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Speed BC, Nelson BD, Perlman G, Klein DN, Kotov R, Hajcak G. Personality and emotional processing: A relationship between extraversion and the late positive potential in adolescence. Psychophysiology 2015; 52:1039-47. [PMID: 25847353 DOI: 10.1111/psyp.12436] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
Abstract
Neuroticism and extraversion are multifaceted affective-laden personality traits that have been associated with major depressive disorder (MDD). Research and theory have argued that extraversion, and particularly its facet positive emotionality, is specific to MDD, while neuroticism is common across internalizing disorders. Converging evidence has suggested that MDD is associated with reduced engagement with emotional stimuli, but it remains unclear whether either extraversion, neuroticism, or both modulate reactivity to emotional cues. The late positive potential (LPP) is an event-related brain potential that is uniquely suited to assess engagement with emotional stimuli because it reflects sustained attention toward emotional content. The current study examined the LPP in relation to personality traits that may confer risk for depression by examining the relationship between the LPP and both neuroticism and extraversion in never-depressed adolescent girls. Specifically, 550 girls aged 13.5-15.5 with no lifetime history of depression completed an emotional picture-viewing task, and the LPP was measured in response to neutral, pleasant, and unpleasant pictures. Personality traits were gathered via self- and informant report. Results indicated that high extraversion was associated with a potentiated LPP to emotional pictures-and this effect was accounted for by positive emotionality in particular. In contrast, there was no association between the LPP and neuroticism or its facets. The present study is one of the first to demonstrate that extraversion is associated with variation in neural indices of emotional picture processing, similar to what has been observed among individuals with depression and at high risk for depression.
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Hershenberg R, Olino TM, Dyson MW, Davila J, Klein DN. Are personality disorder dimensions related over time? An examination over the course of ten years using multivariate growth modeling. Compr Psychiatry 2015; 58:11-7. [PMID: 25659664 PMCID: PMC4369444 DOI: 10.1016/j.comppsych.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/24/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Despite the well-documented literature on cross-sectional comorbidity, there is a paucity of data on the associations between personality disorders (PDs) over time. Using multivariate growth modeling, the present study examined the inter-relationships between pairs of PD disorder dimensions. METHODS We tested these associations in a sample of 142 depressed outpatients followed-up five times over the course of 10 years. RESULTS We found cross-sectional associations between the initial levels of severity of many pairs of PD dimensions. However, there was limited support for longitudinal associations between PD dimensions. CONCLUSION These findings suggest that the course of PD dimensions is fairly independent of each other, and that initial levels of PD dimensions have relatively little prognostic value for predicting the course of other PD dimensions.
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Meyer A, Hajcak G, Torpey-Newman DC, Kujawa A, Klein DN. Enhanced error-related brain activity in children predicts the onset of anxiety disorders between the ages of 6 and 9. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:266-74. [PMID: 25643204 DOI: 10.1037/abn0000044] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Considering that anxiety disorders frequently begin before adulthood and often result in chronic impairment, it is important to characterize the developmental pathways leading to the onset of clinical anxiety. Identifying neural biomarkers that can predict the onset of anxiety in childhood may increase our understanding of the etiopathogenesis of anxiety, as well as inform intervention and prevention strategies. An event-related potential (ERP), the error-related negativity (ERN), has been proposed as a biomarker of risk for anxiety and has previously been associated with anxiety in both adults and children. However, no previous study has examined whether the ERN can predict the onset of anxiety disorders. In the current study, ERPs were recorded while 236 healthy children, approximately 6 years of age, performed a go/no-go task to measure the ERN. Three years later, children and parents came back to the lab and completed diagnostic interviews regarding anxiety disorder status. Results indicated that enhanced error-related brain activity at age 6 predicted the onset of new anxiety disorders by age 9, even when controlling for baseline anxiety symptoms and maternal history of anxiety. Considering the potential utility of identifying early biomarkers of risk, this is a novel and important extension of previous work.
