Friends for Life: Outcomes of an Indicated School-Based Prevention Program for Childhood Anxiety and Depression

Introduction: Anxiety is highly prevalent in children, and associated with anxiety and depressive disorders in later life. Prevention is therefore of utmost importance. In the Amsterdam, the Netherlands, we implemented FRIENDS for Life, a school-based indicated prevention program against anxiety and depression in children aged 8-13. In several other countries, including the USA, the program has been found effective. However, there are some methodological issues in previous FRIENDS for Life studies which were addressed in the present study. We aimed to evaluate whether the program is also effective in the Netherlands, and test potential moderating effects of gender, age, ethnicity, severity of initial symptoms, peer rejection, and co-morbid externalizing behavior.

Methods: The design of the study was a controlled trial. In total, at T1 screening data of 3636 children were collected, of which 333 participated in the program. The no-intervention control group consisted of 157 children. Pre- and post-intervention (T1 and T2) data on severity of anxiety and depression symptoms as reported by the child, the teacher, and all classmates (peer report) were analyzed. In the intervention group also data on program integrity using classroom based observations and prevention professionals’ reports tapping adherence to protocol, quality of delivery, participant responsiveness, and exposure were collected.

Results: Preliminary analyses using multilevel linear regression adjusting for baseline (T1) scores, age, gender and ethnicity, showed that children in the intervention group experienced significantly fewer symptoms of anxiety and depression on 5 scales of the Revised Child Anxiety and Depression Scale (RCADS) at T2. Differences were for the total internalizing scale: -6.15 95%CI[-10.38,-1.92]; total anxiety scale: -4.40 95%CI[-7.89,-0.92]; social phobia: -1.70 95%CI[-2.73,-0.67]; obsessive compulsive disorder: -0.79 95%CI[-1.48,-0.10]; and major depressive disorder: -1.67 95%CI[-2.67,-0.66].

Conclusions: Preliminary results show that FRIENDS for Life significantly reduces symptoms of anxiety and depression. In further analyses we will examine possible moderators, and the relation between participants’ evaluation, program integrity and outcomes. Results will be used to guide implementation and dissemination activities in the Netherlands.