Strong teens and resilient minds: School-based prevention of depression and suicide

Depression is a major concern of public health. The prevalence of depression in
Dutch adolescents is approximately 3.8%. This rate does not even include those
21,4% with elevated but sub-clinical levels of depressive symptoms. Depression
and suicide are strongly related as depression is the most frequently reported
risk factor associated with adolescent suicide. Since 2010 suicide is the most
important case of death in the age category 15 to 29 years, in the Netherlands.
Given the prevalence, the recurrence and the negative outcomes of adolescent
depression, it is crucial to implement prevention programs for high-risk
adolescents. This study proposes to screen children, offer them a prevention
program to prevent the onset or maintenance of depression and evaluate the
(cost-)effectiveness of this prevention program.

The primary goal is to evaluate the effectiveness of a screening and prevention
program for adolescents who experience depressive symptoms. The secondary goal
is to find factors which possibly relate to the effectiveness of the prevention
program. In addition we investigate the effect of the screening, the effect of
the intervention on suicide risk and the cost-effectiveness.

Randomised controlled trial with two conditions (intervention versus control).
Additionally, adolescents with elevated suicide risk will be monitored by
filling in the same set of questionnaires as the adolescents in the
intervention and control group.

The intervention that is evaluated is called 'Op Volle Kracht'. It consists of
8 lessons of each 60 minutes. The intervention is based on the principles of
cognitive behavioral therapy (CBT). In the first lesson, the participants learn
about emotions en depressive feelings. The adolescents learn which emotions
they experience and how they can recognize them. During this program, they will
use a schedule to find out that activating events, beliefs, emotional
consequences and behavioral consequences are related. In the second lesson, the
adolescent learn about the relationship between activating events, beliefs and
emotional consequences. Beliefs can be optimistic or pessimistic and play a
major role in the emotional consequences. The adolescents learn how they can
recognize pessimistic beliefs. In the third lesson, adolescents learn how they
can recognize the pattern of their beliefs and cognitive errors. In the fourth
lesson, adolescents learn to investigate their thoughts and to find evidence
for and against their thoughts. In the fifth lesson, adolescents continue to
find evidence for and against their thoughts and start to test if their
thoughts are actually true. In the sixth lesson, participants investigate
theirs thoughts by asking the question *what*s next?*. They learn to
questioning their thoughts by fantasizing the worst case scenario*s of their
thoughts. In addition, they learn to make up an action plan to prevent that the
worst case scenario will actually happen. In the seventh lesson, adolescents
learn how they can replace thoughts and how they can prove the alternative
belief is true. The eight and last lesson is meant to finish the intervention
on a fun way. Adolescents can share their experiences about the intervention
and participate in a quiz about all the things they learned. An application is
designed to support the OVK program. In this app, adolescents can manage their
homework and monitor their mood.

The participants in the control condition will receive a psycho-educational
brochure and two emails with useful tips to boost their mood.

The potential value of the study is that we can offer children a prevention
program that is proven to be effective. In order to achieve this goal we need
to evaluate the effectiveness of this prevention program. We are of opinion,
however, that the risks associated with participation can be considered
negligible.