Manon H. J. Hillegers

Background: Over 17% of children live with a chronic somatic illness and are at increased risk of experiencing psychological problems, such as anxiety and depression. Grow It! is a transdiagnostic mobile health (mHealth) intervention that combines experience sampling and personalised mood feedback with daily coping challenges to promote reflection, emotional insight and adaptive coping. The app fosters a collaborative team experience in which participants contribute to growing a shared virtual tree and communicate through a chat function with predesigned stickers. Objective: This study aimed to evaluate the acceptability of the Grow It! app among adolescents with a chronic somatic illness and to identify key lessons the development of other gamified mHealth apps designed to promote well-being.Methods: This preregistered study is part of a randomised waitlist controlled trial. Adolescents with a chronic somatic illness aged 10-18 years old were recruited from a university medical children’s hospital. Upon inclusion, adolescents were randomised to an intervention group that used the Grow It! app or a waitlist control group. Follow up questionnaires were completed immediately after the four week intervention period and three months later. Consecutively, the waitlist control group was also offered the Grow It! app and completed questionnaires immediately after use and three months later. Participants completed user experience survey comprising open ended and closed questions after playing the app. Responses were analysed using qualitative content analysis and descriptive statistics.Results: Between August 2021 and September 2023, 208 adolescents were included in the study. Due to participant attrition, the user experience survey was distributed to 183 participants and completed by 150 (Mage=13.95, 39.33% male, 59.33% female, 1.33% other). The app received a mean overall rating of 7.32 out of 10, and a mean look-and-feel rating of 7.98 out of 10; 84% would recommend the app to a friend. Participants reported that the app helped them recognise their emotions and gain greater self-insight. They also described its design as colourful and visually appealing. Suggested improvements included adjusting the timing and frequency of the momentary assessments, and expanding the chat function to allow free-text messages or a wider selection of stickers. Conclusions: The Grow It! app is well-accepted by adolescents aged 10 to 18 with a chronic somatic illness, although optimising the chat function and reducing questionnaire burden may further improve user experience. Combined with evidence of effectiveness, these findings on acceptability and user experience support the implementation of the Grow It! app in paediatric healthcare.

Fragile X syndrome (FXS) is a neurodevelopmental disorder that affects approximately 1 in 7,000 males and 1 in 11,000 females (Hunter et al., 2014). FXS is caused by an expanded CGG repeat in the f...

Aims: This study aimed to improve the understanding of lithium's safety profile by analysing the frequency and distribution of reported adverse drug reactions (ADRs) compared to second‐generation antipsychotics (SGAs). Methods: Individual case safety reports from VigiBase (1968–October 2023) involving individuals older than 2 years, with lithium or SGAs as a suspected or interacting drug, were included. Medical Dictionary for Regulatory Activities (MedDRA) was used for ADRs classification. Proportional reporting ratios (PRRs) with 95% confidence intervals were calculated across different age groups. Results: The lithium group contained 29 897 reported ADRs. Proportional reporting patterns varied across age groups. In children, lithium was associated with a higher proportion of renal, endocrine, gastrointestinal, skin and cardiac ADRs compared to SGAs. SGAs showed proportionally more ADRs in females, whereas lithium displayed fewer and more balanced sex‐related differences. Renal impairment accounted for a larger proportion of lithium‐related ADRs in older adults compared to children. For SGAs, type 2 diabetes and cardiovascular events showed higher proportional reporting in both younger and older adults than in children. In contrast, thyroid‐related ADRs with lithium and weight‐related ADRs with SGAs were proportionally more common in children. Conclusions: Renal, endocrine and gastrointestinal effects are observed in children using lithium, though serious outcomes like renal failure appear proportionally more often in older adults. SGAs also show age‐specific risk patterns, particularly metabolic and cardiovascular effects in adults. This emphasizes the ongoing need for individualized treatment and continued ADR monitoring and reporting to enhance the understanding of lithium's safety profile and support informed clinical decision‐making.

Background: Identifying how affect and daily behaviors influence each other is central to understanding mood disorder development. This study investigated how negative affect (NA), positive affect (PA), physical activity, and smartphone use influence one another in daily life, and whether familial risk or mood disorder history shapes these relationships. Methods: In a 14-day experience sampling protocol, we measured NA and PA five times a day along with passive sensing of step count and screen-on time. We examined the effect of familial high risk and history of mood disorders on within-person affect–behavior dynamics using Dynamic Structural Equation Modeling. Results: The sample included offspring of parents with bipolar disorder ( n = 82) and control participants (total n = 128, M _age = 37.8, 57% female), of which 32 had a history of mood disorders (recurrent: n = 3, single: n = 29). Results showed a credible bidirectional relationship between step count and PA (step count → PA: β = 0.06; 95% credibility interval [CrI], 0.02–0.09; PA → step count: β = .07; 95% CrI, 0.03–0.11), while NA exhibited no credible associations. Higher PA predicted decreased screen-on time ( β = −.05; 95% CrI, −0.08 to −0.02), while increased screen-on time was associated with subsequent elevated NA ( β = .03; 95% CrI, 0.01–0.06). Familial risk status and recurrent mood disorders did not alter these bidirectional effects, but were associated with lower PA and higher NA on average (all p < 0.001). Conclusions: Findings highlight PA as a key driver in the interplay between behavior and affect. Supporting PA through increased activity may help improve daily emotional experiences, even in those with elevated mood disorder risk.