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Abstract
Self-reports are the most relied on assessment method in psychology. In the area of personality, informant-reports are a reasonable alternative assessment strategy. However, agreement between self- and informant-reports of personality is only moderately good. A portion of the observed discrepancies between self- and informant-reports of personality may come from differences in psychometric measurement across raters. That is, it is unknown whether the constructs assessed via self- and informant-reports are psychometrically identical. We examined four key personality scales--Well-Being, Social Closeness, Stress Reaction, and Harm Avoidance--in male and female dyads who provided self- and informant-reports for their partner. Similarities in self- and informant-reports of personality were evaluated by testing measurement invariance. Overall, models supported configural, metric, and scalar invariance for each of the four personality dimensions. These results suggest that the same psychometric constructs are assessed via self- and informant-reports of these personality dimensions. Informant-reports can be used in studies to avoid biases from relying solely on self-reports.
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Kujawa A, Proudfit GH, Kessel EM, Dyson M, Olino T, Klein DN. Neural reactivity to monetary rewards and losses in childhood: longitudinal and concurrent associations with observed and self-reported positive emotionality. Biol Psychol 2015; 104:41-7. [PMID: 25433097 PMCID: PMC4300239 DOI: 10.1016/j.biopsycho.2014.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 08/06/2014] [Accepted: 11/18/2014] [Indexed: 11/21/2022]
Abstract
Reward reactivity and positive emotion are key components of a theoretical, early-emerging approach motivational system, yet few studies have examined associations between positive emotion and neural reactivity to reward across development. In this multi-method prospective study, we examined the association of laboratory observations of positive emotionality (PE) at age 3 and self-reported positive affect (PA) at age 9 with an event-related potential component sensitive to the relative response to winning vs. losing money, the feedback negativity (ΔFN), at age 9 (N=381). Males had a larger ΔFN than females, and both greater observed PE at age 3 and self-reported PA at age 9 significantly, but modestly, predicted an enhanced ΔFN at age 9. Negative emotionality and behavioral inhibition did not predict ΔFN. Results contribute to understanding the neural correlates of PE and suggest that the FN and PE may be related to the same biobehavioral approach system.
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Farmer RF, Kosty DB, Seeley JR, Duncan SC, Lynskey MT, Rohde P, Klein DN, Lewinsohn PM. Natural course of cannabis use disorders. Psychol Med 2015; 45:63-72. [PMID: 25066537 PMCID: PMC4229487 DOI: 10.1017/s003329171400107x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite its importance as a public health concern, relatively little is known about the natural course of cannabis use disorders (CUDs). The primary objective of this research was to provide descriptive data on the onset, recovery and recurrence functions of CUDs during the high-risk periods of adolescence, emerging adulthood and young adulthood based on data from a large prospective community sample. METHOD Probands (n = 816) from the Oregon Adolescent Depression Project (OADP) participated in four diagnostic assessments (T1-T4) between the ages of 16 and 30 years, during which current and past CUDs were assessed. RESULTS The weighted lifetime prevalence of CUDs was 19.1% with an average onset age of 18.6 years. Although gender was not significantly related to the age of initial CUD onset, men were more likely to be diagnosed with a lifetime CUD. Of those diagnosed with a CUD episode, 81.8% eventually achieved recovery during the study period. Women achieved recovery significantly more quickly than men. The recurrence rate (27.7%) was relatively modest, and most likely to occur within the first 36 months following the offset of the first CUD episode. CUD recurrence was uncommon after 72 months of remission and recovery. CONCLUSIONS CUDs are relatively common, affecting about one out of five persons in the OADP sample prior to the age of 30 years. Eventual recovery from index CUD episodes is the norm, although about 30% of those with a CUD exhibit a generally persistent pattern of problematic use extending 7 years or longer.
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Goldstein BL, Hayden EP, Klein DN. Stability of self-referent encoding task performance and associations with change in depressive symptoms from early to middle childhood. Cogn Emot 2014; 29:1445-55. [PMID: 25530070 DOI: 10.1080/02699931.2014.990358] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Depressed individuals exhibit memory biases on the self-referent encoding task (SRET), such that those with depression exhibit poorer recall of positive, and enhanced recall of negative, trait adjectives (referred to as positive and negative processing biases). However, it is unclear when SRET biases emerge, whether they are stable, and if biases predict, or are predicted by, depressive symptoms. To address this, a community sample of 434 children completed the SRET and a depressive symptoms measure at ages 6 and 9. Negative and positive processing exhibited low, but significant, stability. At ages 6 and 9, depressive symptoms correlated with higher negative, and lower positive, SRET processing. Importantly, lower positive processing at age 6 predicted increased symptoms at age 9. However, negative processing at age 6 did not predict depressive symptoms at age 9, and depressive symptoms at age 6 did not predict SRET processing scores at age 9. This suggests that less positive processing may reflect vulnerability for future depressive symptoms.
