1201
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Qin B, Zhou X, Michael KD, Liu Y, Whittington C, Cohen D, Zhang Y, Xie P. Psychotherapy for depression in children and adolescents: study protocol for a systematic review and network meta-analysis. BMJ Open 2015; 5:e005918. [PMID: 25681311 PMCID: PMC4330321 DOI: 10.1136/bmjopen-2014-005918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Depression is common among children and adolescents and is associated with significantly negative effects. A number of structured psychosocial treatments are administered for depression in children and adolescents; however, evidence of their effectiveness is not clear. We describe the protocol of a systematic review and network meta-analysis to evaluate the efficacy, quality of life, tolerability and acceptability of the use of psychological intervention for this young population. METHODS AND ANALYSIS We will search PubMed, EMBASE, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS, Dissertation Abstracts, European Association for Grey Literature Exploitation (EAGLE) and the National Technical Information Service (NTIS) from inception to July 2014. There will be no restrictions on language, publication year or publication type. Only randomised clinical trials (RCTs) with psychosocial treatments for depression in children and adolescents will be considered. The primary outcome of efficacy will be the mean overall change of the total score in continuous depression severity scales from baseline to end point. Data will be independently extracted by two reviewers. Traditional pairwise meta-analyses will be performed for studies that directly compared different treatment arms. Then we will perform a Bayesian network meta-analyses to compare the relative efficacy, quality of life, tolerability and acceptability of different psychological intervention. Subgroup analyses will be performed by the age of participants and the duration of psychotherapy, and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. The results will be published in a peer-reviewed journal and disseminated electronically and in print. The meta-analysis may be updated to inform and guide management of depression in children and adolescents. TRIALS REGISTRATION NUMBER PROSPERO CRD42014010014.
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Affiliation(s)
- Bin Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Yiyun Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Craig Whittington
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - David Cohen
- Sorbonne Universités; and the Department of Child and Adolescent Psychiatry, Institut des Systèmes Intelligents et de Robotiques, UPMC Univ Paris 06, UMR 7222, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Yuqing Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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1202
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Abstract
This study assessed mental health literacy in Irish adolescents ( N = 187), and explored participants’ help-giving responses toward hypothetical depressed peers. Participants read five vignettes, each describing an adolescent experiencing a life difficulty; two of the characters met Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) criteria for depression. The majority of participants could not identify depression or potential suicidality, but felt concerned for the depressed characters’ well-being. Most participants stated they would provide help if they were the depressed characters’ friends. Correct identification of depression did not influence the type of help offered. A significant proportion of participants did not mention engaging an adult’s assistance, and assessing for suicidality was not mentioned by any participant. Gender differences were found in mental health literacy and the type of responses offered. Education that emphasizes the importance of informing an adult and assessing for suicidal risk is recommended.
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1203
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Archer J. Collaborative care improves clinical outcomes for adolescents with depression treated in primary care. EVIDENCE-BASED MEDICINE 2015; 20:20. [PMID: 25525043 DOI: 10.1136/ebmed-2014-110108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Janine Archer
- University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, UK
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1204
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Platt B, Campbell CA, James AC, Murphy SE, Cooper MJ, Lau JYF. Cognitive reappraisal of peer rejection in depressed versus non-depressed adolescents: functional connectivity differences. J Psychiatr Res 2015; 61:73-80. [PMID: 25533974 DOI: 10.1016/j.jpsychires.2014.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/02/2014] [Accepted: 11/28/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression is the most common psychiatric disorder in adolescence, and is characterised by an inability to down-regulate negative emotional responses to stress. Adult studies suggest this may be associated with reduced functional connectivity between prefrontal and subcortical regions, yet the neurological mechanisms in adolescence remain unclear. METHODS We developed a novel, age-appropriate, reappraisal paradigm to investigate functional connectivity during reappraisal of a real-life source of stress in 15 depressed and 15 non-depressed adolescents. During fMRI, participants i) attended to, and ii) implemented reappraisal techniques (learnt prior to fMRI) in response to, rejection. RESULTS Reappraisal reduced negative mood and belief in negative thoughts in both groups alike, however during reappraisal (versus attend) trials, depressed adolescents showed greater connectivity between the right frontal pole and numerous subcortical and cortical regions than non-depressed adolescents. CONCLUSIONS These findings tentatively suggest that, when instructed, depressed adolescents do have the ability to engage neural networks involved in emotion regulation, possibly because adolescence reflects a period of heightened plasticity. These data support the value of cognitive reappraisal as a treatment tool, identify neural markers that could be used to optimise current therapies, and lay the foundations for developing novel neuroscientific techniques for the treatment of adolescent depression.
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Affiliation(s)
- Belinda Platt
- Department of Experimental Psychology, University of Oxford, South Parks Road, OX1 3UD, UK; Department of Child and Adolescent Psychiatry, Ludwig-Maximilians University of Munich, Waltherstraße 23, 80337, Munich, Germany.
| | - Catherine A Campbell
- Oxford Institute of Clinical Psychology Training, The Isis Education Centre, Roosevelt Drive, Warnford Hospital, Oxford, OX3 7JX, UK; Institute of Psychiatry, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Anthony C James
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Susannah E Murphy
- Oxford Centre for Human Brain Activity, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Myra J Cooper
- Oxford Institute of Clinical Psychology Training, The Isis Education Centre, Roosevelt Drive, Warnford Hospital, Oxford, OX3 7JX, UK
| | - Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford, South Parks Road, OX1 3UD, UK; Institute of Psychiatry, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK
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1205
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Greimel E, Trinkl M, Bartling J, Bakos S, Grossheinrich N, Schulte-Körne G. Auditory selective attention in adolescents with major depression: An event-related potential study. J Affect Disord 2015; 172:445-52. [PMID: 25451449 DOI: 10.1016/j.jad.2014.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/10/2014] [Accepted: 10/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Major depression (MD) is associated with deficits in selective attention. Previous studies in adults with MD using event-related potentials (ERPs) reported abnormalities in the neurophysiological correlates of auditory selective attention. However, it is yet unclear whether these findings can be generalized to MD in adolescence. Thus, the aim of the present ERP study was to explore the neural mechanisms of auditory selective attention in adolescents with MD. METHODS 24 male and female unmedicated adolescents with MD and 21 control subjects were included in the study. ERPs were collected during an auditory oddball paradigm. RESULTS Depressive adolescents tended to show a longer N100 latency to target and non-target tones. Moreover, MD subjects showed a prolonged latency of the P200 component to targets. Across groups, longer P200 latency was associated with a decreased tendency of disinhibited behavior as assessed by a behavioral questionnaire. LIMITATIONS To be able to draw more precise conclusions about differences between the neural bases of selective attention in adolescents vs. adults with MD, future studies should include both age groups and apply the same experimental setting across all subjects. CONCLUSIONS The study provides strong support for abnormalities in the neurophysiolgical bases of selective attention in adolecents with MD at early stages of auditory information processing. Absent group differences in later ERP components reflecting voluntary attentional processes stand in contrast to results reported in adults with MD and may suggest that adolescents with MD possess mechanisms to compensate for abnormalities in the early stages of selective attention.
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Affiliation(s)
- E Greimel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany.
| | - M Trinkl
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany
| | - J Bartling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany
| | - S Bakos
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany
| | - N Grossheinrich
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany; Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany; Translational Brain Medicine in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen/JARA Brain Translational Medicine, Aachen and Juelich, Germany
| | - G Schulte-Körne
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Munich, Pettenkoferstraße 8a, D-80336 Munich, Germany
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1206
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Pearson R, Heron J, Button K, Bentall R, Fernyhough C, Mahedy L, Bowes L, Lewis G. Cognitive styles and future depressed mood in early adulthood: the importance of global attributions. J Affect Disord 2015; 171:60-7. [PMID: 25285900 PMCID: PMC4222738 DOI: 10.1016/j.jad.2014.08.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive theories of depression suggest that beliefs of low self-worth and the tendency to attribute negative events to causes that are global (widespread rather than specific) and stable (will persist rather than change in the future) are associated with the development of depressed mood. Such theories are supported by evidence from prospective studies and have guided the development of successful treatment and prevention strategies such as CBT. However, the relative importance of different psychological constructs within cognitive theories is unknown. This is important to refine cognitive theories and develop more efficient prevention strategies. METHOD We used prospective data from over 3500 young adults from the Avon Longitudinal Study for Parents and Children (ALSPAC) cohort in the UK to investigate the association between cognitive style, measured by short forms of the Dysfunctional Attitudes Scale (DAS) and Cognitive Styles Questionnaire-Short Form (CSQ-SF) at age 18, and future depressed mood at age 19. Structural equation modelling techniques were used to separate cognitive style constructs. RESULTS Cognitive styles were associated with future depressed mood, independently of baseline mood, both as measured by the DAS-SF and the CSQ-SF. Of the different CSQ-SF constructs, only global attributions were associated with both baseline and future mood independently of other constructs. LIMITATIONS The study was subject to attrition and the follow-up was relatively short (10 months). CONCLUSION The findings suggest that the tendency to attribute negative events specifically to global causes could be particularly important for depression. Reducing global attributions is potentially important in the prevention and treatment of depression.
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Affiliation(s)
- R.M. Pearson
- School of Social and Community Medicine, University of Bristol, UK,Corresponding author.
| | - J. Heron
- School of Social and Community Medicine, University of Bristol, UK
| | - K. Button
- School of Social and Community Medicine, University of Bristol, UK
| | - R.P. Bentall
- Institute of psychology health and society, University of Liverpool, UK
| | | | - L. Mahedy
- Institute of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff University, UK
| | - L. Bowes
- Department of Experimental Psychology, University of Oxford, UK
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1207
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Whitman L. Child Psychotherapy, Child Analysis, and Medication: A Flexible, Integrative Approach. PSYCHOANALYTIC STUDY OF THE CHILD 2015; 69:394-415. [PMID: 27337826 DOI: 10.1080/00797308.2016.11785538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.
