Indicated Prevention Transdiagnostic Intervention for Adolescents At High Risk of Emotional Problems
Condition: Anxiety Disorders and Symptoms; Depressive Symptoms
MeSH terms: Anxiety Disorders; Depression
Study type: Interventional

Summary: 
      Emotional disorders (anxiety and/or depression) are severely undiagnosed and untreated
      despite being among the most common mental disorders, particularly at a young age. Half of
      all mental disorders begin by age 14; three-quarters by age 24, which makes adolescence a
      particularly crucial stage. In adolescence, prodromal signs of mental disorders and even
      full-blown clinical conditions often remain undetected, undiagnosed and untreated. However,
      there is an absence of evidence-based protocols to reach at high risk youth for developing
      emotional disorders. There is an urgent need for a paradigm shift by developing intervention
      protocols to early identify and treat vulnerable adolescents, thus preventing them from
      developing severe mental disorders later on in life. Mental health indicated prevention is
      key to helping at-high risk adolescents thrive before emotional disorder evolves. To cover
      this gap, PROCARE-I is conceptualized as a modularized indicated preventive programme for
      adolescents aged 12 to 18 years, adapting UP-A protocol with author's permission and
      supervision. Adolescents will be allocated to a 2-arm intervention trial, delivered as a
      group, as telehealth format as a result of Covid19 restrictions imposed by government. The
      PROCARE-I protocol aims to enhance protective factors that will eventually lead to lasting
      positive effects for adolescents. PROCARE-I will combine quantitative analysis, with special
      attention to vulnerable groups in a sex/gender disaggregated way. The PROCARE-I project is
      expected to have a far impact ultimately contributing to preventing and reducing the
      prevalence of emotional disorders in the young. The outcomes of PROCARE-I will contribute to
      identifying and treating vulnerable adolescents at high risk for emotional mental at an early
      stage, before they incur personal, societal and economic cost. PROCARE-I will be
      culturally-adapted and implemented as a multicenter Randomized-Controlled Trial (RCT).
      PROCARE-I will be designed to be an acceptable, scalable, and sustainable indicated
      prevention program.
    

Detailed description: 
      The general objective of PROCARE-I is to design, implement and evaluate a indicated 8-session
      preventive group intervention for adolescents aged 12-18 at high risk of emotional disorders
      like anxiety and depression. The intervention will be based on the Unified protocol for
      transdiagnostic treatment of emotional disorders in adolescents (UP-A), already proven as
      effective in the US, but adapted with indicated prevention purposes in Spain thanks support
      of main author of the protocol (Prf. Ehrenreich-May). It will be culturally-adapted and
      designed to be an acceptable, scalable, and sustainable indicated prevention program.
      METHODOLOGY The methodology was designed in order to achieve the project's objective of
      treating vulnerable adolescents at high risk of developing emotional disorders. PROCARE-I
      working plan will be divided into 3 interconnected stages. Firstly, in order to identify
      adolescents at high risk of suffering emotional disorders (anxiety and depression), the
      following self-reports will be administered to adolescents: Strengths and Difficulties
      Questionnaire (SDQ) to evaluate adolescents at-risk of emotional disorders, and the Revised
      Child Anxiety and Depression Scale-30 (RCADS-30) will screen for presence/absence of
      emotional symptomatology. Finally, ADIS5-C/P will be administered to rule-out presence of
      anxiety and/or mood disorders. Valuing voices from stakeholders and end-users, the
      investigators will focus on the study of the influence of the above described variables.
      Third, the investigators will test a indicated preventive intervention using multi-center
      randomized control trial in Spain. Special attention will be paid to particularly vulnerable
      young people, such as disabled, refugees, immigrants, or minorities (national, ethnic,
      linguistic, religious, and sexual).

      IMPACT The need to include mental health among the first priorities of the public health
      agenda has been increasingly recognized over the past decades. The outcomes of the PROCARE-I
      project will have a far impact ultimately contributing to preventing and reducing the
      prevalence of mental disorders in the young. These problems are wide-ranging, long-lasting,
      and enormous and impose a range of costs on individuals, families and communities. The
      outcomes of the project, if successful, will have far reaching implications, contributing to
      identifying and treating adolescents at high risk for emotional mental disorders at an early
      stage, before they incur personal, societal and economic cost.
    

Intervention name(s): PROCARE-I (UP-A for indicated purposes); Active control condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This intervention is meant to respond to the heterogeneity inherent in emotional difficulties presentation by extinguishing distress associated with the presentation of heightened negative emotion in general and reduction or elimination of resultant emotionally-driven behaviours, including avoidance, escape, aggression, and controlling behaviours (e.g., reassurance seeking) that reinforce emotional distress intensity over time.; Psychoeducation about many different emotions, emphasis on discussing thoughts, feelings, and behavior as parts of emotion, and emphasis on providing support around generally distressing events.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: One intervention is evaluated in parallel against a active control group
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: ADOLESCENCE; TRANSDIAGNOSTIC; indicated PREVENTION; Randomized-Controlled Trial; high-risk