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208
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Bufferd SJ, Dougherty LR, Olino TM, Dyson MW, Laptook RS, Carlson GA, Klein DN. Predictors of the onset of depression in young children: a multi-method, multi-informant longitudinal study from ages 3 to 6. J Child Psychol Psychiatry 2014; 55:1279-87. [PMID: 24828086 PMCID: PMC4197104 DOI: 10.1111/jcpp.12252] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite growing interest in depression in young children, little is known about which variables predict the onset of depression in early childhood. We examined a range of predictors of the onset of depression diagnoses in a multi-method, multi-informant longitudinal study of a large community sample of young children from ages 3 to 6. METHODS Predictors of the onset of depression at age 6 were drawn from five domains assessed when children were 3 years old: child psychopathology (assessed using a parent diagnostic interview), observed child temperament, teacher ratings of peer functioning, parental psychopathology (assessed using a diagnostic interview), and psychosocial environment (observed parental hostility, parent-reported family stressors, parental education). RESULTS A number of variables predicted the onset of depression by age 6, including child history of anxiety disorders, child temperamental low inhibitory control, poor peer functioning, parental history of mood, anxiety, and substance use disorders, early and recent stressful life events, and less parental education. CONCLUSIONS Predictors of the onset of depression in early childhood tend to be similar to those identified in older youth and adults, and support the feasibility of identifying children in greatest need for early intervention.
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Dunlop BW, Hill E, Johnson BN, Klein DN, Gelenberg AJ, Rothbaum BO, Thase ME, Kocsis JH. Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse. J Sex Med 2014; 12:813-23. [PMID: 25329963 DOI: 10.1111/jsm.12727] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables. AIM We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults. METHODS Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling. MAIN OUTCOME MEASURES The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships. RESULTS CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality. CONCLUSIONS Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.
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Kujawa A, Arfer KB, Klein DN, Proudfit GH. Electrocortical reactivity to social feedback in youth: a pilot study of the Island Getaway task. Dev Cogn Neurosci 2014; 10:140-7. [PMID: 25212683 PMCID: PMC4254368 DOI: 10.1016/j.dcn.2014.08.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 10/27/2022] Open
Abstract
Peer relationships become a major concern in adolescence, yet event-related potential (ERP) measures of reactivity to social feedback in adolescence are limited. In this pilot study, we tested a novel task to elicit reactivity to social feedback in youth. Participants (10-15 years old; 57.9% male; N=19) played a game that involved exchanging personal information with peers, voting to remove players from the game, and receiving rejection and acceptance feedback from peers. Results indicated that participants modified their voting behavior in response to peer feedback, and rejection feedback was associated with a negativity in the ERP wave compared to acceptance (i.e., the feedback negativity, FN). The FN predicted behavioral patterns, such that participants who showed greater neural reactivity to social feedback were less likely to reject co-players. Preliminary analyses suggest that the task may be a useful measure of individual differences: adolescents higher in social anxiety symptoms were less likely to reject peers and showed an enhanced FN to rejection vs. acceptance feedback, and higher depressive symptoms predicted an increased FN to rejection specifically. Results suggest that the FN elicited by social feedback may be a useful, economical neural measure of social processing across development and in clinical research.
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Kujawa A, Proudfit GH, Laptook R, Klein DN. Early Parenting Moderates the Association between Parental Depression and Neural Reactivity to Rewards and Losses in Offspring. Clin Psychol Sci 2014; 3:503-515. [PMID: 26167423 DOI: 10.1177/2167702614542464] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Children of parents with depression exhibit neural abnormalities in reward processing. Examining contributions of parenting could provide insight into the development of these abnormalities and to the etiology of depression. We evaluated whether early parenting moderates the effects of parental depression on a neural measure of reward and loss processing in mid-late childhood. Parenting was assessed when children were preschoolers. At age nine, children completed an event-related potential assessment and the feedback negativity (FN) was measured following rewards and losses (N=344). Maternal authoritative parenting moderated the effect of maternal depression; among offspring of mothers with histories of depression, low authoritative parenting predicted a blunted FN. Observed maternal positive parenting interacted with paternal depression in a comparable manner, indicating that maternal parenting may buffer the effects of paternal depression. Early parenting may be important in shaping the neural systems involved in reward processing among children at high risk for depression.