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1208
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Gearing RE, MacKenzie MJ, Ibrahim RW, Brewer KB, Batayneh JS, Schwalbe CSJ. Stigma and mental health treatment of adolescents with depression in jordan. Community Ment Health J 2015; 51:111-7. [PMID: 25027014 DOI: 10.1007/s10597-014-9756-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/06/2014] [Indexed: 01/09/2023]
Abstract
Stigma is a fundamental barrier to seeking and engaging in mental health treatment for individuals managing depression. This study examines stigma perceptions of mental health treatment for Arab adolescents managing depression using a vignette survey completed by adults in public spaces in Amman, Jordan (n = 108). The vignette was systematically changed across four different conditions that varied the described youth's gender and whether or not they were receiving treatment for their depression. Two-way ANOVAs found that gender and receipt of mental health treatment influenced perceptions of stigma. Seeking treatment, however, did not increase perceived stigma, and receiving mental health treatment rather than no treatment was found as more likely to be a helpful approach for both males and females. Findings indicate that personal level stigma may have greater effects on females whereas public stigma may exert more influence on males. Participants endorsed that adolescents with depression are most likely to be helped when a family sought treatment rather than not seeking treatment. Findings also indicate that the community seems to appreciate the need for treatment and the likelihood of benefiting from formal mental health services.
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Affiliation(s)
- Robin E Gearing
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA,
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1209
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Agerup T, Lydersen S, Wallander J, Sund AM. Maternal and paternal psychosocial risk factors for clinical depression in a Norwegian community sample of adolescents. Nord J Psychiatry 2015; 69:35-41. [PMID: 24848784 DOI: 10.3109/08039488.2014.919021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Parental characteristics can increase the risk of the development of adolescent depression. In this study, we focus on the parental factors of parents in a non-intact relationship, dissatisfaction with personal economy, physical illness or disability, and internalizing and externalizing problems. The aim is to examine which of these parental risk factors, separately for mothers and fathers, are associated with clinical depression in adolescents in a community sample. METHODS In the Youth and Mental Health study, 345 adolescents (mean age ± standard deviation 15.0 ± 0.6 years, range 13.8-16.6 years; 72.5% girls) and their parents (79% at least one parent) completed questionnaires and the diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL). Adolescents were classified into current major depressive disorder or dysthymia (n = 46), depression not otherwise specified (n = 48), or no depression (n = 251). The parental risk factors were based on interview and the Adult Self-Report. Risk factors associated with mothers (n = 267) and fathers (n = 167) were separately analyzed using ordinal logistic regression with current depression category as the dependent variable. All analyses were adjusted for youth sex and age. RESULTS Mothers' economical dissatisfaction, physical illness/disability, internalizing problems and externalizing problems were associated with adolescent current depression (P ≤ 0.02). Adjusting for all other factors, only mothers' internalizing problems (P < 0.001) remained significantly associated with adolescent depression. Fathers' risk factors were not associated with adolescent depression. CONCLUSION Characteristics of mothers are associated with adolescent current depression. Mothers' internalizing problems is independently strongly associated with increased risk of current adolescent depression. Clinicians should assess mothers' mental health when treating depressed adolescents.
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Affiliation(s)
- T Agerup
- Faculty of Medicine, The Regional Centre for Child and Adolescent Mental Health (RBUP), Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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1210
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Pannekoek JN, van der Werff SJA, Meens PHF, van den Bulk BG, Jolles DD, Veer IM, van Lang NDJ, Rombouts SARB, van der Wee NJA, Vermeiren RRJM. Aberrant resting-state functional connectivity in limbic and salience networks in treatment--naïve clinically depressed adolescents. J Child Psychol Psychiatry 2014; 55:1317-27. [PMID: 24828372 DOI: 10.1111/jcpp.12266] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression is prevalent and typically has its onset in adolescence. Resting-state fMRI could help create a better understanding of the underlying neurobiological mechanisms during this critical period. In this study, resting-state functional connectivity (RSFC) is examined using seed regions-of-interest (ROIs) associated with three networks: the limbic network, the default mode network (DMN) and the salience network. METHODS Twenty-six treatment-naïve, clinically depressed adolescents of whom 18 had comorbid anxiety, and 26 pair-wise matched healthy controls underwent resting-state fMRI. The three networks were investigated using a seed-based ROI approach with seeds in the bilateral amygdala (limbic network), bilateral dorsal anterior cingulate cortex (dACC; salience network) and bilateral posterior cingulate cortex (default mode network). RESULTS Compared to healthy controls, clinically depressed adolescents showed increased RSFC of the left amygdala with right parietal cortical areas, and decreased right amygdala RSFC with left frontal cortical areas including the ACC, as well as with right occipito-parietal areas. The bilateral dACC showed decreased RSFC with the right middle frontal gyrus, frontal pole, and inferior frontal gyrus in clinically depressed adolescents. No abnormalities in DMN RSFC were found, and differences in RSFC did not correlate with clinical measures. CONCLUSIONS The aberrant RSFC of the amygdala network and the dACC network may be related to altered emotion processing and regulation in depressed adolescents. Our results provide new insights into RSFC in clinically depressed adolescents and future models on adolescent depression may include abnormalities in the connectivity of salience network.
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Affiliation(s)
- Justine Nienke Pannekoek
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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1211
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Anderson R, Ukoumunne OC, Sayal K, Phillips R, Taylor JA, Spears M, Araya R, Lewis G, Millings A, Montgomery AA, Stallard P. Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis. J Child Psychol Psychiatry 2014; 55:1390-7. [PMID: 24813670 DOI: 10.1111/jcpp.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. METHODS A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration--ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex U.K. secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years (QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. RESULTS Although there was lower quality-adjusted life-years over 12 months (-.05 QALYs per person, 95% confidence interval -.09 to -.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI -0.57 to 0.95, p = .62), or costs (£142, 95% CI -£132 to £415, p = .31) per person for CBT versus usual school provision. CONCLUSIONS Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision.
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Affiliation(s)
- Rob Anderson
- PenTAG, University of Exeter Medical School, Exeter, UK
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1212
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Agerup T, Lydersen S, Wallander J, Sund AM. Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: patterns and parental risk factors. Child Psychiatry Hum Dev 2014; 45:753-64. [PMID: 24553737 DOI: 10.1007/s10578-014-0444-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.
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Affiliation(s)
- T Agerup
- The Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine, Norwegian University of Science and Technology, MTFS, P.O. Box 8905, 7491, Trondheim, Norway,
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1213
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Zhou X, Michael KD, Liu Y, Del Giovane C, Qin B, Cohen D, Gentile S, Xie P. Systematic review of management for treatment-resistant depression in adolescents. BMC Psychiatry 2014; 14:340. [PMID: 25433401 PMCID: PMC4254264 DOI: 10.1186/s12888-014-0340-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/17/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Current guidelines for treatment-resistant depression in adolescents remain inadequate. This study aimed to systematically review the management of treatment-resistant depression in adolescent patients. METHODS We conducted an electronic database search of PUBMED, EMBASE, Cochrane, Web of Science and PsycINFO for studies with adolescent treatment-resistant depression published up to January 2014. Treatment-resistant depression was defined as failure to respond to at least one course of psychological or pharmacological treatment for depression with an adequate dosage, duration, and appropriate compliance during the current illness episode. The Cochrane risk-of-bias method was used to assess the quality of randomized controlled trials. A meta-analysis of all active treatments was conducted. RESULTS Eight studies with 411 depressed adolescents that fit predetermined criteria investigated pharmacological treatments and psychotherapies. Six were open-label studies, and two were randomized controlled trials. The overall response rate for all active treatments investigated was 46% (95% CI 33 to 59; N = 411) with a moderately high degree of heterogeneity (I2 = 76.1%, 95% CI = 47%-86%). When only the two randomized trials were included, the overall response rate of active treatment was 53% (95% CI = 38-67; N = 347). In these randomized trials, SSRI therapy plus CBT was significantly more effective than SSRI therapy alone, while amitriptyline was not more effective than placebo. CONCLUSIONS Approximately half of the adolescents who presented with treatment-refractory depression responded to active treatment, which suggests that practitioners should remain persistent in managing these challenging cases. The combination of antidepressant medication and psychotherapy should be recommended for adolescents who present with treatment-resistant depression.
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Affiliation(s)
- Xinyu Zhou
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,Institute of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, Boone, North Carolina USA
| | - Yiyun Liu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,Institute of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Cinzia Del Giovane
- Department of Clinical and Diagnostic Medicine and Public Health-Italian Cochrane Centre, University of Modena and Reggio Emilia, Modena, Italy
| | - Bin Qin
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,Institute of Neuroscience, Chongqing Medical University, Chongqing, China
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, CNRS UMR 7222 “Institut des Systèmes Intelligents et Robotiques”, Hôpital de la Pitié-Salpétrière, Paris, France
| | | | - Peng Xie
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,Institute of Neuroscience, Chongqing Medical University, Chongqing, China
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1214
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Dhir A, Sarvaiya J. The efficacy of vortioxetine for the treatment of major depressive disorder. Expert Rev Neurother 2014; 14:1349-63. [PMID: 25418918 DOI: 10.1586/14737175.2014.987131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Vortioxetine (Lu AA21004; Brintellix(®)) has received approval from various international regulatory agencies for the treatment of major depression. The drug molecule has a multimodal mechanism of action that projects it as a unique molecule for the treatment of major depression. These mechanisms include property to inhibit serotonin reuptake via inhibiting serotonin transporters and acting on multiple serotonin receptor subtypes. Vortioxetine is an agonist of 5-HT1A, a partial agonist of 5-HT1B and an antagonist of 5-HT1D, 5-HT3 and 5-HT7 serotoninergic receptors. The molecule has been found to be effective and well-tolerable to be administered in humans for the treatment of major depression. Precautions should be exercised when vortioxetine is prescribed with cytochrome P450 inducers and inhibitors. This review attempts to compile the efficacy profile of vortioxetine in different clinical trials and the results are compared with other standard antidepressants.
