Adolescent and adult differences in major depression symptom profiles

Random Forest with Sampling Techniques for Handling Imbalanced Prediction of University Student Depression

In this work, we propose a combined sampling technique to improve the performance of imbalanced classification of university student depression data. In experimental results, we found that combined random oversampling with the Tomek links under sampling methods allowed generating a relatively balanced depression dataset without losing significant information. In this case, the random oversampling technique was used for sampling the minority class to balance the number of samples between the datasets. Then, the Tomek links technique was used for undersampling the samples by removing the depression data considered less relevant and noisy. The relatively balanced dataset was classified by random forest. The results show that the overall accuracy in the prediction of adolescent depression data was 94.17%, outperforming the individual sampling technique. Moreover, our proposed method was tested with another dataset for its external validity. This dataset’s predictive accuracy was found to be 93.33%.

Serious physical injury and depressive symptoms among adolescents aged 12-15 years from 21 low- and middle-income countries

BACKGROUND

Little is known about the relationship between physical injury and depression in youths from low- and middle-income countries (LMICs). Therefore, the aim of this study was to analyze the association between serious physical injury and depressive symptoms among adolescents in 21 LMICs.

METHODS

Data from the Global School-based Student Health Survey (2003-2008) were analyzed. Serious physical injury and depressive symptoms in the past 12 months were assessed with self-report measures. The association between serious physical injury and depressive symptoms was examined using multivariable logistic regression analysis and meta-analysis.

RESULTS

The final sample consisted of 44,333 adolescents aged 12-15 years. After adjustment for sex, age, food insecurity, alcohol consumption, and country, an increasing number of serious physical injuries in the past 12 months was associated with increments in the odds for depressive symptoms in a dose-dependent fashion. Those who had ≥6 serious injuries (vs. no injuries) were 2.79 (95%CI=2.23-3.48) times more likely to have depressive symptoms. The pooled odds ratio (OR) (95%CI) for the association between at least one serious physical injury and depressive symptoms obtained by meta-analysis based on country-wise estimates was 1.83 (1.67-2.01) with a moderate level of between-country heterogeneity (I²=56.0%).

LIMITATIONS

This was a cross-sectional study and causality of the association cannot be deduced.

CONCLUSIONS

Serious physical injury may be a risk factor for depressive symptoms among adolescents in LMICs. Efforts to prevent physical injury and the provision of adequate health care for those who are injured may improve mental wellbeing among adolescents in this setting.

Annual Research Review: Defining and treating pediatric treatment-resistant depression

BACKGROUND

Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression is a significant risk factor for suicide, which is now the second leading cause of death in young people. Up to twenty per cent of adolescents will experience MDD before adulthood, and while a substantial proportion will improve with standard-of-care treatments (psychotherapy and medication), roughly one third will not.

METHODS

Here, we have reviewed the literature in order to discuss the concept of treatment-resistant depression (TRD) in adolescence, examine risk factors, diagnostic difficulties, and challenges in evaluating symptom improvement, and providing guidance on how to define adequate medication and psychotherapy treatment trials.

RESULTS

We propose a staging model for adolescent TRD and review the treatment literature. The evidence base for first- and second-line treatments primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, and IMPACT). After two medications and a trial of evidence-based psychotherapy have failed to alleviate depressive symptoms, the evidence becomes quite thin for subsequent treatments. Here, we review the evidence for the effectiveness of medication switches, medication augmentation, psychotherapy augmentation, and interventional treatments (i.e., transcranial magnetic stimulation, electroconvulsive therapy, and ketamine) for adolescent TRD. Comparisons are drawn to the adult TRD literature, and areas for future pediatric depression research are highlighted.

CONCLUSIONS

As evidence is limited for treatments in this population, a careful consideration of the known risks and side effects of escalated treatments (e.g., mood stabilizers and atypical antipsychotics) is warranted and weighed against potential, but often untested, benefits.

Pediatric Clinical Endpoint and Pharmacodynamic Biomarkers: Limitations and Opportunities

Medical research in children typically lags behind that of adult research in both quantity and quality. The conduct of rigorous clinical trials in children can raise ethical concerns because of children's status as a 'vulnerable' population. Moreover, carrying out studies in pediatrics also requires logistical considerations that rarely occur with adult clinical trials. Due to the relatively smaller number of pediatric studies to support evidence-based medicine, the practice of medicine in children is far more reliant upon expert opinion than in adult medicine. Children are at risk of not receiving the same level of benefits from precision medicine research, which has flourished with new technologies capable of generating large amounts of data quickly at an individual level. Although progress has been made in pediatric pharmacokinetics, which has led to safer and more effective dosing, gaps in knowledge still exists when it comes to characterization of pediatric disease and differences in pharmacodynamic response between children and adults. This review highlights three specific therapeutic areas where biomarker development can enhance precision medicine in children: asthma, type 2 diabetes mellitus, and pain. These 'case studies' are meant to update the reader on biomarkers used currently in the diagnosis and treatment of these conditions, and their shortcomings within a pediatric context. Current research on surrogate endpoints and pharmacodynamic biomarkers in the above therapeutic areas will also be described. These cases highlight the current lack in pediatric specific surrogate endpoints and pharmacodynamic biomarkers, as well as the research presently being conducted to address these deficiencies. We finally briefly highlight other therapeutic areas where further research in pediatric surrogate endpoints and pharmacodynamic biomarkers can be impactful to the care of children.

Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women

IMPORTANCE

Oral contraceptives have been associated with an increased risk of subsequent clinical depression in adolescents. However, the association of oral contraceptive use with concurrent depressive symptoms remains unclear.

OBJECTIVES

To investigate the association between oral contraceptive use and depressive symptoms and to examine whether this association is affected by age and which specific symptoms are associated with oral contraceptive use.

DESIGN, SETTING, AND PARTICIPANTS

Data from the third to sixth wave of the prospective cohort study Tracking Adolescents' Individual Lives Survey (TRAILS), conducted from September 1, 2005, to December 31, 2016, among females aged 16 to 25 years who had filled out at least 1 and up to 4 assessments of oral contraceptive use, were used. Data analysis was performed from March 1, 2017, to May 31, 2019.

EXPOSURE

Oral contraceptive use at 16, 19, 22, and 25 years of age.

MAIN OUTCOMES AND MEASURES

Depressive symptoms were assessed by the DSM-IV-oriented affective problems scale of the Youth (aged 16 years) and Adult Self-Report (aged 19, 22, and 25 years).

RESULTS

Data from a total of 1010 girls (743-903 girls, depending on the wave) were analyzed (mean [SD] age at the first assessment of oral contraceptive use, 16.3 [0.7]; (mean [SD] age at the final assessment of oral contraceptive use, 25.6 [0.6] years). Oral contraceptive users particularly differed from nonusers at age 16 years, with nonusers having a higher mean (SD) socioeconomic status (0.17 [0.78] vs -0.15 [0.71]) and more often being virgins (424 of 533 [79.5%] vs 74 of 303 [24.4%]). Although all users combined (mean [SD] ages, 16.3 [0.7] to 25.6 [0.6] years) did not show higher depressive symptom scores compared with nonusers, adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (β coefficient for interaction with age, -0.021; 95% CI, -0.038 to -0.005; P = .0096). Adolescent contraceptive users particularly reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers.

CONCLUSIONS AND RELEVANCE

Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence.

Evidence for Specific Associations Between Depressive Symptoms, Psychotic Experiences, and Suicidal Ideation in Chilean Adolescents From the General Population

Associations between psychotic experiences and suicidal ideation are not yet fully understood, and the potential role of depressive symptoms in this relationship remains unclear. The current study examined relationships between depressive symptoms (DS), psychotic experiences (PE) and suicidal ideation (SI) using two complementary approaches on cross-sectional data from a community sample of adolescents aged 13-19 years (N = 1,591). First, we investigated the association between the three domains using mediation analysis, showing that depressive symptoms partly mediate the relationship between psychotic experiences and suicidal ideation. Second, we looked at associations between the three domains at item level using network analysis. Specific associations between symptoms of the three domains were found, indicating depressive symptoms of sadness, avolition, pessimism, and self-criticalness/worthlessness as the most central symptoms in the network. Suicidal ideation was associated with the depressive symptoms pessimism and worthlessness, to social anxiety, and to perceptual anomalies. Our results show that the mediating effect of depressive symptoms between psychotic experiences and suicidal ideation may be due to associations between specific aspects of SI, depressive symptoms and psychotic experiences. These findings can contribute to the planning of health services and programs aimed at the timely detection of psychopathology and suicidal risk in young people.

Direct sunlight exposure reduces hair cortisol levels in rhesus monkeys (Macaca mulatta)

Major depressive disorder (MDD), commonly known as depression, is a mental disease characterized by a core symptom of low mood. It lasts at least two weeks (Badamasi et al., 2019; Wang et al., 2019) and is frequently accompanied by low self-esteem, loss of interest in routinely enjoyable activities, low energy, and unexplained pain (Huey et al., 2018; Park et al., 2012; Post & Warden, 2018; Rice et al., 2019; Xiao et al., 2018). Approximately 2%-8% of adults with MDD commit suicide (Richards & O'Hara, 2014; Strakowski & Nelson, 2015), and around half of suicidal individuals suffer depression or other mood disorders (Bachmann, 2018).