Search

The aims of this study were to examine correlates of self-reported depressive symptoms within the school area, and possible predictors of change in depressive symptom levels over a 1-year period in a large representative sample of 12 to 15-year-old adolescents in central Norway. The school variables were: school stress, class wellbeing, teacher support, and grades. Possible confounding factors were age, SES, ethnicity, and parental divorce. We also examined the strengths of these relationships. In the cross-sectional multivariate analyses of the whole sample, at time-point one (T1), all four school factors were independently associated with depressive symptom levels at small to moderate levels. In the longitudinal multivariate analyses of the whole sample, self-reported depressive symptom levels at time-point two (T2) were predicted by depressive symptom levels at T1, gender and teacher support. For girls, three of the school variables significantly predicted depressive symptom levels at T2, while this was not the case for boys. Prevention in schools might be of importance.

The objectives of the study were to describe monthly variations in issues in calls to a help-line for children and adolescents. All 80,983 calls to a Red Cross Help-Line for children in 1991–1997 were included. In 22,698 calls, information about age, sex or issue could be identified. A monthly variation in frequency of calls with peaks in April and November and a correlation with the absolute values of monthly changes in length of day were found. Conversations concerning psychiatric suffering were more frequent in January or February and less frequent than expected in May/June and December. Conversations about sexuality correlated with the frequencies of births in the adult population 9 months later. A spring and fall peak in total calling and a winter peak in calls for depression, anxiety, pain and neglect were described.

Background: The aim of the study was to examine the relationships between various psychosocial factors and depressive symptoms in early adolescence. Methods: A representative sample of 2,465 12–14-year-old adolescents comprising 50.8% girls and 49.2% boys, with a mean age of 13.7 years, was recruited in two counties in Norway. The participation rate was 88.3%. Depressive symptoms were measured by the Mood and Feelings Questionnaire (MFQ). Results: Correlations between the total sum of stressful events/daily hassles and the total sum of MFQ were moderately high, rs=.49 and rs=.53, respectively. Depressive symptoms were more strongly correlated with school-related stress among boys than girls, whereas the correlation between daily hassles and depressive symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher mean total MFQ scores among adolescents not living with both natural parents, those who had moved more than twice and those with more than 3 siblings or having fewer than 2 close friends. Further, adolescents from Third World societies and adopted adolescents, those from lower SES groups, having unemployed parents or living in coastal areas had higher mean depressive symptom scores. The results of multiple regression analyses yielded the following six significant predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life events, gender, number of friends, ethnicity and mother's employment status. Altogether, these variables accounted for 43% of the total variance in MFQ scores. Conclusions: It is concluded that these psychosocial predictors should be addressed when assessing depressive symptoms in early adolescence. The findings of the study are discussed in view of previous research in the field and their clinical significance.

Objective: To investigate whether insecure attachment is a predictor of subsequent depressive symptoms among adolescents 12–14 years of age, when controlled for depressive levels the preceding year, various demographic and psychosocial factors, and stressful life events. Method: A representative sample of 2,360 young adolescents was assessed at two time points 1 year apart. Measures included were depressive symptoms measured by the Mood and Feelings Questionnaire (MFQ), attachment to parents and friends measured by the Inventory of Parent and Peer Attachment, stressful events, and various sociodemographic factors. The initial response rate was 88.3% and the attrition rate was 4.3%. Results: The proportions of high scorers (MFQ > 33) increased threefold from T 1 to T 2 (3.4% to 10.9%). Results of multivariate logistic regression analyses showed that the following variables at T 1 were predictive of depressive symptoms at T 2 : severe depressive symptoms (odds ratio [OR] = 5.30), gender (OR = 4.08), attachment to parents (OR = 1.36), and stressful life events (OR = 1.12). No interactions between attachment and severe depressive symptoms and gender and stressful life events, respectively, were found. Conclusions: Insecure attachment to parents may contribute to the development of severe depressive symptoms among young adolescents. Improving the adolescent–parent relationship could be a focus for interventions both in community services and in clinical work.

Background: To investigate seasonal variations in telephone calls to a help-line for children, and their correlation to changes in length of day, latitude and age. Method: 691,787 calls to the Red Cross Help-Line in Norway for children in the three-year period 1996–1998 were included. Results: Monthly frequencies of calls deviated significantly from an expected even distribution (χ2=9446.34, df=11, P

1.Regional Centre for Child and Adolescent Mental Health, Norwegian University of Science and Technology, Trondheim, Norway2.St. Olav’s University Hospital, Trondheim, NorwayCorrespondenceAnne Mari Undheim, Ph.D., The RegionalCentre for Child and Adolescent Mental Health(RBUP), Department of Neuroscience,Faculty of Medicine, Norwegian University of Scienceand Technology (NTNU), PO Box 8905,N-7491 Trondheim, Norway.Tel: +47 73 55 15 00 |Fax: +47 73 55 15 39 |Email: anne.m.undheim@ntnu.noReceived17 January 2011; accepted 18 January 2011.DOI:10.1111/j.1651-2227.2011.02174.x

The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.