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Affiliation(s)
- Ashish Dhir
- Institute of Research and Development, Gujarat Forensic Sciences University, Gandhinagar, Gujarat-382007, India
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1215
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Screening for rumination and brooding may be a feasible method of identifying adolescents at high risk for depression. J Pediatr Nurs 2014; 29:688-95. [PMID: 24950241 DOI: 10.1016/j.pedn.2014.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to explore the usefulness of a standardized measure of rumination and brooding (Ruminative Response Scale [RRS]), to accurately identify adolescents at risk for depression. Participants (N=111; mean age=13.06 years) completed standardized measures in a cross-sectional study. ROC analyses yielded high area under the curve estimates for the RRS (.94, p<.001) and the brooding subscale (.91, p<.001), indicating both are excellent at discriminating between adolescents at high and low risk for depressive symptoms. Findings suggest depression prevention may benefit from screening for and targeting rumination or brooding with adolescence.
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1216
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Harold GT, Leve LD, Kim HK, Mahedy L, Gaysina D, Thapar A, Collishaw S. Maternal caregiving and girls' depressive symptom and antisocial behavior trajectories: an examination among high-risk youth. Dev Psychopathol 2014; 26:1461-75. [PMID: 25422973 PMCID: PMC4244652 DOI: 10.1017/s095457941400114x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Past research has identified maternal depression and family of origin maltreatment as precursors to adolescent depression and antisocial behavior. Caregiving experiences have been identified as a factor that may ameliorate or accentuate adolescent psychopathology trajectories. Using a multilevel approach that pools the unique attributes of two geographically diverse, yet complementary, longitudinal research designs, the present study examined the role of maternal caregiver involvement as a factor that promotes resilience-based trajectories related to depressive symptoms and antisocial behaviors among adolescent girls. The first sample comprises a group of US-based adolescent girls in foster care (n = 100; mean age = 11.50 years), each of whom had a history of childhood maltreatment and removal from their biological parent(s). The second sample comprises a group of UK-based adolescent girls at high familial risk for depression (n = 145; mean age = 11.70 years), with all girls having biological mothers who experienced recurrent depression. Analyses examined the role of maternal caregiving on girls' trajectories of depression and antisocial behavior, while controlling for levels of co-occurring psychopathology at each time point. Results suggest increasing levels of depressive symptoms for girls at familial risk for depression but decreasing levels of depression for girls in foster care. Foster girls' antisocial behavior also decreased over time. Maternal caregiver involvement was differentially related to intercept and slope parameters in both samples. Results are discussed with respect to the benefits of applying multilevel (multisample, multiple outcome) approaches to identifying family-level factors that can reduce negative developmental outcomes in high-risk youth.
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1217
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Lin FG, Chou YC, Wu CH, Lin JD. Short-term and long-term influences of family arguments and gender difference on developing psychological well-being in Taiwanese adolescents. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2735-2743. [PMID: 25077832 DOI: 10.1016/j.ridd.2014.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/07/2014] [Indexed: 06/03/2023]
Abstract
Adolescent mental health is crucial for social competence and accomplishment in later life. The World Health Organization (WHO) estimates that approximately 20% of adolescents suffer from psychological symptoms. However, improving family risk and school environments can largely promote adolescent mental health. A longitudinal survey was conducted to investigate adolescent psychological well-being (PWB) status and associated factors in adolescents 15-20 years of age. Family and school context variables were interviewed and recorded. A total of 2896 participants were included from high, middle, and less urbanized resident areas in Northern Taiwan with completed interview data. Using multivariate regression analysis, factors associated with adolescent PWB at various stages included quarrelsome parents, quarrels with parents, severed friendships, and cigarette and alcohol use. In all three adolescent stages, females yielded higher psychological symptom scores than did males, and diverse weights of risk factors on PWB were observed between genders. Family arguments and cigarette and alcohol use were found to have more pronounced effects on outcomes among females than males. Whereas males are more sensitive to severed friendships than females, cigarette and alcohol use showed more harmful effects on mental health in earlier adolescence than in later life. Moreover, family arguments and severed friendships in earlier adolescence were found to have lasting effects on PWB in later adolescence. In this study, gender differences were observed in the temporal relationship on adolescent mental health. Variables of family arguments and severed friendships exhibited short-term and long-term effects on adolescent mental health across the early to late developmental stages. The family argument environment and regulating cigarette and alcohol use are worthy of focus to promote adolescent mental health.
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Affiliation(s)
- Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Hsun Wu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jing-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
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1218
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Rawal A, Riglin L, Ng-Knight T, Collishaw S, Thapar A, Rice F. A longitudinal high-risk study of adolescent anxiety, depression and parent-severity on the developmental course of risk-adjustment. J Child Psychol Psychiatry 2014; 55:1270-8. [PMID: 24905789 PMCID: PMC4282404 DOI: 10.1111/jcpp.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adolescence is associated with developments in the reward system and increased rates of emotional disorders. Familial risk for depression may be associated with disruptions in the reward system. However, it is unclear how symptoms of depression and anxiety influence the development of reward-processing over adolescence and whether variation in the severity of parental depression is associated with hyposensitivity to reward in a high-risk sample. METHODS We focused on risk-adjustment (adjusting decisions about reward according to the probability of obtaining reward) as this was hypothesized to improve over adolescence. In a one-year longitudinal sample (N = 197) of adolescent offspring of depressed parents, we examined how symptoms of depression and anxiety (generalized anxiety and social anxiety) influenced the development of risk-adjustment. We also examined how parental depression severity influenced adolescent risk-adjustment. RESULTS Risk-adjustment improved over the course of the study indicating improved adjustment of reward-seeking to shifting contingencies. Depressive symptoms were associated with decreases in risk-adjustment over time while social anxiety symptoms were associated with increases in risk-adjustment over time. Specifically, depression was associated with reductions in reward-seeking at favourable reward probabilities only, whereas social anxiety (but not generalized anxiety) led to reductions in reward-seeking at low reward probabilities only. Parent depression severity was associated with lowered risk-adjustment in offspring and also influenced the longitudinal relationship between risk-adjustment and offspring depression. CONCLUSIONS Anxiety and depression distinctly alter the pattern of longitudinal change in reward-processing. Severity of parent depression was associated with alterations in adolescent offspring reward-processing in a high-risk sample.
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Affiliation(s)
- Adhip Rawal
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Lucy Riglin
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Terry Ng-Knight
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Stephan Collishaw
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of MedicineCardiff, UK
| | - Anita Thapar
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of MedicineCardiff, UK
| | - Frances Rice
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
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1219
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Eyre O, Jones RB, Mars B, Hammerton G, Sellers R, Potter R, Thapar A, Rice F, Collishaw S, Thapar A. Reported child awareness of parental depression. PSYCHIATRIC BULLETIN 2014; 38:122-7. [PMID: 25237522 PMCID: PMC4115390 DOI: 10.1192/pb.bp.113.044198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 11/23/2022]
Abstract
Aims and method To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression. Results Seventy-three per cent of participating children were perceived as being aware of their parent’s depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology. Clinical implications Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child.
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Affiliation(s)
- Olga Eyre
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Rhys Bevan Jones
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Becky Mars
- School of Social and Community Medicine, University of Bristol, UK
| | - Gemma Hammerton
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Ruth Sellers
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Robert Potter
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK ; Cwm Taf Health Board, UK
| | - Ajay Thapar
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK ; Taff Riverside Practice, Cardiff, UK
| | - Frances Rice
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stephan Collishaw
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Anita Thapar
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
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1220
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Kounali D, Zammit S, Wiles N, Sullivan S, Cannon M, Stochl J, Jones P, Mahedy L, Gage SH, Heron J, Lewis G. Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence. Psychol Med 2014; 44:2557-2566. [PMID: 25055173 PMCID: PMC4108252 DOI: 10.1017/s0033291714000026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/20/2013] [Accepted: 12/20/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND An argument often used to support the view that psychotic experiences (PEs) in general population samples are a valid phenotype for studying the aetiology of schizophrenia is that risk factors for schizophrenia show similar patterns of association with PEs. However, PEs often co-occur with depression, and no study has explicitly tested whether risk factors for schizophrenia are shared between PEs and depression, or are psychopathology specific, while jointly modelling both outcomes. METHOD We used data from 7030 subjects from a birth cohort study. Depression and PEs at age 18 years were assessed using self-report questionnaires and semi-structured interviews. We compared the extent to which risk factors for schizophrenia across sociodemographic, familial, neurodevelopmental, stress-adversity, emotional-behavioural and substance use domains showed different associations with PEs and depression within bivariate models that allowed for their correlation. RESULTS Most of the exposures examined were associated, to a similar degree, with an increased risk of both outcomes. However, whereas female sex and family history of depression showed some discrimination as potential risk factors for depression and PEs, with stronger associations in the former, markers of abnormal neurodevelopment showed stronger associations with PEs. CONCLUSIONS The argument that PEs are valid markers for studying the aetiology of schizophrenia, made simply on the basis that they share risk factors in common, is not well supported. PEs seem to be a weak index of genetic and environmental risk for schizophrenia; however, studies disentangling aetiological pathways to PEs from those impacting upon co-morbid psychopathology might provide important insights into the aetiology of psychotic disorders.