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Goldstein BL, Klein DN. A review of selected candidate endophenotypes for depression. Clin Psychol Rev 2014; 34:417-27. [PMID: 25006008 DOI: 10.1016/j.cpr.2014.06.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 06/08/2014] [Accepted: 06/12/2014] [Indexed: 12/13/2022]
Abstract
Endophenotypes are proposed to occupy an intermediate position in the pathway between genotype and phenotype in genetically complex disorders such as depression. To be considered an endophenotype, a construct must meet a set of criteria proposed by Gottesman and Gould (2003). In this qualitative review, we summarize evidence for each criterion for several putative endophenotypes for depression: neuroticism, morning cortisol, frontal asymmetry of cortical electrical activity, reward learning, and biases of attention and memory. Our review indicates that while there is strong support for some depression endophenotypes, other putative endophenotypes lack data or have inconsistent findings for core criteria.
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Meyer A, Hajcak G, Torpey DC, Kujawa A, Kim J, Bufferd S, Carlson G, Klein DN. Increased error-related brain activity in six-year-old children with clinical anxiety. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 41:1257-66. [PMID: 23700171 DOI: 10.1007/s10802-013-9762-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Anxiety disorders are the most frequently diagnosed form of psychopathology in children and often result in chronic impairment that persists into adulthood. Identifying neurobehavioral correlates of anxiety that appear relatively early in life would inform etiological models of development and allow intervention and prevention strategies to be implemented more effectively. The error-related negativity (ERN), a negative deflection in the event-related potential at fronto-central sites approximately 50 ms following the commission of errors, has been consistently found to be larger among anxious adults. The current study sought to extend these findings to even younger individuals: the ERN was elicited by a Go/NoGo task in 48 six year-old children with a clinical anxiety disorder assessed by diagnostic interview and 48 age-matched controls. In addition to child anxiety disorder, the ERN was examined in relation to maternal history of anxiety disorder, which was previously related to a smaller ERN. Anxious children were characterized by a larger (i.e., more negative) ERN and maternal history of anxiety disorder was associated with a smaller ERN. Thus, the relationship between an increased ERN and clinical anxiety is evident by age 6, and this effect appears independent from an opposing influence of maternal anxiety history on the ERN. These findings support the ERN as a promising neurobehavioral marker of anxiety, and implications are discussed.
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Hill RM, Pettit JW, Lewinsohn PM, Seeley JR, Klein DN. Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk. J Affect Disord 2014; 158:133-8. [PMID: 24655777 PMCID: PMC4052553 DOI: 10.1016/j.jad.2014.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. METHODS Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. RESULTS Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. LIMITATIONS Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. CONCLUSIONS Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs.
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Abstract
There are two divergent viewpoints on the phenomenology and outcome of bipolar I (BP I) disorder in youth. Disparities evolved as unintended consequences from investigators' inconsistencies both in translating the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, and DSM-IV criteria and in operationalizing them differently in their standardized assessments. Rates of conservatively diagnosed BP I are lower both in community studies of youths than in adults and from liberally defined BP I in youths. Rates of co-occurring attention-deficit hyperactivity disorder (ADHD) are lower in conservatively than liberally defined children and adolescents with BP I. Rates of both BP I and of ADHD are lower in offspring of BP I probands, and outcome more closely approximates that of adults with BP I in conservatively versus liberally defined children and teens with BP I. Both perspectives can claim evidence for reliability and validity that support their positions. However, the samples are so different that it is difficult to compare studies conducted from these different perspectives.