In a stratified random and representative sample of 2,560 13- to 14-year-old Norwegian girls and boys, depressive symptoms were assessed by means of the Mood and Feelings Questionnaire (MFQ). The MFQ showed a good internal consistency (alpha), and test-retest correlations (r) for three-week and three-month intervals were 0.84 and 0.80 respectively. Convergent and discriminative validity were also assessed. The mean total MFQ score for the whole sample was 10.6 (SD 9.5). The results showed a significant sex by age interaction effect in that girls increased their mean total MFQ sum score by age while the boys' scores decreased slightly. Reports of unattractiveness, restlessness, indecisiveness and transient feelings of low mood were common in the total sample, while unhappiness, irritability, self-dislike and concentration problems were common among high-scoring subjects. Girls experienced more often lowered mood, were more concerned with their appearance and had more self-depreciatory notions than boys, while boys more often than girls had lower school satisfaction. Girls were preponderant among the high-scoring subjects. The results of logistic regression analyses showed that concentration problems were the strongest predictor of high scores. The findings are discussed in view of similar epidemiological studies in which DSM-IV criteria have been used in the assessment of depressive symptoms and disorders among adolescents.

Objective We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. Method This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Results Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. Conclusion DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information—Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129.

Relationships between depression and coping among nonattempters, attempters, and repeaters of suicidal acts were examined across adolescence. A representative sample of students (T1: n = 2464; mean age, 13.7 years; 50.8% female; 88.3% participation) was reassessed with the same questionnaire after 1 year (T2). High scorers on the Mood and Feelings Questionnaire were gender- and age-matched randomly with low and middle scorers. This subset was assessed using diagnostic interviews at T2 (n = 345, 94% participation) and 5 years later using the same interview and questionnaire (T3, n = 252; mean age, 20.0 years; 73% participation). The Coping Inventory for Stressful Situations measured coping as three stable traits. Coping changed partly with age, depression, and attempt status. Differences in depression emerged before coping differences and remained stable. Consistently, repeaters reported higher depression and lesser task-oriented coping. Antecedent depression predicted decreased task-oriented coping and increased emotional coping at age 20 years. Language: en

Background: Prevalence of depressive disorders among adolescents has varied across studies. The present study aims to assess current and lifetime prevalence and characteristics of adolescent Major Depressive Disorder (MDD), Dysthymia and Depression NOS among adolescents in Central Norway in addition to socio-demographics and use of mental health care. Method: In the Youth and Mental Health Study a representative sample of 2432 junior high school students (mean age 14.9 years, SD = 0.6) from two counties in Central Norway were screened with the Mood and Feelings Questionnaire (MFQ). A subset of 345 of these adolescents (72.5% girls), 220 high scorers (MFQ = > 26), 74 middle scorers (MFQ 7-25), and 50 low scorers (MFQ < 7), 1 unknown score, were drawn and interviewed with the Kiddie SADS-PL (Present-Life Version). In all, 79% had parental interviews as well. All estimates of prevalence rates and population shares were weighted back using a sandwich estimator to yield true population estimates. Results: Almost one in four subjects (23%) had life-time depression. Prevalences of current Major Depressive Disorder (MDD), Dysthymia and “Double depression” were 2.6%, 1.0% and 0.6%, respectively, and for Depression NOS 6.3%. All depressive disorders were characterized by long duration of episodes with large variations, and for any depressive disorder onset before 12 years of age. In multivariate analyses MDD and Dysthymia were most strongly associated with gender and not living with both biological parents. There was no gender difference for Depression NOS. Although a considerable number of depressed subjects had received mental health care, the reason for contact with services was seldom due to affective symptoms. Less than 20% had been in contact with specialist mental health services. Conclusion: High rates of Depression NOS, early onset of depressive episodes, long duration, and low use of specialized services point to the need for improved diagnostic assessment and treatment for young individuals. © 2011 Sund et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of this study was to examine the relationships between being bullied and aggressive behavior and self-reported mental health problems among young adolescents. A representative population sample of 2,464 young Norwegian adolescents (50.8% girls) aged 12–15 years was assessed. Being bullied was measured using three items concerning teasing, exclusion, and physical assault. Self-esteem was assessed by Harter’s self-perception profile for adolescents. Emotional and behavioral problems were measured by the Moods and Feelings Questionnaire (MFQ) and the youth self-report (YSR). Aggressive behavior was measured by four items from the YSR. One-tenth of the adolescents reported being bullied, and 5% reported having been aggressive toward others during the past 6 months. More of the students being bullied and students being aggressive toward others reported parental divorce, and they showed higher scores on all YSR subscales and on the MFQ questions, and lower scores on the global self-worth subscale (Harter) than students not being bullied or aggressive. A few differences emerged between the two groups being bullied or being aggressive toward others: those who were aggressive showed higher total YSR scores, higher aggression and delinquency scores, and lower social problems scores, and reported higher scores on the social acceptance subscale (Harter) than bullied students. However, because social problems were demonstrated in both the involved groups, interventions designed to improve social competence and interaction skills should be integrated in antibullying programs.

