to tailor relapse prevention strategies to individual (affective) vulnerability.

Trial Registration: ISRCTN15472145, retrospectively registered.
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http://dx.doi.org/10.1016/j.conctc.2017.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898558PMC
September 2017

The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders.

J Child Psychol Psychiatry 2018 07 9;59(7):763-772. Epub 2018 Mar 9.

Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.

Background: Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment formats.

Methods: A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question.

Results: In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-up data were examined separately.

Conclusions: Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required.
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http://dx.doi.org/10.1111/jcpp.12872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055633PMC
July 2018

Offspring of depressed and anxious patients: Help-seeking after first onset of a mood and/or anxiety disorder.

J Affect Disord 2018 02 8;227:618-626. Epub 2017 Nov 8.

University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands. Electronic address:

Background: Offspring of patients with depressive and/or anxiety disorders are at high risk of developing a similar disorder themselves. Early recognition and treatment may have substantial effects on prognosis. The main aim of this study was to examine the time to initial help-seeking and its determinants in offspring after the first onset of a mood and/or anxiety disorder.

Methods: Data are presented of 215 offspring with a mood and/or anxiety disorder participating in a cohort study with 10 year follow-up. We determined age of disorder onset and age of initial help-seeking. Offspring characteristics (gender, IQ, age of onset, disorder type, suicidal ideation) and family characteristics (socioeconomic status, family functioning) were investigated as potential predictors of the time to initial help-seeking.

Results: The estimated overall proportion of offspring of depressed/anxious patients who eventually seek help after onset of a mood and/or anxiety disorder was 91.9%. The time to initial help-seeking was more than two years in 39.6% of the offspring. Being female, having a mood disorder or comorbid mood and anxiety disorder (relative to anxiety) and a disorder onset in adolescence or adulthood (relative to childhood) predicted a shorter time to initial help-seeking.

Limitations: Baseline information relied on retrospective reports. Age of onsets and age of initial help-seeking may therefore be subject to recall bias.

Conclusion: Although most offspring eventually seek help after onset of a mood/anxiety disorder, delays in help-seeking were common, especially in specific subgroups of patients. This information may help to develop targeted strategies to reduce help-seeking delays.
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http://dx.doi.org/10.1016/j.jad.2017.11.017DOI Listing
February 2018

Methylphenidate Has Superior Efficacy Over Parent-Child Interaction Therapy for Preschool Children with Disruptive Behaviors.

J Child Adolesc Psychopharmacol 2018 02 13;28(1):66-73. Epub 2017 Nov 13.

1 Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands .

Objective: To compare the effectiveness between parent-child interaction therapy (PCIT) and methylphenidate in preschool children with attention-deficit/hyperactivity disorder (ADHD) symptoms and disruptive behaviors who had remaining significant behavior problems after previous behavioral parent training.

Methods: We included 35 preschool children, ranging in age between 3.4 and 6.0 years. Participants were randomized to PCIT (n = 18) or methylphenidate (n = 17). Outcome measures were maternal ratings of the intensity and number of behavior problems and severity of ADHD symptoms. Changes from pretreatment to directly posttreatment were compared between groups using two-way mixed analysis of variance. We also made comparisons of both treatments to a nonrandomized care as usual (CAU) group (n = 17) regarding intensity and number of behavior problems. All children who started one of the treatments were included in the analyses.

Results: Mothers reported a significantly more decreased intensity of behavior problems after methylphenidate (pre-post effect size d = 1.50) compared with PCIT (d = 0.64). ADHD symptoms reduced significantly over time only after methylphenidate treatment (d = 0.48) and not after PCIT. Changes over time of children in the CAU treatment were nonsignificant.

Conclusions: Although methylphenidate was more effective than PCIT, both interventions may be effective in the treatment of preschool children with disruptive behaviors. Our findings are preliminary as our sample size was small and the use of methylphenidate in preschool children lacks profound safety data as reflected by its off-label status. More empirical support is needed from studies with larger sample sizes.
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http://dx.doi.org/10.1089/cap.2017.0123DOI Listing
February 2018

The Inventory of Depressive Symptomatology Self Report (IDS-SR): Psychometric properties of the Indonesian version.

PLoS One 2017 23;12(10):e0187009. Epub 2017 Oct 23.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.

Background: Depression screening and examination in Indonesia are highly challenging due to the disproportionately low number of mental health professionals in comparison to the Indonesian population. Self-report questionnaires on depression are cost-effective and time-efficient. The current study investigates the psychometric properties of the Indonesian Inventory of Depressive Symptomatology Self Report (IDS-SR).

Methods: The participants were 904 Indonesians (aged 16-61; 50.2% female), recruited via an online survey using Qualtrics. Confirmatory factor analysis of the one-factor, three-factor, and four-factor model were explored. Convergent and divergent validity of the total score of the Indonesian IDS-SR and each factor were examined, as well as the Cronbach's Alpha reliability. In addition, an optimal cut-off score for the Indonesian IDS-SR was established using ROC curve analysis.

Results: The three-factor model of "cognitive/mood", "anxiety/arousal", and "sleep disturbance" was the best fit with the Indonesian IDS-SR data. Convergent and divergent validity were good. Cronbach's Alpha reliability was excellent for the total score, good for the factors "cognitive/mood" and "anxiety/arousal", but insufficient for the factor "sleep disturbance". The optimal cut-off score of the Indonesian IDS-SR was 14, with 87% sensitivity and 86% specificity.

Conclusions: As a multifactorial instrument to measure depression that has good validity and reliability, the Indonesian IDS-SR can be used to assess depressive symptoms for the purpose of research and clinical practice. The optimal cut-off score of the Indonesian IDS-SR is in accordance with the internationally used cut-off score.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187009PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653354PMC
November 2017
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