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Dougherty LR, Smith VC, Olino TM, Dyson MW, Bufferd SJ, Rose SA, Klein DN. Maternal psychopathology and early child temperament predict young children's salivary cortisol 3 years later. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014. [PMID: 23192743 DOI: 10.1007/s10802-012-9703-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Neuroendocrine dysfunction is hypothesized to be an early emerging vulnerability marker for depression. We tested whether the main and interactive effects of maternal psychopathology and early child temperamental vulnerability for depression assessed at age three predicted offspring's basal cortisol function at age 6 years. 228 (122 males) children participated in the baseline and follow-up assessments. At age three, maternal lifetime psychopathology was assessed with a diagnostic clinical interview, and child temperamental positive affectivity (PA) and negative affectivity (NA) were assessed using laboratory observations. At age six, children's waking and evening cortisol were assessed on 2 days. Maternal lifetime anxiety predicted offspring's higher morning cortisol at age six. Child temperamental NA at age three predicted higher evening cortisol at age six. There was a significant interaction between maternal lifetime depression and child temperamental PA at age three in predicting offspring's morning cortisol at age six. For the offspring of mothers with lifetime depression, higher PA at age 3 predicted lower morning cortisol at age 6. These findings highlight the importance of examining the main and interactive effects of maternal psychopathology and early child temperamental vulnerability in predicting the development of offspring's stress physiology. Findings hold significance in identifying etiological mechanisms of risk and delineating the complex developmental pathways to psychopathology.
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Pettit JW, Hartley C, Lewinsohn PM, Seeley JR, Klein DN. Is liability to recurrent major depressive disorder present before first episode onset in adolescence or acquired after the initial episode? JOURNAL OF ABNORMAL PSYCHOLOGY 2013; 122:353-8. [PMID: 23713498 DOI: 10.1037/a0032655] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many individuals who experience a major depressive episode will subsequently develop recurrent episodes. Although numerous studies have investigated predictors of recurrent episodes, methodological limitations have made it difficult to determine the extent to which liability to recurrent major depressive disorder (rMDD) exists prior to first onset or develops after first onset. This study used a prospective design in a community sample of adolescents to examine variables before and after first onset MDD as predictors of rMDD over a 12-year follow-up. Among 59 adolescents who experienced first onset MDD, 72.88% developed rMDD during the follow-up period. Parental history of rMDD and lifetime history of minor depression prior to MDD onset significantly predicted rMDD. These two effects replicated in ancillary analyses in an expanded sample of N = 205. Following MDD onset, a higher number of major life events significantly predicted rMDD. Liability to rMDD exists prior to MDD onset in the form of familial risk and less severe mood disturbances, whereas liability to rMDD in the form of elevated stress may develop following a first onset in adolescence.
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Dougherty LR, Smith VC, Bufferd SJ, Stringaris A, Leibenluft E, Carlson GA, Klein DN. Preschool irritability: longitudinal associations with psychiatric disorders at age 6 and parental psychopathology. J Am Acad Child Adolesc Psychiatry 2013; 52:1304-13. [PMID: 24290463 PMCID: PMC3860177 DOI: 10.1016/j.jaac.2013.09.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/08/2013] [Accepted: 09/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is increasing scientific and clinical attention to chronic irritability in youth. However, little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of chronic irritability with psychiatric disorders and parental psychopathology in a large community sample of preschoolers. METHOD Four hundred sixty-two preschool-age children were assessed at 3 and 6 years of age. Child psychopathology was assessed at baseline (3 years) and follow-up (6 years) using a diagnostic interview, the Preschool Age Psychiatric Assessment, with parents. Items from the Preschool Age Psychiatric Assessment were used to create a dimensional measurement of chronic irritability. Parental psychopathology was assessed with a diagnostic interview at baseline. RESULTS Chronic irritability was concurrently associated with a wide range of psychiatric disorders and functional impairment at 3 and 6 years of age. Irritability at 3 years predicted depression, oppositional defiant disorder, and functional impairment at 6 years after controlling for baseline disorders. Irritability also was associated with parental depression and anxiety. CONCLUSIONS Findings underscore the central role of irritability in early-emerging mental health problems. They are consistent with longitudinal studies in older youth indicating that chronic irritability predicts later depression and anxiety and support the importance of early detection and interventions targeting preschool irritability.