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Affiliation(s)
- D. Kounali
- School of Social and Community Medicine,
University of Bristol, UK
| | - S. Zammit
- School of Social and Community Medicine,
University of Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and
Genomics, Cardiff University,
Wales, UK
| | - N. Wiles
- School of Social and Community Medicine,
University of Bristol, UK
| | - S. Sullivan
- School of Social and Community Medicine,
University of Bristol, UK
| | - M. Cannon
- Royal College of Surgeons in Ireland and Beaumont
Hospital, Dublin, Ireland
| | - J. Stochl
- Department of Psychiatry,
University of Cambridge, UK
| | - P. Jones
- Department of Psychiatry,
University of Cambridge, UK
| | - L. Mahedy
- MRC Centre for Neuropsychiatric Genetics and
Genomics, Cardiff University,
Wales, UK
| | - S. H. Gage
- School of Social and Community Medicine,
University of Bristol, UK
| | - J. Heron
- School of Social and Community Medicine,
University of Bristol, UK
| | - G. Lewis
- School of Social and Community Medicine,
University of Bristol, UK
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1221
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Henje Blom E, Duncan LG, Ho TC, Connolly CG, LeWinn KZ, Chesney M, Hecht FM, Yang TT. The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA). Front Hum Neurosci 2014; 8:630. [PMID: 25191250 PMCID: PMC4137278 DOI: 10.3389/fnhum.2014.00630] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/28/2014] [Indexed: 01/08/2023] Open
Abstract
Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8–20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.
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Affiliation(s)
- Eva Henje Blom
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden ; Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Larissa G Duncan
- Department of Family and Community Medicine, University of California San Francisco San Francisco, CA, USA ; Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tiffany C Ho
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Colm G Connolly
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Margaret Chesney
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tony T Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
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1222
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Tavitian LR, Ladouceur CD, Nahas Z, Khater B, Brent DA, Maalouf FT. Neutral face distractors differentiate performance between depressed and healthy adolescents during an emotional working memory task. Eur Child Adolesc Psychiatry 2014; 23:659-67. [PMID: 24248754 DOI: 10.1007/s00787-013-0492-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/26/2013] [Indexed: 11/24/2022]
Abstract
The aim of the present study is to examine the effect of neutral and emotional facial expressions on voluntary attentional control using a working memory (WM) task in adolescents with major depressive disorder (MDD). We administered the Emotional Face n-back (EFNBACK) task, a visual WM task with neutral, happy and angry faces as distractors to 22 adolescents with MDD (mean age 15.7 years) and 21 healthy controls (HC) (mean age 14.7 years). There was a significant group by distractor type interaction (p = 0.045) for mean percent accuracy rates. Group comparisons showed that MDD youth were less accurate on neutral trials than HC (p = 0.027). The two groups did not differ on angry, happy and blank trials (p > 0.05). Reaction time did not differ across groups. In addition, when comparing the differences between accuracies on neutral trials and each of the happy and angry trials, respectively [(HAP-NEUT) and (ANG-NEUT)], there was a group effect on (HAP-NEUT) where the difference was larger in MDD than HC (p = 0.009) but not on ANG-NEUT (p > 0.05). Findings were independent of memory load. Findings indicate that attentional control to neutral faces is impaired and negatively affected performance on a WM task in adolescents with MDD. Such an impact of neutral faces on attentional control in MDD may be at the core of the social-cognitive impairment observed in this population.
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Affiliation(s)
- Lucy R Tavitian
- Department of Cross Cultural Psychology, Tilburg University, Tilburg, The Netherlands
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1223
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Service use in adolescents at risk of depression and self-harm: prospective longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1231-40. [PMID: 24570203 DOI: 10.1007/s00127-014-0843-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Although depression and self-harm are common mental health problems in adolescents, there are barriers to accessing help. Using a community-based sample, this study investigates predictors of service contacts for adolescents at high risk of depression and self-harm. METHODS Three thousand seven hundred and forty-nine (3,749) 12- to 16-year-olds in UK secondary (high) schools provided baseline and 6 months' follow-up data on mood, self-harm and service contacts with a range of primary and secondary healthcare services. RESULTS Although most adolescents at high risk of depression or self-harm had seen their general practitioner (GP) in the previous 6 months, less than one-third had used primary or secondary healthcare services for emotional problems. 5 % of adolescents who reported self-harm had seen specialist child and adolescent mental health services in the previous 6 months. In longitudinal analyses, after adjustment for confounders, both depression and self-harm predicted the use of any healthcare services [adjusted odds ratio (AOR) = 1.34 (95 % CI 1.09, 1.64); AOR = 1.38 (95 % CI 1.02, 1.86), respectively] and of specialist mental health services [AOR = 5.48 (95 % CI 2.27, 13.25); AOR = 2.58 (95 % CI 1.11, 6.00), respectively]. Amongst those with probable depression, 79 % had seen their GP and 5 % specialist mental health services in the preceding year. CONCLUSIONS Most adolescents at high risk of depression or self-harm see their GP over a 6-month period although only a minority of them access specialist mental health services. Their consultations within primary care settings provide a potential opportunity for their identification and for signposting to appropriate specialist services.
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1224
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Kerr DCR, DeGarmo DS, Leve LD, Chamberlain P. Juvenile justice girls' depressive symptoms and suicidal ideation 9 years after Multidimensional Treatment Foster Care. J Consult Clin Psychol 2014; 82:684-93. [PMID: 24731234 PMCID: PMC4115007 DOI: 10.1037/a0036521] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Multidimensional Treatment Foster Care (MTFC) has been found to reduce delinquency among girls in juvenile justice through 2-year follow-up. Given that such girls are at elevated risk for suicide and depression into adulthood, we tested MTFC effects on long-term trajectories of suicidal ideation and depressive symptoms. METHOD Girls (N = 166; mean [SD] age = 15.3 [1.2] years; 68% White) with a recent criminal referral who were mandated to out-of-home care were enrolled in 2 sequential cohorts. Girls were randomized to receive MTFC (n = 81) or group care (GC) treatment as usual (TAU; n = 85); the second MTFC cohort also received modules targeting substance use and risky sexual behavior. Depressive symptoms and suicidal ideation were assessed repeatedly through early adulthood (mean [SD] follow-up = 8.8 [2.9] years). Suicide attempt history was assessed in early adulthood. RESULTS Girls assigned to MTFC showed significantly greater decreases in depressive symptoms across the long-term follow-up than GC girls (π = -.86, p < .05). Decreases in suicidal ideation rates were slightly stronger in MTFC than in GC as indicated by a marginal main effect (odds ratio [OR] = .92, p < .10) and a significant interaction that favored MTFC in the second cohort relative to the first (OR = .88, p < .01). There were no significant MTFC effects on suicide attempt. CONCLUSIONS MTFC decreased depressive symptoms and suicidal thinking beyond the decreases attributable to time and TAU. Thus, MTFC has further impact on girls' lives than originally anticipated.
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Affiliation(s)
| | | | - Leslie D Leve
- Department of Counseling Psychology and Human Services, University of Oregon
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1225
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Lewis AJ, Bertino MD, Bailey CM, Skewes J, Lubman DI, Toumbourou JW. Depression and suicidal behavior in adolescents: a multi-informant and multi-methods approach to diagnostic classification. Front Psychol 2014; 5:766. [PMID: 25101031 PMCID: PMC4101965 DOI: 10.3389/fpsyg.2014.00766] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification. METHOD Within the context of assessment of eligibility for a randomized clinical trial, 50 parent-adolescent pairs (mean age of adolescents = 15.0 years) were interviewed separately with a structured diagnostic interview for depression, the KID-SCID. Adolescent self-report and parent-report versions of the Strengths and Difficulties Questionnaire, the Short Mood and Feelings Questionnaire and the Depressive Experiences Questionnaire were also administered. We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via questionnaire methods. RESULTS Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report. Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms. Adolescent self-report measures can be combined to improve the accuracy of classification. Parents tend to over report their adolescent's depressive symptoms while under reporting their suicidal thoughts and behavior. CONCLUSION Parent proxy report is clearly less reliable than the adolescent's own report of their symptoms and subjective experiences, and could be considered inaccurate for research purposes. While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution.
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Affiliation(s)
- Andrew J Lewis
- School of Psychology, Deakin University Melbourne, VIC, Australia
| | | | | | - Joanna Skewes
- School of Psychology, Deakin University Melbourne, VIC, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Turning Point, Monash University Melbourne, VIC, Australia
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1226
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Kulkarni AA, Swinburn BA, Utter J. Associations between diet quality and mental health in socially disadvantaged New Zealand adolescents. Eur J Clin Nutr 2014; 69:79-83. [DOI: 10.1038/ejcn.2014.130] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 05/18/2014] [Accepted: 05/27/2014] [Indexed: 11/09/2022]
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1227
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Bluth K, Blanton PW. The influence of self-compassion on emotional well-being among early and older adolescent males and females. JOURNAL OF POSITIVE PSYCHOLOGY 2014; 10:219-230. [PMID: 25750655 DOI: 10.1080/17439760.2014.936967] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-compassion has been associated with well-being in adult samples, but has rarely been assessed in adolescents. In this study, 90 students ages 11-18 completed an online survey assessing self-compassion, life satisfaction, perceived stress and positive and negative affect. Findings indicated that older female adolescents had lower self-compassion than either older male adolescents or early adolescents of either gender, and self-compassion was associated significantly with all dimensions of emotional well-being with the exception of positive affect. Additionally, phase of adolescence, but not gender, was found to moderate the relationship between self-compassion and dimensions of well-being; for older adolescents, the inverse relationship between self-compassion and negative affect was stronger. Lastly, the influence of the various components of self-compassion was investigated and discussed.