This longitudinal study within the Generation R cohort (n = 1,085) examined how maternal, child, and contextual factors relate to maternal sensitivity across childhood. Maternal sensitivity was observed at child ages 1, 3, 4, and 10 using the Ainsworth and Erickson scales. Predictors included maternal history of childhood maltreatment, family functioning, prenatal psychopathology, child temperament, genetic predisposition to psychopathology, marital status, and education. Linear mixed-effects models revealed that no maternal, child, or contextual characteristics predicted baseline levels or linear changes in maternal sensitivity from ages 1 to 10 after correcting for multiple testing. However, post-hoc analysis identified a nonlinear decline in sensitivity, ocurring primarily during the child's first four years. Sensitivity analyses for ages 1 to 4 similarly showed no significant predictors, except child sex: mothers exhibted higher sensitivity toward daughters. Overall, maternal sensitivity appears largely independent of these background factors, highlighting the need for further replication beyond infancy.

BACKGROUND Over 17% of children in the Netherlands live with a chronic illness. They are at risk of developing mental health problems, affecting quality of life and health outcomes. OBJECTIVE This study evaluates a preventive, transdiagnostic mobile health intervention, the Grow It! app, aiming to enhance overall well being by creating emotional insight and reflection, whilst encouraging the use of adaptive coping strategies. METHODS Using a randomised waitlist controlled design, adolescents aged 10–18 years with a chronic somatic illness were recruited through a university medical hospital and randomised to a waitlist control group or an intervention group that used the Grow It! app. Follow up assessments were conducted immediately after the four week intervention period and three months later. After the final follow-up, the waitlist control group also used the Grow It! app and completed questionnaires immediately after and three months later. Primary outcome measures were symptoms of anxiety and depression. Data were analysed with linear mixed models on an intention-to-treat basis. RESULTS Between August 2021 and September 2023, 208 participants were enrolled (Mage=13.96, SD=2.20, 57.69% female), with 105 randomised to the Grow It! intervention group and 103 to the waitlist control group. At the overall group level, symptoms of anxiety (χ2(3, 497.01)=2.08, p=.1021) and depression (χ²(3, 497.01)=0.71, p=.5459) remained stable over time, indicating no significant change across the full sample. However, among adolescents who used the Grow It! app, adolescents with elevated anxiety/depressive at baseline demonstrated the greatest benefit, showing larger symptom reductions than those who initially reported low symptom levels. CONCLUSIONS These findings suggest that the Grow It! app may offer meaningful benefits for adolescents with a chronic somatic illness experiencing elevated mood and anxiety symptoms, highlighting its potential value as a preventive and supportive tool in paediatric healthcare. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN) 17883961; https://doi.org/10.1186/ISRCTN17883961

Background: Over 17% of children in the Netherlands live with a chronic illness. They are at risk of developing mental health problems, affecting quality of life and health outcomes. This study evaluates a preventive, transdiagnostic mobile health intervention, the Grow It! app, aiming to enhance overall well being by creating emotional insight and reflection, whilst encouraging the use of adaptive coping strategies.Methods: Using a randomised waitlist controlled design, adolescents aged 10–18 years with a chronic somatic illness were recruited through a university medical hospital and randomised to a waitlist control group or an intervention group that used the Grow It! app. Follow up assessments were conducted immediately after the four week intervention period and three months later. After the final follow-up, the waitlist control group also used the Grow It! app and completed questionnaires immediately after and three months later. Primary outcome measures were symptoms of anxiety and depression. Data were analysed with linear mixed models on an intention-to-treat basis.Findings: Between August 2021 and September 2023, 208 participants were enrolled (Mage=13.96, SD=2.20, 57.69% female), with 105 randomised to the Grow It! intervention group and 103 to the waitlist control group. At the overall group level, symptoms of anxiety (χ2(3, 497.01)=2.08, p=.1021) and depression (χ²(3, 497.01)=0.71, p=.5459) remained stable over time, indicating no significant change across the full sample. However, among adolescents who used the Grow It! app, adolescents with elevated anxiety/depressive at baseline demonstrated the greatest benefit, showing larger symptom reductions than those who initially reported low symptom levels..Interpretation: These findings suggest that the Grow It! app may offer meaningful benefits for adolescents with a chronic somatic illness experiencing elevated mood and anxiety symptoms, highlighting its potential value as a preventive and supportive tool in paediatric healthcare.

