Baseline Well-Being Predicts Response to Adolescent Emotional Risk Intervention

Adolescents with lower initial quality of life show higher response rates to personalized preventive interventions for emotional disorders.

For Doctors in a Hurry

Clinicians lack clear guidance on which adolescents at emotional risk will benefit from personalized preventive mental health interventions.
The study analyzed 233 adolescents aged 12 to 18 years using latent profile analysis to categorize emotional risk levels.
Post-intervention, 56.4 percent of participants achieved a respondent profile characterized by low emotional risk and high resilience.
The researchers concluded that baseline quality of life significantly influences the probability of positive response to the intervention.
Physicians should assess subjective quality of life to tailor preventive strategies for adolescents at risk of emotional problems.

Predicting Intervention Response in Adolescent Emotional Disorders

Emotional disorders in adolescents represent a substantial clinical burden, frequently arising from early maltreatment or complex environmental stressors [1]. Transdiagnostic cognitive behavioral therapy has emerged as a robust strategy to address shared psychological mechanisms across anxiety and depression, demonstrating significant improvements in adolescent functioning with a standardized mean difference of -0.56 [2]. While these interventions aim to bolster resilience and emotion regulation, the high rate of comorbidity and heterogeneous presentations in this age group complicate treatment planning [3]. Recent evidence suggests that integrating emotional intelligence training into clinical settings can significantly impact the prevention of these disorders by enhancing subjective well-being [4]. A new study now examines how pre-intervention well-being profiles dictate the likelihood of a successful transition from at-risk status to clinical recovery.

Baseline Stratification of Emotional Risk

The researchers evaluated a cohort of 233 adolescents aged 12 to 18 years who were clinically identified as being at emotional risk for developing internalizing disorders. This population participated in the PROCARE+ program, which is a personalized, transdiagnostic, selective preventive intervention designed to mitigate the development of emotional disorders by targeting shared psychological mechanisms. Unlike universal prevention strategies, this selective approach focuses specifically on individuals demonstrating early indicators of vulnerability, aiming to bolster resilience before clinical thresholds for diagnosis are met. To categorize the participants before the intervention, the study utilized Latent Profile Analysis (a statistical method used to identify subgroups within a population based on shared characteristics rather than a single symptom score). This analysis identified two distinct baseline profiles among the 233 participants based on their psychological presentation. The majority of the sample, comprising 77.7 percent of the adolescents, was classified into Baseline Profile 1, which was characterized by moderate emotional risk and a positive quality of life. In contrast, the remaining 22.3 percent of the cohort fell into Baseline Profile 2, defined by moderate emotional risk coupled with a low quality of life. These baseline classifications provided a framework for measuring how initial subjective well-being, a patient's self-reported perception of their position in life and general health, influences the subsequent efficacy of the preventive measures.

Characterizing Clinical Response and Non-Response

Following the completion of the PROCARE+ intervention, the researchers utilized Latent Profile Transition Analysis (a longitudinal statistical technique that tracks how individuals move between different risk or health categories over time) to evaluate the outcomes. After the intervention, two distinct post-treatment profiles emerged from the data, providing a clear framework for distinguishing between those who benefited from the preventive measures and those who did not. The respondent profile accounted for 56.4 percent of the sample, representing more than half of the adolescents who participated in the study. This group demonstrated a successful shift toward psychological stability, as the respondent profile was characterized by low emotional risk along with high levels of resilience, emotion regulation, and quality of life. For clinicians, this profile represents the ideal outcome of a preventive intervention, where the individual not only avoids a clinical diagnosis but also gains the psychological tools necessary for long-term stability. In contrast, a significant portion of the cohort did not achieve the same level of improvement. The non-respondent profile accounted for 43.6 percent of the sample, indicating that nearly four out of ten adolescents remained at elevated risk despite the intervention. This non-respondent profile was marked by the presence of risk for developing emotional problems and lower levels of resilience, emotion regulation, and quality of life compared to their responding peers. These findings are clinically significant because they suggest that a standard transdiagnostic approach may not be sufficient for all at-risk youth. By identifying the specific characteristics of non-responders, such as persistent deficits in emotion regulation (the ability to monitor, evaluate, and modify emotional reactions), physicians can better understand which patients may require more intensive or specialized follow-up care to prevent the onset of formal emotional disorders.

The Quality of Life Paradox in Treatment Transition

To understand how individual clinical trajectories evolved during the PROCARE+ intervention, the researchers employed Latent Profile Transition Analysis to map the movement of participants between risk categories. This analysis revealed four distinct transition patterns among the 233 participants, illustrating the various paths adolescents took from their baseline risk status to their post-intervention clinical state. While the intervention aimed to move all participants into a healthy respondent profile, the data showed that the proportion of responders was similar across both initial baseline profiles, meaning that adolescents starting with moderate risk and positive quality of life were just as likely to reach the respondent category as those starting with low quality of life. However, a more complex picture emerged when examining those who did not reach the healthy respondent profile. The researchers found significant differences in the proportion of non-responders between the baseline groups, suggesting that initial well-being dictates the likelihood of intervention failure. In a counterintuitive finding, adolescents who reported low quality of life at baseline were more likely to move to the respondent profile after the intervention. Conversely, those who entered the study with a high quality of life at baseline were more likely to move to the non-respondent profile following the intervention. This suggests that a higher subjective sense of well-being at the outset may actually correlate with a diminished response to this specific transdiagnostic preventive protocol. These findings indicate that subjective quality of life before intervention impacts treatment response in a way that challenges traditional clinical assumptions. For the practicing physician, this suggests that an adolescent who appears to be functioning well despite moderate emotional risk may actually be at higher risk for intervention non-response. The data highlight a critical need to tailor preventive interventions based on at-risk adolescents' emotional and well-being profiles before the start of care. Patients presenting with high baseline quality of life may require different or more intensive intervention strategies to achieve the same level of resilience and emotion regulation as their peers who start with lower subjective well-being.

Study Info

Respondent and non-respondent profiles for at-risk adolescents following a personalised, transdiagnostic, selective preventive intervention

David Jiménez-Vázquez, Luis Joaquín García López, Laura Zafra-Palomino, Pilar Rico‐Bordera

Journal Journal of Affective Disorders

Published December 18, 2025