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Danzig AP, Bufferd SJ, Dougherty LR, Carlson GA, Olino TM, Klein DN. Longitudinal associations between preschool psychopathology and school-age peer functioning. Child Psychiatry Hum Dev 2013; 44:621-32. [PMID: 23334266 PMCID: PMC4231779 DOI: 10.1007/s10578-012-0356-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current study examined the effects of preschool psychopathology on peer functioning around school entry. Children (N = 211) were assessed at ages 3 and 6. A semi-structured diagnostic interview, the Preschool Age Psychiatric Assessment, was administered to a parent at both time points to assess psychopathology. The peer functioning constructs examined at age 6 included child popularity, socially inappropriate behavior, and conflicted shyness. Simultaneous multiple regressions revealed that age 3 anxiety disorder diagnosis was the only unique diagnostic predictor of age 6 socially inappropriate behavior and conflicted shyness, with age 3 anxiety dimensional scores uniquely predicting all three peer constructs. Age 3 anxiety disorder had direct effects on both socially inappropriate behavior and conflicted shyness, which were not mediated by concurrent anxiety disorder at age 6. Thus, preschool anxiety disorders may have enduring effects on child peer relationships in the early school-age years. Possible explanations and implications are explored.
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Steidtmann D, Manber R, Blasey C, Markowitz JC, Klein DN, Rothbaum BO, Thase ME, Kocsis JH, Arnow BA. Detecting critical decision points in psychotherapy and psychotherapy + medication for chronic depression. J Consult Clin Psychol 2013; 81:783-92. [PMID: 23750462 PMCID: PMC3925064 DOI: 10.1037/a0033250] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We sought to quantify clinical decision points for identifying depression treatment nonremitters prior to end-of-treatment. METHOD Data came from the psychotherapy arms of a randomized clinical trial for chronic depression. Participants (n = 352; 65.6% female; 92.3% White; mean age = 44.3 years) received 12 weeks of cognitive behavioral analysis system of psychotherapy (CBASP) or CBASP plus an antidepressant medication. In half of the sample, receiver operating curve analyses were used to identify efficient percentage of symptom reduction cut points on the Inventory of Depressive Symptoms-Self-Report (IDS-SR) for predicting end-of-treatment nonremission based on the Hamilton Rating Scale for Depression (HRSD). Sensitivity, specificity, predictive values, and Cohen's kappa for identified cut points were calculated using the remaining half of the sample. RESULTS Percentage of IDS-SR symptom reduction at Weeks 6 and 8 predicted end-of-treatment HRSD remission status in both the combined treatment (Week 6 cut point = 50.0%, Cohen's κ = .42; Week 8 cut point = 54.3%, Cohen's κ = .45) and psychotherapy only (Week 6 cut point = 60.7%, Cohen's κ = .41; Week 8 cut point = 48.7%, Cohen's κ = .49). Status at Week 8 was more reliable for identifying nonremitters in psychotherapy-only treatment. CONCLUSIONS Those with chronic depression who will not remit in structured, time-limited psychotherapy for depression, either with therapy alone or in combination with antidepressant medication, are identifiable prior to end of treatment. Findings provide an operationalized strategy for designing adaptive psychotherapy interventions.
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Torpey DC, Hajcak G, Kim J, Kujawa AJ, Dyson MW, Olino TM, Klein DN. Error-related brain activity in young children: associations with parental anxiety and child temperamental negative emotionality. J Child Psychol Psychiatry 2013; 54:854-62. [PMID: 23294040 PMCID: PMC3624051 DOI: 10.1111/jcpp.12041] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is increasing interest in error-related brain activity in anxiety disorders. The error-related negativity (ERN) is a negative deflection in the event-related potential approximately 50 ms after errors compared to correct responses. Recent studies suggest that the ERN may be a biomarker for anxiety, as it is positively associated with anxiety disorders and traits in adults and older youth. However, it is not known if the ERN in young children is related to risk for anxiety disorders. We addressed this by examining the association of six-year olds' ERNs with two established risk factors for anxiety: parental anxiety disorder and child temperamental negative emotionality (NE). METHOD The ERN was assessed using a Go/No-Go task in a community sample of 413 six-year olds. In a prior assessment at age 3, child temperament was evaluated using a laboratory observational measure and parental psychopathology was assessed using semi-structured diagnostic interviews. RESULTS Children of mothers with anxiety disorders and children with greater temperamental NE (particularly fearfulness) exhibited significantly smaller ERNs than their peers. Paternal psychopathology, maternal mood and substance use disorders, and child positive emotionality were not associated with children's ERNs. CONCLUSION Both maternal anxiety disorders and child NE (particularly fearfulness) were significantly associated with children's ERNs. However, the direction of these associations was opposite to the relations between ERNs and anxiety in older youth and adults. These results suggest that there may be a difference between risk and disorder status in the relation of error-related brain activity to anxiety between early childhood and late childhood/ early adolescence.
