12 Chapter 1 experienced anxiety and/or depression throughout their lives (Copeland et al., 2014; Kessler et al., 2005; Kessler & Walters, 1998). Most concerning is that mental health problems among older adolescents and young adults have been increasing over the past decades (Centraal Bureau voor de Statistiek, 2018; Collishaw et al., 2010; Schoemaker et al., 2019), as well as more recently due to the Covid-19 pandemic (Al Omari et al., 2020; A. Knopf, 2020; Rauschenberg et al., 2021; Salari et al., 2020). Anxiety and depression have been associated with detrimental short- and long-term consequences for the individual (Balázs et al., 2013; World Health Organization, 2001), such as academic underachievement (Owens et al., 2012; Woodward & Fergusson, 2001), problems in social and family functioning (Hoglund & Chisholm, 2014; Woodward & Fergusson, 2001), increased risk for substance (ab)use and dependence (Merikangas et al., 1998; Woodward & Fergusson, 2001), suicidal behaviour (Bolton et al., 2008; Glied & Pine, 2002), other psychopathology (Lavigne et al., 2015; Priddis et al., 2014), unemployment (Fergusson et al., 2001), and early parenthood (Fergusson & Woodward, 2002). These negative outcomes have not only been associated with clinical anxiety and depressive disorders, but also subclinical levels of anxiety and depressive symptoms cause significant distress and impair youth’s functioning in multiple domains (Balázs et al., 2013; Roza et al., 2003). Moreover, subclinical anxiety and depressive symptoms put individuals at significant risk for later development of full-blown anxiety and depressive disorders (Aalto-Setälä et al., 2002; Copeland et al., 2014; Lewinsohn et al., 2000; D. S. Pine et al., 1999). Besides individual consequences, (subclinical) anxiety and depression also have societal consequences. They are the leading cause of disability among youth (GBD Mental Disorders Collaborators, 2022; Gore et al., 2011; World Health Organization, 2021) and impose an enormous burden on health care costs (Bodden et al., 2008) and other (indirect) societal costs, such as absenteeism at work, sick leave and incapacity for work (Meijer et al., 2006; Smit et al., 2006). It is known that untreated symptoms persist into adulthood, and that recurrence and chronic courses of anxiety and depression are common (Asselmann & Beesdo-Baum, 2015; Kovacs et al., 2016; Reef et al., 2009), continuing to affect youth’s daily life and increasing risk for further health issues (Balázs et al., 2013; Essau et al., 2002). Given the high rates of anxiety and depressive symptoms in youth, as well as their severe impact on individuals’ daily and future functioning and economic consequences, it is of critical importance to prevent these symptoms from exacerbating in to full-blown disorders.
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