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Introduction: In randomized trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and variability of treatment effects are often neglected, particularly over the long-term course.Objective: Ratings of depression severity over 104 weeks of follow-up after yearlong acute and continuation treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were investigated to cluster intraindividual trajectories and identify risk and protective factors. Methods: Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to group intraindividual long-term trajectories from one of the largest psychotherapy trials in early-onset chronic depression.Results: Two-year post-treatment trajectories of N=176 patients with early-onset chronic depression were clustered into four groups. Only 16.5% of patients remitted (Cluster 1), while the majority continued to experience subthreshold (35.8% Cluster 2) or major depressive symptoms (47.7% Cluster 3-4). Patients previously treated with the CBASP had a 45% lower risk of experiencing major depressive symptoms (Cluster 3) than patients in the SP group (RR=0.55, 95% CI=0.31 to 0.97, p=.03). Further treatment in the health care system during follow-up, especially psychological outpatient treatment, reduced depression severity. Comorbid disorders or childhood emotional/physical abuse had detrimental effects.Conclusion: Despite significant effects in favor of acute treatment with CBASP compared to SP, the majority of patients experienced subthreshold or major depressive symptoms over two years of follow-up. This calls for a long-term perspective with innovative treatment approaches such as the sequential model or modular psychotherapy.

Background: The network approach to psychopathology, which assesses associations between individual symptoms, has recently been applied to evaluate treatments for mental disorders. While various options for conducting a network analysis in intervention research exist, no structured guidelines have been established yet. To gain an overview and evaluate the potential of different analytic options, we conducted a systematic review on these studies. Methods: We systematically searched the literature with combining terms on network analysis, mental health problems, and intervention studies. Studies were included if they constructed a symptom network, analysed data that was collected before, during or after a treatment for mental disorders, and yielded information about the treatment effect. Information on sample characteristics, the intervention, the research design, the estimated networks, the statistical analyses, and open science practices were extracted. Results: Across the 56 included studies, network analyses varied widely. About half of the studies estimated cross-sectional networks without a treatment node, e.g., for different treatment groups separately or for a single group before, and after treatment. About 20% of the studies analysed cross-sectional networks including a treatment node and a third of the studies estimated longitudinal networks. Studies differed on how networks were estimated, which network parameters were calculated, and which statistical tests were applied. Conclusion: This review highlighted that many different analytic options exist when applying the network approach to intervention research. As the potential of the network approach depends on the applied methodologies, the analytic choices need to be further investigated and structured guidelines need to be developed.

Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians’ perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians’ perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians’ PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians’ PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians’ PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity., HIGHLIGHTS Symptom networks were investigated to understand better refugee youth’s symptomatology. Intrusions were central; PTSD and depression symptoms related mainly to symptoms in their own domain. Despite differences, clinicians’ perceptions showed moderate fit to the empirical data.