Were violent/nonviolent traumatic life events and victimization by/witnessing violence associates of attempted suicide among depressed adolescents who were also less resilient at early adulthood? The present study examined a subset of mainly depressed, age- and gender-matched, adolescents derived from a representative sample of 2464 students (T1, mean age = 13.7 years) followed up after 1 year (T2Q) and reassessed 5 years later (T3, n = 252, mean age = 20.0 years, 73% participation), with a questionnaire, including the Connor-Davidson Resilience Scale and The Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version psychiatric interviews, which also tapped traumatic life events. Logistic regression analyses revealed that attempters were victims, not witnesses of violence, more depressed, and less resilient than nonattempters, and that resilience was a moderator of lifetime violent events and attempted suicide, even in the presence of antecedent depression.

Knowledge of sleep problems and their relationships among adolescent psychiatric patients is limited. This study investigated whether adolescents in specialty mental health care differ in rate and correlates of sleep problems from adolescents in a community sample; 2465 adolescents from a community sample were compared with a representative clinical sample of 129 adolescent patients.Comparisons were made on frequent sleep problems according to scores on the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing coping styles, stresses and family functioning.Sleep problems were more frequent in the clinical sample than the community sample (31.3% vs. 5%). Sleeping little and being overtired were the most common sleep problems. Sleep problems were multivariately associated with internalizing problems in both samples. Poor family functioning and distractive coping were multivariately associated with sleep problems among adolescent patients, whereas depressive symptoms were multivariately associated in community adolescents.Prevalences of sleep problems were high among adolescent patients. However, sleep problems may be in danger of being unnoticed in clinical practice. Clinicians should ask about such problems and be aware of possible connections with family functioning, depression and suicidality. Therapeutic interventions directed towards sleep problems should be considered.

To examine whether levels of physical activity or sedentary activity are risk factors for the development of depressive symptoms in early adolescence. A representative sample of 2,464 12- to 15-year-old adolescents living in the middle of Norway was assessed twice, during the years 1998 (T1) and 1999/2000 (T2). The attrition rate was 4.3%. We assessed depressive symptoms (using the Mood and Feelings Questionnaire, MFQ) and levels of physical and sedentary activities at baseline and follow-up. Various potentially confounding factors, including demographic factors, were assessed at baseline. The MFQ scores at T1 were cross-sectionally associated with low levels of vigorous exercise. A possible buffering effect of vigorous exercise on the relationship between stressful life events and depression was demonstrated. In longitudinal analysis low levels of vigorous exercise and high levels of sedentary activities (boys only) predicted a high score (MFQ ≥ 25) at T2. Low levels of vigorous exercise and high levels of sedentary activities (boys only) constituted independent risk factors for the development of a high level of depressive symptoms in a 1-year study of young adolescents. This knowledge should be considered by policy makers, preventative services, and health-care professionals.

In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively, while 1-year incidence rates were 3.6% and 1.7%, respectively. In multivariate analysis, five predictors significantly differentiated self-harmers from non-self-harming adolescents. Early school adolescents having frequent or intense suicidal ideation over an extended time period and attempting self-harm repeatedly with or without suicide intent should be identified and offered treatment.

To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence.A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265).Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms.Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

Objective To examine the influences of familial, peer and individual predictors of suicidal acts in a longitudinal study with a subset of school adolescents reporting high levels of depressive symptoms. Method A representative sample of Norwegian school students (N = 2464, mean age 13.7 years, T1) was reassessed after 1 year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate at T3 was 76.9% (n = 265). The questionnaire explored various relationships with family members, peers and individual factors such as lifestyle habits, and physical health. Results Irrespective of time, history of a suicidal act significantly predicted a later suicidal act. Not living with both biological parents and a diagnosis of any depressive disorder were significant predictors for younger and older adolescents, respectively. Conclusions In line with the findings of previous clinical studies, our results underline the importance of identifying previous suicidal acts, depressive disorders, broken homes and risk behaviours such as smoking and intoxication in the assessment of suicidal risk across adolescence.

