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Objective: To examine the effectiveness of a transdiagnostic program (i.e., EMOTION) targeting symptoms of anxiety and depression in school children by comparing the intervention condition (EC) to a control condition (CC). Method: A clustered randomized design was used with schools as the unit of randomization. Children (N = 1,686) aged 8-12 years in 36 schools completed screening using the Multidimensional Anxiety Scale (MASC-C) and The Mood and Feelings Questionnaire Short version (SMFQ). Scoring 1 SD above a population-based mean on anxiety and/or depression, 873 children were invited to participate. Intent-to-treat analyses were performed, and mixed effects models were used. Results: Analyses revealed significant reductions of anxious and depressive symptoms as reported by the children, where children in the intervention condition EC had almost twice the reduction in symptoms compared to the control condition CC. For parent report of the child's depressive symptoms, there was a significant decrease of symptoms in the intervention condition EC compared to CC. However, parents did not report a significant decrease in anxious symptoms in the intervention condition EC as compared to CC. Conclusion: A transdiagnostic prevention program, provided in schools, was successful in reducing youth-reported symptoms of anxiety and depression, and parent-reported depression. The EMOTION program has the potential to reduce the incidence of anxious and depressive disorders in youth.

BackgroundSymptoms of anxiety and depression are prevalent and highly comorbid in children, contributing to considerable impairment even at a subclinical level. Difficulties with emotion regulation are potentially related to both anxious and depressive symptoms. Research looking at maternal contributions to children’s mental health dominates the literature but ignores the potentially important contributions of fathers.MethodThe present study is part of the Coping Kids study in Norway, a randomized controlled study of a new indicated preventive intervention for children, EMOTION. EMOTION aims to reduce levels of anxious and depressive symptoms in children aged 8–12 years. Using cross sectional data and multiple regression analyses, we investigated the relations between anxious and depressive symptoms and emotion regulation in n = 602 children. Symptoms were reported by the child, mothers and fathers. Emotion regulation was reported by mothers and fathers.ResultsSymptoms of anxiety, as reported by parents, were associated with poorer emotion regulation. This association was also demonstrated for depressive symptoms as reported by both parents and children. When analyzing same gender reports, parental gender did not differentiate the relationship between anxiety symptoms and emotion regulation. For depressive symptoms, we did find a differentiating effect of parental gender, as the association with dysregulation of emotion was stronger in paternal reports, and the association with adaptive emotion regulation was stronger in maternal reports. When using reports from the opposite parent, the emotion regulation difficulties were still associated with depressive and anxiety symptoms, however exhibiting somewhat different emotional regulation profiles.ConclusionProblems with emotion regulation probably coexists with elevated levels of internalizing symptoms in children. In future research, both caregivers should be included.Trial registrationThe regional ethics committee (REC) of Norway approved the study. Registration number: 2013/1909; Project title: Coping Kids: a randomized controlled study of a new indicated preventive intervention for children with symptoms of anxiety and depression. ClinicalTrials.gov; Protocol ID 228846/H10.

BackgroundAnxiety and depressive symptoms are common in childhood, however problems in need of intervention may not be identified. Children at risk for developing more severe problems can be identified based on elevated symptom levels. Quality of life and self-esteem are important functional domains and may provide additional valuable information.MethodsSchoolchildren (n = 915), aged 9–13, who considered themselves to be more anxious or sad than their peers, completed self-reports of anxiety (Multidimensional Anxiety Scale for children (MASC-C), depression (The Short Mood and Feelings Questionnaire; SMFQ), quality of life (Kinder Lebensqualität Fragebogen; KINDL) and self-esteem (Beck self-concept inventory for youth (BSCI-Y) at baseline of a randomized controlled indicative study. Using multivariate analyses, we examined the relationships between internalizing symptoms, quality of life and self-esteem in three at-risk symptom groups. We also examined gender and age differences.Results52.1 % of the screened children scored above the defined at-risk level reporting elevated symptoms of either Anxiety and Depression (Combined group) (26.6 %), Depression only (15.4 %) or Anxiety only (10.2 %). One-way ANOVA analysis showed significant mean differences between the symptom groups on self-reported quality of life and self-esteem. Regression analysis predicting quality of life and self-esteem showed that in the Depression only group and the Combined group, symptom levels were significantly associated with lower self-reported scores on both functional domains. In the Combined group, older children reported lower quality of life and self-esteem than younger children. Internalizing symptoms explained more of the variance in quality of life than in self-esteem. Symptoms of depression explained more of the variance than anxious symptoms. Female gender was associated with higher levels of internalizing symptoms, but there was no gender difference in quality of life and self-esteem.ConclusionInternalizing symptoms were associated with lower self-reported quality of life and self-esteem in children in the at-risk groups reporting depressive or depressive and anxious symptoms. A transdiagnostic approach targeting children with internalizing symptoms may be important as an early intervention to change a possible negative trajectory. Tailoring the strategies to the specific symptom pattern of the child will be important to improve self-esteem.Trial registrationTrial registration in Clinical trials: NCT02340637, June 12, 2014.