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Affiliation(s)
- Karen Bluth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, CB #7200, Chapel Hill, NC 27599, USA
| | - Priscilla W Blanton
- Department of Child and Family Studies, University of Tennessee, 1215 W. Cumberland Ave., Knoxville, TN, USA
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1228
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Andersen SL, Olsen J, Wu CS, Laurberg P. Psychiatric disease in late adolescence and young adulthood. Foetal programming by maternal hypothyroidism? Clin Endocrinol (Oxf) 2014; 81:126-33. [PMID: 24467638 DOI: 10.1111/cen.12415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lack of maternal thyroid hormones during foetal brain development may lead to structural abnormalities in the brain. We hypothesized that maternal hypothyroidism during the pregnancy could programme the foetus to development of psychiatric disease later in life. DESIGN Danish nationwide register study. PARTICIPANTS Singletons live-born 1980-1990. MEASUREMENTS Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) with 95% confidence interval for offspring redemption of ≥2 prescriptions of a psychiatric drug from age 15 to 31 years. RESULTS Among 542 100 adolescents and young adults included, altogether 3979 (0·7%) were born to mothers with hypothyroidism registered before 1996. In crude analyses, the use of a psychiatric drug was more frequent in late adolescence and young adulthood when the mother had hypothyroidism (P < 0·001); however, several possible confounders had to be taken into account. For example, mothers with hypothyroidism often also had a psychiatric registration (38·5% vs 27·7%, P < 0·001) and the use of psychiatric drugs changed over time. After adjustment for confounders including birth year, maternal age and maternal psychiatric history, maternal hypothyroidism was associated with an increased risk of having redeemed prescriptions of anxiolytics [aHR 1·23 (1·03-1·48)] and antipsychotics [aHR 1·22 (1·03-1·44)] in late adolescence and young adulthood. For antidepressants, aHR was 1·07 (0·98-1·17). CONCLUSIONS The association between maternal hypothyroidism and the use of a psychiatric drug in late adolescence and young adulthood was partly confounded by maternal psychiatric history, but foetal programming by maternal hypothyroidism may be part of the mechanisms leading to the use of anxiolytics and antipsychotics.
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1229
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Pesola F, Shelton KH, van den Bree MBM. Sexual orientation and alcohol problem use among U.K. adolescents: an indirect link through depressed mood. Addiction 2014; 109:1072-80. [PMID: 24612217 DOI: 10.1111/add.12528] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/04/2013] [Accepted: 02/18/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Sexual minority adolescents are more likely to engage in alcohol use than their heterosexual counterparts; however, the underlying reasons remain unclear and longitudinal research is limited. Owing to evidence that this group also experiences greater depressive symptoms than their peers, we aimed to (i) assess to what extent depressed mood explains the increased likelihood of engaging in alcohol use among sexual minority adolescents, and (ii) explore potential gender-specific patterns. DESIGN Structural equation modelling was used to test the indirect relationship between sexual orientation and alcohol use through depressed mood, with heterosexuals as the reference group. SETTINGS AND PARTICIPANTS A total of 3710 adolescents (12% sexual minority), from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, assessed between the ages of 15 and 18 years. MEASUREMENTS Sexual orientation was assessed at age 15, while alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) at age 18. Depressed mood was indexed by the Short Mood and Feelings Questionnaire (SMFQ) at age 16. FINDINGS Sexual minority adolescents were more likely to engage in alcohol problem use compared to their heterosexual counterparts [Btotal = 0.12, 95% confidence interval (CI) = 0.04-0.20, P = 0.003]. Depressed mood explained 21% of the link between sexual orientation and alcohol use after adjustment for covariates and earlier measures (Z = 3.2, P = 0.001). No gender differences were observed. CONCLUSIONS A higher prevalence of alcohol problem use in adolescents who are gay, lesbian or bisexual is partly explained by increased rates of depression in this group.
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Affiliation(s)
- Francesca Pesola
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Stringaris A, Lewis G, Maughan B. Developmental pathways from childhood conduct problems to early adult depression: findings from the ALSPAC cohort. Br J Psychiatry 2014; 205:17-23. [PMID: 24764545 PMCID: PMC4076653 DOI: 10.1192/bjp.bp.113.134221] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/27/2013] [Accepted: 01/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pathways from early-life conduct problems to young adult depression remain poorly understood. AIMS To test developmental pathways from early-life conduct problems to depression at age 18. METHOD Data (n = 3542) came from the Avon Longitudinal Study of Parents and Children (ALSPAC). Previously derived conduct problem trajectories (ages 4-13 years) were used to examine associations with depression from ages 10 to 18 years, and the role of early childhood factors as potential confounders. RESULTS Over 43% of young adults with depression in the ALSPAC cohort had a history of child or adolescent conduct problems, yielding a population attributable fraction of 0.15 (95% CI 0.08-0.22). The association between conduct problems and depression at age 18 was considerable even after adjusting for prior depression (odds ratio 1.55, 95% CI 1.24-1.94). Early-onset persistent conduct problems carried the highest risk for later depression. Irritability characterised depression for those with a history of conduct problems. CONCLUSIONS Early-life conduct problems are robustly associated with later depressive disorder and may be useful targets for early intervention.
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Affiliation(s)
- Argyris Stringaris
- Argyris Stringaris, MD, PhD, MRCPsych, Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Glyn Lewis, PhD, Division of Psychiatry, University College London; Barbara Maughan, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, UK
| | - Glyn Lewis
- Argyris Stringaris, MD, PhD, MRCPsych, Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Glyn Lewis, PhD, Division of Psychiatry, University College London; Barbara Maughan, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, UK
| | - Barbara Maughan
- Argyris Stringaris, MD, PhD, MRCPsych, Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Glyn Lewis, PhD, Division of Psychiatry, University College London; Barbara Maughan, PhD, MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, UK
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1231
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Park JH, Bang YR, Kim CK. Sex and Age Differences in Psychiatric Disorders among Children and Adolescents: High-Risk Students Study. Psychiatry Investig 2014; 11:251-7. [PMID: 25110497 PMCID: PMC4124183 DOI: 10.4306/pi.2014.11.3.251] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aims of the present study are to investigate the rate of the psychiatric disorders in psychiatrically high-risk children and adolescents and to examine sex and age differences in the diagnosis of psychiatric disorders. METHODS The participants included students aged 6-16 from the 27 elementary and the 45 middle schools in Busan, Korea. We screened psychopathology using the Korean version of Child Behavior Checklist (K-CBCL) or the Youth Self Report (K-YSR). A total of 2,912 students were selected as high-risk students on the basis of cut-off scores (T-score ≥60) for a total behavior problem score of K-CBCL/K-YSR. Of these high-risk students, 1,985 students participated in and completed individual diagnostic interviews. Psychiatric diagnosis was assessed using a Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia. Multivariate logistic regression analysis was conducted to examine sex and age differences of psychiatric diagnosis. RESULTS Based on sex, boys were more likely to have ADHD and girls were more likely to have depression. Based on age, children were more likely to have ADHD and adolescents were more likely to have affective disorder, conduct disorder, psychotic disorder, and anxiety disorders except separation anxiety disorder. CONCLUSION This is the largest study to conduct face-to-face interviews with subjects and parent(s) among Korean studies in this field. The present study revealed significant differences across sex and age among specific psychiatric disorders in children and adolescents. Future population-based studies will be required to ascertain the sex- and age-related differences of psychiat prevalence.
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Affiliation(s)
- Jae Hong Park
- Department of Psychiatry, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Rong Bang
- Department of Psychiatry, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Chul Kwon Kim
- Department of Psychiatry, Dong-A University College of Medicine, Busan, Republic of Korea
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Schepman K, Fombonne E, Collishaw S, Taylor E. Cognitive styles in depressed children with and without comorbid conduct disorder. J Adolesc 2014; 37:622-31. [PMID: 24931565 DOI: 10.1016/j.adolescence.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
Abstract
Little is known about patterns of cognitive impairment in depression comorbid with conduct disorder. The study included clinically depressed children with (N = 23) or without conduct disorder (N = 29), and controls without psychiatric disorder (N = 37). Cognitive biases typical of depression and patterns of social information processing were assessed. Both depressed groups had substantially higher rates of negative cognitive distortions, attributional biases and ruminative responses than non-depressed children. Children in the comorbid group made more hostile attributions and suggested more aggressive responses for dealing with threatening social situations, whilst children with depression only were more likely to be unassertive. Depression has a number of similar depressotypic cognitive biases whether or not complicated by conduct disorder, and may be potentially susceptible to similar interventions. The results also highlight the importance of recognising social information processing deficits when they occur and targeting those too, especially in comorbid presentations.