Objectives: Associations between physical activity and affect (activity‐affect dynamics) vary among individuals for which reasons remain unclear. We examined whether such heterogeneity is explained by psychiatric status or sociodemographic, clinical, and ambulatory assessment characteristics. Methods: Two‐week ambulatory assessment data of 300 participants with current ( n = 79), subthreshold ( n = 67), and no ( n = 154) depressive and/or anxiety disorders or symptoms were obtained from the Netherlands Study of Depression and Anxiety. Positive and negative affect (PA/NA) were assessed with ecological momentary assessment (5xdaily) and physical activity using actigraphy. Group iterative multiple model estimation was used to model associations shared across the sample, psychiatric subgroups, and those specific to individuals. Results: No activity‐affect associations were shared across the sample (i.e., present in > 75% of all individuals) or psychiatric subgroups (i.e., present in > 51% of individuals within subgroups). Nevertheless, 45% of participants had at least one activity‐affect association, with considerable heterogeneity in their nature. The most frequent association was a positive contemporaneous association between physical activity and PA (present in 25% of the sample). Conclusions: These findings suggest large heterogeneity in activity‐affect dynamics among individuals and underscore the importance of considering the unique dynamics of the individual.

Objectives: Three clinical staging models for bipolar disorder (BD) have been published, each with a different but complementary approach and focus. The International Society for Bipolar Disorders Staging Task Force aimed to integrate these models into one comprehensive three‐dimensional staging model, separately rating bipolar spectrum, nonmood psychopathology, and (inter‐episodic) functional impairment. Method: Via a series of in‐person and online meetings, Delphi‐surveys, and email discussions, the task force members step‐by‐step reached consensus on the overall structure of the model and the definition of the various stages. Results: The resulting BD staging model describes the progression of mood psychopathology, nonmood psychopathology, and functional impairment in three independently rated dimensions. The stages of the mood psychopathology are M0 (at risk for BD having a 1st or 2nd degree family member with BD); M1 (prodromal); M2 (first episode classifying for BD‐I or BD‐II); M3 (recurrent BD); and M4 (chronic unremitting BD), with various substages. Single or recurrent major depression in persons at familial risk for BD is positioned in stage M1. The stages for nonmood psychopathology are: N0 (no symptoms); N1 (subsyndromal symptoms); N2 (one nonmood disorder); N3 (two nonmood disorders); N4 (three or more nonmood disorders). The stages for functional impairment are: F0 (no); F1 (mild); F2 (moderate); F3 (marked); and F4 (severe impairment). Fictitious case vignettes are presented to demonstrate how to apply the model. Limitations of clinical staging are discussed. Conclusion: The proposed three‐dimensional clinical staging model for illness progression comprehensively captures the complexity of illness presentation and heterogeneous illness progression in BD, including psychiatric comorbidities and degree of functional impairment. The model provides a framework that requires validation in research and clinical practice.

Objective: Bipolar disorder (BD) often emerges during mid‐adolescence and young adulthood, and leads to functional and social impairment, with a prevalence of 0.87% among Dutch youth. Lithium, the first‐line BD maintenance treatment, stabilizes mood, prevents suicide, and is well tolerated, yet its use has declined as long‐term second‐generation antipsychotics (SGAs) prescriptions increased. This study explores the prevalence, incidence, duration, prior and concurrent use of psychotropic medications, and dosage patterns of lithium dispensing in Dutch youth. Method: A retrospective cohort study using the Dutch community pharmacy‐based IADB.nl database included 567 youths (6–25 years), who were dispensed lithium between 2011 and 2022. Results: The yearly prevalence of lithium dispensing per 100,000 fluctuated between 30.3 in 2011 and 34.8 in 2022 ( p = 0.40), with the lowest prevalence in 6–12‐year‐olds and highest in 20–25‐year‐olds. Females had overall higher prevalence rates than males ( p = 0.03). Overall incidence rose from 7.9 to 9.3 ( p = 0.68). In 2011, incidence was 10.7 for both the 13–19 and 20–25 age groups. By 2022, this decreased to 4.2 in 13–19‐year‐olds and increased to 19.0 in 20–25‐year‐olds. Approximately 55% of individuals received other psychotropics before lithium, and 52% concurrently, with SGAs and antidepressants being most commonly dispensed. Conclusion: Despite lithium's efficacy and status as first‐line BD maintenance treatment, its dispensing in Dutch youth remains low compared to the BD prevalence. This may be due to misdiagnosis of BD and/or clinicians' reluctance to prescribe lithium, highlighting the need for improved diagnostics, clinician education, and further research into lithium's safety in youths.