Open Access Highly Accessed Open Badges Study protocol

Preventing mood and anxiety disorders in youth: a multi-centre RCT in the high risk offspring of depressed and anxious patients

Maaike H Nauta1*, Helma Festen1, Catrien G Reichart2, Willem A Nolen3, A Dennis Stant4, Claudi LH Bockting1, Nic JA van der Wee5, Aartjan Beekman6, Theo AH Doreleijers7, Catharina A Hartman3, Peter J de Jong1 and Sybolt O de Vries38

Author Affiliations

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

2 Curium/Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK, Oegstgeest, The Netherlands

3 Department of Psychiatry/Interdisciplinary Center of Pathology of Emotion, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

4 Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

5 Department of Psychiatry and Leiden Institute for Brain and Cognition, Leiden University Medical Center, Albinusfreef 2, 2333 ZA, Leiden, The Netherlands

6 Department of Psychiatry and EMGO institute, VU University Medical Center/GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands

7 de Bascule/Academic Medical Center Amsterdam, p/a Postbus 303, 1115 ZG, Duivendrecht, the Netherlands

8 Mental Health Care Friesland (GGz Friesland), Borniastraat 34B, 8934 AD, Leeuwarden, The Netherlands

For all author emails, please log on.

BMC Psychiatry 2012, 12:31  doi:10.1186/1471-244X-12-31

Published: 17 April 2012



Anxiety and mood disorders are highly prevalent and pose a huge burden on patients. Their offspring is at increased risk of developing these disorders as well, indicating a clear need for prevention of psychopathology in this group. Given high comorbidity and non-specificity of intergenerational transmission of disorders, prevention programs should target both anxiety and depression. Further, while the indication for preventive interventions is often elevated symptoms, offspring with other high risk profiles may also benefit from resilience-based prevention programs.


The current STERK-study (Screening and Training: Enhancing Resilience in Kids) is a randomized controlled clinical trial combining selected and indicated prevention: it is targeted at both high risk individuals without symptoms and at those with subsyndromal symptoms. Individuals without symptoms meet two of three criteria of the High Risk Index (HRI; female gender, both parents affected, history of a parental suicide (attempt). This index was developed in an earlier study and corresponds with elevated risk in offspring of depressed patients. Children aged 8–17 years (n = 204) with subthreshold symptoms or meeting the criteria on the HRI are randomised to one of two treatment conditions, namely (a) 10 weekly individual child CBT sessions and 2 parent sessions or (b) minimal information. Assessments are held at pre-test, post-test and at 12 and 24 months follow-up. Primary outcome is the time to onset of a mood or anxiety disorder in the offspring. Secondary outcome measures include number of days with depression or anxiety, child and parent symptom levels, quality of life, and cost-effectiveness. Based on models of aetiology of mood and anxiety disorders as well as mechanisms of change during interventions, we selected potential mediators and moderators of treatment outcome, namely coping, parent–child interaction, self-associations, optimism/pessimism, temperament, and emotion processing.


The current intervention trial aims to significantly reduce the risk of intergenerational transmission of mood and anxiety disorders with a short and well targeted intervention that is directed at strengthening the resilience in potentially vulnerable children. We plan to evaluate the effectiveness and cost-effectiveness of such an intervention and to identify mechanisms of change.

Trial registration


Prevention; Offspring; Anxiety; Depression; Randomised controlled trial; Cost effectiveness