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Affiliation(s)
- Karen Schepman
- Cardiff University, School of Medicine, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Child and Adolescent Psychiatry Section, Haydn Ellis Building, Cardiff, CF24 4HQ, UK.
| | - Eric Fombonne
- Autism Research Center, Department of Psychiatry, Oregon Health and Science University, OHSU Doernbecher Children's Hospital, Portland, OR, USA
| | - Stephan Collishaw
- Cardiff University, School of Medicine, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Child and Adolescent Psychiatry Section, Haydn Ellis Building, Cardiff, CF24 4HQ, UK
| | - Eric Taylor
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
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Guo H, Yang W, Cao Y, Li J, Siegrist J. Effort-reward imbalance at school and depressive symptoms in Chinese adolescents: the role of family socioeconomic status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6085-98. [PMID: 24919130 PMCID: PMC4078567 DOI: 10.3390/ijerph110606085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/16/2014] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
Abstract
Depression is a major mental health problem during adolescence. This study, using a sample of Chinese adolescents, examined the separate and combined effects of perceived school-related stress and of family socioeconomic status (SES) on the prevalence of depressive symptoms. A total of 1774 Chinese students from Grades 7–12 were recruited into our questionnaire survey. School-related stress was measured by the Effort-Reward Imbalance Questionnaire-School Version, family SES was assessed by a standardized question, and depressive symptoms were evaluated by the Center for Epidemiological Studies Depression Scale for Children. Multivariate logistic regression was applied, adjusting for age, gender, grade, smoking, alcohol drinking and physical activity. It was found that high school-related stress and low family SES were associated with elevated odds of depressive symptoms, respectively. The effect of school-related stress was particularly strong in low SES group. In adolescents with both high stress at school and low SES, the odds ratio was 9.18 (95% confidence interval = 6.53–12.89) compared to the reference group (low stress at school and high SES). A significant synergistic interaction effect was observed (synergy index = 2.28, 95% confidence interval = 1.56–3.32). The findings indicated that perceived school-related stress, in terms of effort-reward imbalance, was related to depressive symptoms in this sample of Chinese adolescents. The strong interaction with family SES suggests that health promoting efforts in school settings should be targeted specifically at these socially deprived groups.
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Affiliation(s)
- Hongxiang Guo
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Wenjie Yang
- School of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Ying Cao
- First High School of Zhengzhou, Zhengzhou 450000, China.
| | - Jian Li
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstrasse 1, Düsseldorf 40225, Germany.
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Life-Science Centre, University of Düsseldorf, Düsseldorf 40225, Germany.
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1234
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Tavitian L, Atwi M, Bawab S, Hariz N, Zeinoun P, Khani M, Maalouf FT. The Arabic Mood and Feelings Questionnaire: psychometrics and validity in a clinical sample. Child Psychiatry Hum Dev 2014; 45:361-8. [PMID: 24081605 DOI: 10.1007/s10578-013-0406-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to provide clinicians in the Arab World with a child and adolescent depression screening tool. Child and parent versions of the Mood and Feelings Questionnaire (CMFQ and PMFQ respectively) were translated to Arabic and administered along with the Strengths and Difficulties Questionnaire (SDQ) to 30 children and adolescents and with mood disorders and 76 children and adolescents with other psychiatric disorders seeking treatment at a child and adolescent psychiatry clinic. DSM-IV diagnoses were generated through clinical interviews by a psychiatrist blinded to self-reports. Internal consistency for both versions was excellent with moderate inter-informant agreement and good convergent validity with the SDQ emotional symptoms subscales on the child and parent forms. The CMFQ and PMFQ significantly differentiated between currently depressed participants and those with other psychiatric disorders. CMFQ scores were a stronger predictor of categorization into depressed and non-depressed groups than the PMFQ. Two modes of cutoffs were calculated with one favoring sensitivity (a score of 26 for the CMFQ and 22 for the PMFQ) and another favoring specificity (a score of 31 for the CMFQ and 28 for the PMFQ).
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Affiliation(s)
- Lucy Tavitian
- Department of Psychiatry, American University of Beirut Medical Center, POBox 11-0236, Riad El Solh, Beirut, 11072020, Lebanon
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Koyama A, Matsushita M, Ushijima H, Jono T, Ikeda M. Association between depression, examination-related stressors, and sense of coherence: the Ronin-Sei study. Psychiatry Clin Neurosci 2014; 68:441-7. [PMID: 24506541 DOI: 10.1111/pcn.12146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 11/18/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
AIMS In the Japanese education system, students who fail university entrance exam often go to special preparatory schools to prepare for the following year's exam. These students are called ronin-sei. The purpose of this study was to clarify: (i) depression and somatic complaints in ronin-sei; and (ii) the association between depression, examination-related stressors, and sense of coherence (SOC). METHODS A total of 914 ronin-sei from two preparatory schools were asked to answer a self-rating questionnaire. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and SOC was measured using the SOC-13 Scale. RESULTS Overall, 57.9% of subjects were considered to have depression (CES-D ≥ 16) and 19.8% had severe depression (CES-D ≥ 26). Higher CES-D scores were associated with a higher rate of somatic complaints. In hierarchical logistic regression analysis, having no one to talk to about his/her worries and having parents who disagree about the first-choice of university and faculty were independent risk factors for depression and severe depression, respectively, even after controlling for SOC. CONCLUSIONS Preparatory school students have various somatic complaints, and their depression is in part related to examination-related stressors. To maintain mental health, it is important to enhance SOC, to understand their examination-related stressors and to provide adequate support for these students.
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Affiliation(s)
- Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Plasma fluoxetine concentrations and clinical improvement in an adolescent sample diagnosed with major depressive disorder, obsessive-compulsive disorder, or generalized anxiety disorder. J Clin Psychopharmacol 2014; 34:318-26. [PMID: 24743718 DOI: 10.1097/jcp.0000000000000121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED Fluoxetine (FLX) has been one of the most widely studied selective serotonin reuptake inhibitors in adolescents. Despite its efficacy, however, 30% to 40% of patients do not respond to treatment. AIMS The aim of this study was to evaluate whether clinical improvement or adverse events are related to the corrected dose of FLX at 8 and 12 weeks after starting treatment in a sample of adolescents diagnosed with major depressive disorder, obsessive-compulsive disorder, or generalized anxiety disorder. METHODS Seventy-four subjects aged between 10 and 17 years participated in the study. Clinical improvement was measured with the Clinical Global Impression-Improvement Scale, whereas the UKU (Udvalg for Klinske Undersogelser) scale was administered to assess adverse effects of treatment. RESULTS Fluoxetine per kilograms of body weight was related to serum concentration of FLX, NORFLX (norfluoxetine), FLX + NORFLX, and FLX/NORFLX. No relationship was found between dose-corrected FLX levels and therapeutic or adverse effects. No differences in serum concentrations were found between responders and nonresponders to treatment. Sex differences were observed in relation to dose and FLX serum concentration. The analysis by diagnosis revealed differences in FLX dose between obsessive-compulsive disorder patients and both generalized anxiety disorder and major depressive disorder patients. CONCLUSIONS Fluoxetine response seems to be influenced by factors such as sex, diagnosis, or certain genes that might be involved in the drug's pharmacokinetics and pharmacodynamics. Clinical and pharmacogenetic studies are needed to elucidate further the differences between treatment responders and nonresponders.
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1237
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Lewis G, Collishaw S, Thapar A, Harold GT. Parent-child hostility and child and adolescent depression symptoms: the direction of effects, role of genetic factors and gender. Eur Child Adolesc Psychiatry 2014; 23:317-27. [PMID: 23963643 DOI: 10.1007/s00787-013-0460-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
Identifying environmental risk factors in the pathway to depression is an important research goal. To extend prior research, designs that rule out alternative explanatory factors; genetic effects and reverse causation, and permit tests of both parent and child gender are required. The present study used two different samples to address these issues. A longitudinal community sample of 316 families (157 boys, 159 girls) aged 11-12 years (mean 11.7) at Time 1 and 12-13 years at Time 2 (mean 12.7) was used to test the direction of effects between parent hostility and child and adolescent depression symptoms. A genetically sensitive sample of 1,075 twin pairs; 653 dizygotic (135 male, 183 female, 335 opposite sex) and 422 monozygotic (180 male and 242 female) aged 12-20 years (mean 16.12) was used to test whether parent hostility had environmental effects. Analyses were conducted separately by parent and child gender. Using cross-lagged panel analyses, the association between mother-daughter hostility and depression symptoms was found to be longitudinal and bidirectional with reciprocal effects between mothers and daughters. Behavioural genetic analyses in the twin sample revealed a significant environmental link between mother hostility and symptoms of daughter depression independent of genetic factors. A significant pathway was found between daughter depressive symptoms and father hostility but not vice versa. This association was accounted for by genetic factors in behavioural genetic analyses. Findings provide evidence of an environmental risk pathway to depression symptoms and identify patterns of variation according to parent and child gender. Results are discussed in relation to underlying explanatory processes and clinical implications.
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Affiliation(s)
- Gemma Lewis
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
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Affiliation(s)
- Olga Eyre
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cathays, Cardiff CF24 4HQ, UK.
| | - Anita Thapar
- Child and Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cathays, Cardiff CF24 4HQ, UK
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1239
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Haroz EE, Ybarra ML, Eaton WW. Psychometric evaluation of a self-report scale to measure adolescent depression: the CESDR-10 in two national adolescent samples in the United States. J Affect Disord 2014; 158:154-60. [PMID: 24655780 PMCID: PMC4366134 DOI: 10.1016/j.jad.2014.02.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a need for brief instruments to screen for depression in adolescents that are valid, reliable and freely available. The aim of this study was to investigate the psychometric properties of a 10-item version of the CESD-R (CESDR-10) in two national adolescent samples. METHODS Sample 1 consisted of N=3777 youths (mean age 15.7) and Sample 2 contained N=1150 adolescents (mean age 14.5). We performed confirmatory factor analysis, evaluated construct validity, examined differential item functioning, and assessed internal consistency reliability (α). RESULTS The results suggest generally strong psychometric properties for the CESDR-10. The CFA 1-factor model showed good model fit. Construct validity was partially supported in Sample 1 and mostly supported for Sample 2 based upon the characteristics examined. The CESDR-10 showed configural and metric invariance across both samples and full measurement invariance across sex. There were no notable differences in discrimination parameters or clinically significant differential item functioning between samples or sexes. LIMITATIONS Criterion related validity was not assessed in this study. Further studies should evaluate the scale in comparison to a psychiatric diagnosis. In addition, this study utilized a web-based format of administration which may influence participants׳ answers. In future studies, the CESDR-10 should be administered in other settings to more thoroughly establish its generalizability. CONCLUSION In clinical and non-clinical settings alike, time pressures make the availability of brief but valid screening measures critical. Findings support future use of the CESDR-10.