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Arnow BA, Steidtmann D, Blasey C, Manber R, Constantino MJ, Klein DN, Markowitz JC, Rothbaum BO, Thase ME, Fisher AJ, Kocsis JH. The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. J Consult Clin Psychol 2013; 81:627-38. [PMID: 23339536 PMCID: PMC3742444 DOI: 10.1037/a0031530] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving cognitive behavioral analysis system of psychotherapy (CBASP) vs. brief supportive psychotherapy (BSP). METHOD 395 adults (57% female; Mage = 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16-20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at Weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at 2-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change. RESULTS A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) = 62.48, p < .001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1, 1234) = 8.31, p = .004. CONCLUSIONS The results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression. Contrary to expectations, the therapeutic alliance was more strongly related to outcome in CBASP, the more directive of the 2 therapies.
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Kujawa A, Klein DN, Proudfit GH. Two-year stability of the late positive potential across middle childhood and adolescence. Biol Psychol 2013; 94:290-6. [PMID: 23872165 DOI: 10.1016/j.biopsycho.2013.07.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/26/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
The late positive potential (LPP) may be a useful measure of individual differences in emotional processing across development, but little is known about the stability of the LPP across time. We assessed the LPP and behavioral measures of emotional interference following pleasant, unpleasant, and neutral images in 8- to 13-year-old youth. Approximately two years later, the same participants completed the task again (N=34). Results indicated that the LPP is moderately-to-highly reliable across development. Stability was lower and more inconsistent for behavioral measures. In addition, consistent with previous cross-sectional analyses, a decrease in occipital activity was observed at the second assessment. Results indicate that the LPP appears to be a stable measure of emotional processing, even across a fairly large period of development.
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Sheikh HI, Kryski KR, Smith HJ, Dougherty LR, Klein DN, Bufferd SJ, Singh SM, Hayden EP. Catechol-O-methyltransferase gene val158met polymorphism and depressive symptoms during early childhood. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:245-52. [PMID: 23475824 PMCID: PMC5288403 DOI: 10.1002/ajmg.b.32141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/04/2013] [Indexed: 11/08/2022]
Abstract
Catechol-O-Methyltransferase (COMT) is a critical regulator of catecholamine levels in the brain. A functional polymorphism of the COMT gene, val158met, has been linked to internalizing symptoms (i.e., depression and anxiety) in adolescents and adults. We extended this research by investigating whether the val158met polymorphism was associated with childhood symptoms of depression and anxiety in two independent samples of young children (Ns = 476 and 409). In both samples, preschool-aged children were genotyped for the COMT val158met polymorphism. Symptoms of psychopathology were assessed via parent interviews and primary caregiver reports. In both samples, children homozygous for the val allele had higher levels of depressive symptoms compared to children with at least one copy of the met allele. Our findings extend previous research in older participants by showing links between the COMT val158met polymorphism and internalizing symptoms in early childhood.
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Kryski KR, Dougherty LR, Dyson MW, Olino TM, Laptook RS, Klein DN, Hayden EP. Effortful control and parenting: associations with HPA axis reactivity in early childhood. Dev Sci 2013; 16:531-41. [PMID: 23786471 DOI: 10.1111/desc.12050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 12/27/2012] [Indexed: 12/01/2022]
Abstract
While activation of the hypothalamic-pituitary-adrenal (HPA) axis is an adaptive response to stress, excessive HPA axis reactivity may be an important marker of childhood vulnerability to psychopathology. Parenting, including parent affect during parent-child interactions, may play an important role in shaping the developing HPA system; however, the association of parent affect may be moderated by child factors, especially children's emerging self-regulatory skills. We therefore tested the relationship between parent affectivity and 160 preschoolers' cortisol reactivity during a laboratory visit, examining children's effortful control (EC) as a moderator. Greater parent negative affectivity was related to greater initial and increasing cortisol over time, but only when children were low in EC. Higher parent positive affectivity was related to a higher baseline cortisol for children with low EC and lower baseline cortisol for children with high EC. Results indicate that children's EC moderates the extent to which parent affect shapes stress reactive systems in early childhood.
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