Identifying contributing factors to StayFine after depression and anxiety Towards personalised relapse prevention interventions for adolescents and young adults using repeated daily assessments and individual networks

Depression and anxiety are common and often develop at a young age. After remission, there is a substantial risk of relapse: up to 70% for depression and 48% for anxiety in youth. Relapse prevention interventions can contribute to a longer time to relapse, and may potentially lower the negative consequences of recurrent episodes. The studies included in this thesis aim to contribute to an effective personalised relapse prevention intervention for youth remitted from depression and/or anxiety. A meta-analysis demonstrates that medication continuation and psychological relapse prevention interventions are effective strategies to lower the risk of relapse for depression as compared to control conditions. No studies for anxiety were identified. Next, a study protocol describes a randomised controlled trial examining the StayFine-intervention-app among youth in remission of depression or anxiety. The app is used for (1) Ecological Momentary Assessment (EMA) and (2) the guided and personalised relapse prevention intervention-modules. The personalisation of the intervention-modules was data-driven, including an individual network based on EMA, and was combined with shared decision making. We describe the personalisation procedure and the feasibility of this approach. Thereafter, the potential of EMA and individual networks as predictor and evaluation method is discussed. Currently, EMA-based mean levels of positive affect are put forward as promising contributing factor to further explore in future studies. There is limited support that fluctuations and data from individual networks are contributing factors to prognosis in remitted youth. We conclude with a discussion on implications and suggestions for future research.