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Affiliation(s)
- Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, United States.
| | - Michele L Ybarra
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, United States; Center for Innovative Public Health Research, San Clemente, CA, United States
| | - William W Eaton
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, United States
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Cruz-Fuentes CS, Benjet C, Martínez-Levy GA, Pérez-Molina A, Briones-Velasco M, Suárez-González J. BDNF Met66 modulates the cumulative effect of psychosocial childhood adversities on major depression in adolescents. Brain Behav 2014; 4:290-7. [PMID: 24683520 PMCID: PMC3967543 DOI: 10.1002/brb3.220] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/13/2013] [Accepted: 12/23/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The interplay among lifetime adversities and the genetic background has been previously examined on a variety of measures of depression; however, only few studies have focused on major depression disorder (MDD) in adolescence. METHODS Using clinical data and DNA samples from mouthwash gathered from an epidemiological study on the prevalence of mental disorders in youths between 12 and 17 years old, we tested the statistical interaction between a set of psychosocial adversities experienced during childhood (CAs) with two common polymorphisms in the brain-derived neurotrophic factor (BDNF) (Val66Met) and SLC6A4 (L/S) genes on the probability of suffering MDD in adolescence. RESULTS Genotype or allele frequencies for both polymorphisms were similar between groups of comparison (MDD N = 246; controls N = 270). The CAs factors: Abuse, neglect, and family dysfunctions; parental maladjustment, parental death, and to have experienced a life-threatening physical illness were predictors of clinical depression in adolescents. Remarkably, the cumulative number of psychosocial adversities was distinctly associated with an increase in the prevalence of depression but only in those Val/Val BDNF individuals; while the possession of at least a copy of the BDNF Met allele (i.e., Met +) was statistically linked with a "refractory" or resilient phenotype to the noticeable influence of CAs. CONCLUSION Liability or resilience to develop MDD in adolescence is dependent of a complex interplay between particular environmental exposures and a set of plasticity genes including BDNF. A better understanding of these factors is important for developing better prevention and early intervention measures.
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Affiliation(s)
- Carlos S Cruz-Fuentes
- Psychiatric Genetics Department, Clinical Research Branch, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
| | - Corina Benjet
- Epidemiology and Psychosocial Research Division, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
| | - Gabriela A Martínez-Levy
- Psychiatric Genetics Department, Clinical Research Branch, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
| | - Amado Pérez-Molina
- Psychiatric Genetics Department, Clinical Research Branch, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
| | - Magdalena Briones-Velasco
- Psychiatric Genetics Department, Clinical Research Branch, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
| | - Jesús Suárez-González
- Psychiatric Genetics Department, Clinical Research Branch, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz" Mexico City, México
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Richard A, Rohrmann S, Mohler-Kuo M, Rodgers S, Moffat R, Güth U, Eichholzer M. Urinary phytoestrogens and depression in perimenopausal US women: NHANES 2005-2008. J Affect Disord 2014; 156:200-5. [PMID: 24434020 DOI: 10.1016/j.jad.2013.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/20/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fluctuating hormonal levels observed during the menopausal transition may increase vulnerability to depression in susceptible women. Thus, it is of interest to examine the effect of natural estrogens such as phytoestrogens on the risk of depression in perimenopausal women. METHODS Our analysis included 193 perimenopausal women of the National Health and Nutrition Survey (NHANES) 2005-2008 aged 45-55 years. Urinary concentrations of phytoestrogens (isoflavones and lignans) were measured by HPLC-APPI-MS/MS. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression models examined the association of phytoestrogens concentrations (creatinine-standardized and log-transformed) with depression (yes/no). RESULTS Unadjusted odds ratios (OR) of the associations between urinary phytoestrogen concentrations and perimenopausal depression were below 1; however, only lignans were significantly inversely associated with depression. The latter findings were not attenuated in multivariate analysis including age, race, body mass index, poverty income ratio, smoking, alcohol consumption, cancer, diabetes, and cardiovascular disease (lignans: OR=0.66; 95% confidence intervals (CI) 0.50-0.87, enterodiol: OR=0.63; 95% CI 0.51-0.78, enterolactone: OR=0.75; 95% CI 0.60-0.93). LIMITATIONS Our cross-sectional study design does not allow for causal inferences. Because information to precisely assess perimenopausal symptoms was missing, we defined perimenopause based on women's age. CONCLUSIONS Lower lignans but not isoflavones concentrations were statistically significantly associated with an increased risk of depression in perimenopausal women. Because of medical risks associated with the use of hormone therapy, further investigation on the effect of lignans on the risk of depression in perimenopausal women is warranted.
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Affiliation(s)
- Aline Richard
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland.
| | - Sabine Rohrmann
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland
| | - Meichun Mohler-Kuo
- Mental Health and Social Epidemiology, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Rebecca Moffat
- University Hospital Basel, Women's Hospital, Switzerland
| | - Uwe Güth
- Cantonal Hospital Winterthur, Department of Gynecology and Obstetrics, Switzerland
| | - Monika Eichholzer
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland
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1242
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Henje Blom E, Serlachius E, Chesney MA, Olsson EMG. Adolescent girls with emotional disorders have a lower end-tidal CO2 and increased respiratory rate compared with healthy controls. Psychophysiology 2014; 51:412-8. [PMID: 24571123 PMCID: PMC4286011 DOI: 10.1111/psyp.12188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/02/2013] [Indexed: 11/27/2022]
Abstract
Hyperventilation has been linked to emotional distress in adults. This study investigates end-tidal carbon dioxide (ETCO2), respiratory rate (RR), and heart rate variability (HRV) in adolescent girls with emotional disorders and healthy controls. ETCO2, RR, HRV, and ratings of emotional symptom severity were collected in adolescent female psychiatric patients with emotional disorders (n = 63) and healthy controls (n = 62). ETCO2 and RR differed significantly between patients and controls. ETCO2, HR, and HRV were significant independent predictors of group status, that is, clinical or healthy, while RR was not. ETCO2 and RR were significantly related to emotional symptom severity and to HRV in the total group. ETCO2 and RR were not affected by use of selective serotonin reuptake inhibitors. It is concluded that emotional dysregulation is related to hyperventilation in adolescent girls. Respiratory-based treatments may be relevant to investigate in future research.
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Affiliation(s)
- Eva Henje Blom
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of California San Francisco, San Francisco, USA
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1243
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Garmy P, Jakobsson U, Carlsson KS, Berg A, Clausson EK. Evaluation of a school-based program aimed at preventing depressive symptoms in adolescents. J Sch Nurs 2014; 31:117-25. [PMID: 24526572 PMCID: PMC4390603 DOI: 10.1177/1059840514523296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.
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Affiliation(s)
- Pernilla Garmy
- Department of Health Science, Kristianstad University, Kristianstad, Sweden Center for Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Agneta Berg
- Department of Health Science, Kristianstad University, Kristianstad, Sweden Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | - Eva K Clausson
- Department of Health Science, Kristianstad University, Kristianstad, Sweden
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1244
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Pannekoek JN, van der Werff SJA, van den Bulk BG, van Lang NDJ, Rombouts SARB, van Buchem MA, Vermeiren RRJM, van der Wee NJA. Reduced anterior cingulate gray matter volume in treatment-naïve clinically depressed adolescents. NEUROIMAGE-CLINICAL 2014; 4:336-42. [PMID: 24501702 PMCID: PMC3913835 DOI: 10.1016/j.nicl.2014.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 01/23/2023]
Abstract
Adolescent depression is associated with increased risk for suicidality, social and educational impairment, smoking, substance use, obesity, and depression in adulthood. It is of relevance to further our insight in the neurobiological mechanisms underlying this disorder in the developing brain, as this may be essential to optimize treatment and prevention of adolescent depression and its negative clinical trajectories. The equivocal findings of the limited number of studies on neural abnormalities in depressed youth stress the need for further neurobiological investigation of adolescent depression. We therefore performed a voxel-based morphometry study of the hippocampus, amygdala, superior temporal gyrus, and anterior cingulate cortex (ACC) in 26 treatment-naïve, clinically depressed adolescents and 26 pair-wise matched healthy controls. Additionally, an exploratory whole-brain analysis was performed. Clinically depressed adolescents showed a volume reduction of the bilateral dorsal ACC compared to healthy controls. However, no association was found between gray matter volume of the ACC and clinical severity scores for depression or anxiety. Our finding of a smaller ACC in clinically depressed adolescents is consistent with literature on depressed adults. Future research is needed to investigate if gray matter abnormalities precede or follow clinical depression in adolescents. Voxel-based morphometry ROI and exploratory whole-brain analyses were performed Depressed adolescents showed a smaller anterior cingulate cortex compared to healthy controls No association found between gray matter volume of the effect and clinical scores for depression
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Affiliation(s)
- Justine Nienke Pannekoek
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Steven J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - Bianca G van den Bulk
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Natasja D J van Lang
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A R B Rombouts
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Institute of Psychology, Leiden University, Leiden, The Netherlands ; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark A van Buchem
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert R J M Vermeiren
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands ; Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
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1245
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Stevens JR, Jarrahzadeh T, Brendel RW, Stern TA. Strategies for the prescription of psychotropic drugs with black box warnings. PSYCHOSOMATICS 2013; 55:123-33. [PMID: 24360525 DOI: 10.1016/j.psym.2013.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Black Box Warning (BBW) is the Food and Drug Administration's highest level of drug warning. It signifies that a medication has serious (or potentially life-threatening) side effects and is prominently displayed on a medication's package insert. It literally consists of the medication warning and is surrounded by a bold black border. OBJECTIVE This article aims to review data related to BBWs on psychotropic medications currently used in clinical practice, with special attention to clinical situations and questions relevant to consultation-liaison psychiatrists. RESULTS We review 3 clinical advisories or BBWs for psychotropic medications (i.e., antidepressant medication and suicidality in the pediatric population, stimulant medication and sudden death in the pediatric population, and antipsychotic medication and increased mortality in the elderly) and discuss the effect they have had on prescribing practices. We provide a table of current BBWs relevant to psychotropic medications. CONCLUSIONS BBWs can have unintended and far-reaching consequences, albeit with a limited ability to target specific populations and practice patterns. Although it is critical for clinicians to be aware of these serious potential side effects and to inform patients about these warnings, medications with boxed warnings remain Food and Drug Administration-approved and may have critically important therapeutic roles.