The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral? Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics. As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality. Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones.

Objective.—To examine the prevalence rate, course, annual incidence, and predictors of frequent headaches (at least once a week) in a 1-year longitudinal study of a representative school sample of 2355 adolescents aged 12 to 14 years. Methods.—Information was gathered by means of questionnaires administered to the subjects at school. Results.—The overall prevalence estimates of frequent headaches, including those subjects reporting another type of frequent pain, were 8.1% and 8.9% at the two assessment points (T1 and T2), and 3.3% to 4% for frequent headaches without other frequent pain complaints. Both forms of frequent headaches were about three times more common among girls than boys. Persistence of frequent headaches (with possible pain comorbidity) was high, in that more than one-third of adolescents reporting frequent headaches continued to have such headaches 1 year later. Persistence also increased with age, in particular among 13- to 14-year-old girls. The overall annual incidence of frequent headaches in the whole sample was 6.5%. While incidence was about twice as high among adolescent girls than boys, there was a steady increase among girls, whereas the rates were stable in boys. The results of multivariate regression analyses showed that frequent headaches at 1-year follow-up could be significantly predicted by frequent headaches at first assessment, impairment (reduced leisure time activities), and high depressive symptom scores, in addition to gender (girls had a worse outcome). Conclusions.—Frequent headaches, among girls in early adolescence in particular, should be carefully evaluated, and treatment offered to those who are impaired in their daily life functioning. Ke yw ords: adolescence, headache, migraine, prevalence, incidence, prognosis (Headache 2005;45:684-691)

The purpose of the present study was to examine growth in children on extended stimulant treatment. Ninety-one hyperactive boys were studied, of whom 68 were treated with amphetamine and 23 with methylphenidate. The age range was 3-10 years. All children were treated with one of these stimulants for a minimum of 1 year. The yearly mean values for height and weight were all between the 25th and 90th percentile of the population norms. During the 1st year of treatment children who used amphetamine showed significantly smaller weight gains than those who used methylphenidate (F = 6.9, df = 64, P < 0.05). Four patients (17%) in the methylphenidate group and 21 (31%) in the amphetamine group had a weight loss during the 1st year, ranging from 0 to 9.5 kg. Within this group of 25 patients there was a significantly higher number of children with a pretreatment weight greater than that of the 50th percentile group (chi-square = 5.59, P < 0.05). All 25 patients showed sufficient weight gain at later examinations. Multiple regression analyses showed that neither cumulative doses nor age had a significant effect on growth when initial weight and height were controlled for. These findings indicate that, for most children, extended treatments with amphetamine or methylphenidate do not have negative effects on growth. However, some children show weight loss during the 1st year of treatment, more often when amphetamine is used. Among those children who may show reduced weight gain, most are above mean weight before treatment begins.

In a one-year longitudinal study, emotional/behavioural correlates and predictors of four common pain complaints (headaches, stomach, back and limb pain), were examined in a representative school sample of 2360 adolescents aged 12- to 15-years. At first assessment, 18.3% reported being bothered by a frequent pain (at least once a week) and 40% of the pain sufferers had two or more pain locations, more commonly reported by girls. Subjects having any of the four frequent pains reported having fewer friends and were more often absent from school. Frequency and number of reported pains among adolescents were positively related to levels of internalising and externalising problems. These latter problems were consistently and significantly higher among adolescents with frequent back and limb pains, however, when coexistence of another frequent pain was controlled, differences were small. Number of pains at the one-year follow-up was significantly predicted by frequent back pain and headache, depressive symptoms scores, somatic complaints (other than pain), number of friends and reduced leisure time activities during the follow-up period. Frequent back pain and depressive symptoms also predicted multiple frequent pains (vs single frequent pain) at the follow-up as did recent parental divorce. It is concluded that various emotional and behavioural problems, and which are commonly regarded as being specifically related to pain type or location among adolescents, depend rather on frequency and coexistence of multiple frequent pains. Assessment of adolescents with frequent and multiple pains should, therefore, include broad screening of internalising as well as externalising problems as well as various aspects of impairment.

Background: Anxiety 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. Methods: Schoolchildren (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. Results: 52.1 % 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. Conclusion: Internalizing 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 registration: Trial registration in Clinical trials: NCT02340637, June 12, 2014. © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.