Cognitive strategies that adolescents use to cope with negative emotions might show distinct profiles of cognitive emotion regulation strategies, which could be differentially associated with depressive symptoms. In total, 411 Dutch adolescents who had experienced at least one stressful life event that required some coping strategy participated in this study, including 334 nonclinical and 77 clinically depressed adolescents (12–21 years). A person-centered approach with Latent Profile Analysis was used to identify underlying profiles of cognitive emotion regulation based on the adolescents’ reports of their use of cognitive emotion regulation strategies when they were confronted with stressful life events. Nine different strategies, five adaptive and four maladaptive, were used as indicators. Four profiles with distinct features were found in the nonclinical sample, as well as in the combined sample of nonclinical and clinically depressed adolescents: Low Regulators, High Regulators, Maladaptive Regulators, and Adaptive Regulators. In both samples, the High Regulators profile was most commonly used, followed by the Adaptive, Maladaptive, and Low Regulators profile. Maladaptive Regulators endorsed higher levels of depressive symptoms relative to Low, High, and Adaptive Regulators. The findings underscore the utility of using a person-centered approach in order to identify patterns of cognitive emotion regulation deficits in psychopathology.

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-ofillness 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.

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.