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Affiliation(s)
- Jonathan R Stevens
- Henry Ford Health Systems, Dearborn, MI; Wayne State University, Detroit, MI.
| | | | - Rebecca Weintraub Brendel
- Red Sox Foundation and Massachusetts General Hospital (MGH), Home Base Program, Boston, MA; Harvard Medical School (HMS), Boston, MA
| | - Theodore A Stern
- Harvard Medical School (HMS), Boston, MA; Avery D. Weisman Psychiatry Consultation Service at MGH, Boston, MA
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1246
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Chen J, Li X, Natsuaki MN, Leve LD, Harold GT. Genetic and environmental influences on depressive symptoms in Chinese adolescents. Behav Genet 2013; 44:36-44. [PMID: 24311200 DOI: 10.1007/s10519-013-9632-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 11/26/2013] [Indexed: 11/28/2022]
Abstract
Adolescent depression is common and has become a major public health concern in China, yet little research has examined the etiology of depression in Chinese adolescents. In the present study, genetic and environmental influences on Chinese adolescent depressive symptoms were investigated in 1,181 twin pairs residing in Beijing, China (ages 11-19 years). Child- and parent-versions of the children's depression inventory were used to measure adolescents' depressive symptoms. For self-reports, genetic factors, shared environmental factors, and non-shared environmental factors accounted for 50, 5, and 45 % of the variation in depressive symptoms, respectively; for parent-reports, genetic factors, shared environmental factors, and non-shared environmental factors accounted for 51, 18, and 31 % of the variation, respectively. These estimates are generally consistent with previous findings in Western adolescents, supporting the cross-cultural generalizability of etiological model of adolescent depression. Neither qualitative nor quantitative sex differences were found in the etiological model. Future studies are needed to investigate how genes and environments work together (gene-environment interaction, gene-environment correlation) to influence depression in Chinese adolescents.
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Affiliation(s)
- Jie Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, LinCuiLu 16, Chaoyang District, Beijing, 100101, China
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1247
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Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, O'Connor TG, Stein A. Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 2013; 70:1312-9. [PMID: 24108418 PMCID: PMC3930009 DOI: 10.1001/jamapsychiatry.2013.2163] [Citation(s) in RCA: 395] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Some small studies suggest that maternal postnatal depression is a risk factor for offspring adolescent depression. However, to our knowledge, no large cohort studies have addressed this issue. Furthermore, only 1 small study has examined the association between antenatal depression and later offspring depression. Understanding these associations is important to inform prevention. OBJECTIVE To investigate the hypothesis that there are independent associations between antenatal and postnatal depression with offspring depression and that the risk pathways are different, such that the risk is moderated by disadvantage (low maternal education) with postnatal depression but not with antenatal depression. DESIGN, SETTING, AND PARTICIPANTS Prospective investigation of associations between symptoms of antenatal and postnatal parental depression with offspring depression at age 18 years in a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) with data from more than 4500 parents and their adolescent offspring. MAIN OUTCOMES AND MEASURES Diagnosis of offspring aged 18 years with major depression using the International Classification of Diseases, 10th Revision. RESULTS Antenatal depression was an independent risk factor. Offspring were 1.28 times (95% CI, 1.08-1.51; P = .003) more likely to have depression at age 18 years for each standard deviation increase in maternal depression score antenatally, independent of later maternal depression. Postnatal depression was also a risk factor for mothers with low education, with offspring 1.26 times (95% CI, 1.06-1.50; P = .01) more likely to have depression for each standard deviation increase in postnatal depression score. However, for more educated mothers, there was little association (odds ratio, 1.09; 95% CI, 0.88-1.36; P = .42). Analyses found that maternal education moderated the effects of postnatal but not antenatal depression. Paternal depression antenatally was not associated with offspring depression, while postnatally, paternal depression showed a similar pattern to maternal depression. CONCLUSIONS AND RELEVANCE The findings suggest that treating maternal depression antenatally could prevent offspring depression during adulthood and that prioritizing less advantaged mothers postnatally may be most effective.
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Affiliation(s)
- Rebecca M Pearson
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, England
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1248
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Zeiders KH, Updegraff KA, Umaña-Taylor AJ, Wheeler LA, Perez-Brena NJ, Rodríguez SA. Mexican-origin youths' trajectories of depressive symptoms: the role of familism values. J Adolesc Health 2013; 53:648-54. [PMID: 23886552 PMCID: PMC4126584 DOI: 10.1016/j.jadohealth.2013.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/07/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe Mexican-origin youths' trajectories of depressive symptoms from early to late adolescence and examine the role of three aspects of familism values: supportive, obligation, and referent. METHODS Mexican-origin adolescents (N = 492) participated in home interviews and provided self-reports of depressive symptoms and cultural values at four assessments across an 8-year span. Using a cohort sequential design and accounting for the nesting within the 246 families (two youths per family), we examined depressive symptoms from ages 12 to 22 years and the within-person, between-sibling, and between-family effects of familism values. RESULTS Mexican-origin males' depressive symptoms decreased across adolescence, whereas females' symptoms exhibited a cubic pattern of change. Results revealed that increases in supportive and referent familism values within individuals and across families were related to lower levels of depressive symptoms. Findings were most pronounced for referent familism values, as a between-sibling effect also emerged. Obligation familism values were not associated with depressive symptoms. CONCLUSIONS Our findings provide important descriptive information about Mexican-origin youths' depressive symptoms and highlight the promotive role of familism values.
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Affiliation(s)
| | | | | | - Lorey A. Wheeler
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University
| | | | - Sue A. Rodríguez
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University
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1249
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Mazurek Melnyk B, Kelly S, Lusk P. Outcomes and Feasibility of a Manualized Cognitive-Behavioral Skills Building Intervention: Group COPE for Depressed and Anxious Adolescents in School Settings. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 27:3-13. [PMID: 24131237 DOI: 10.1111/jcap.12058] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Despite the increasing prevalence of depressive and anxiety disorders in adolescents, less than 25% of affected teens receive any treatment. METHODS A preexperimental one-group pre- and posttest pilot study design with 4-week follow-up was used to assess the feasibility and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) brief-focused manualized seven-session cognitive-behavioral skills building group intervention delivered in two high schools to 16 adolescents referred by a school-based nurse practitioner for depression or elevated anxiety symptoms. FINDINGS Adolescents reported significant decreases in depression and anxiety on the Beck Youth Inventory as well as increases in personal beliefs about managing negative emotions. Evaluations indicated that the group COPE intervention was a positive experience for the teens. CONCLUSIONS COPE is a promising brief-focused cognitive behavioral therapy-based intervention that can be delivered effectively to teens in school settings using a group format.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- The Ohio State University College of Nursing, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Kelly
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Pamela Lusk
- The Ohio State University College of Nursing, Columbus, OH, USA
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1250
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Stapinski LA, Montgomery AA, Heron J, Jerrim J, Vignoles A, Araya R. Depression symptom trajectories and associated risk factors among adolescents in Chile. PLoS One 2013; 8:e78323. [PMID: 24147131 PMCID: PMC3795668 DOI: 10.1371/journal.pone.0078323] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 09/11/2013] [Indexed: 11/20/2022] Open
Abstract
Adolescence is a key period for studying the development of depression, with studies in Europe and North America showing a pattern of elevated risk that begins in early adolescence and continues to increase as adolescents age. Few studies have examined the course of adolescent depression and associated risk factors in low and middle-income countries. This longitudinal cohort study examined depression symptom trajectories and risk factors in a sample of socio-economically disadvantaged adolescents in Chile (n = 2,508). Data were collected over an 18-month period as part of a clinical trial for secondary students aged 12 to 18 (median age 14). Clinical levels of depression were prevalent in this sample at baseline (35% for girls and 28% for boys); yet latent growth models of symptom trajectories revealed a pattern of decreasing symptoms over time. There was evidence of an anxiety-depression developmental pathway for girls, with elevated anxiety levels initially predicting poorer depression outcomes later on. Poor problem-solving skills were associated with initial depression levels but did not predict the course of depressive symptoms. Critically, the declining symptom trajectories raise important methodological issues regarding the effects of repeated assessment in longitudinal studies.
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Affiliation(s)
- Lexine A. Stapinski
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Alan A. Montgomery
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - John Jerrim
- Institute of Education, University of London, London, United Kingdom
| | - Anna Vignoles
- Institute of Education, University of London, London, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Ricardo Araya
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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