A longitudinal look at the relation between depression and anxiety in children and adolescents

Longitudinal associations between post-traumatic distress and depressive symptoms following a traumatic event: a test of three models

BACKGROUND

Symptoms of post-traumatic stress disorder (PTSD) and depression are highly co-morbid following a traumatic event. Nevertheless, decisive evidence regarding the direction of the relationship between these clinical entities is missing.

METHOD

The aim of the present study was to examine the nature of this relationship by comparing a synchronous change model (PTSD and depression are time synchronous, possibly stemming from a third common factor) with a demoralization model (i.e. PTSD symptoms causing depression) and a depressogenic model (i.e. depressive symptoms causing PTSD symptoms). Israeli adult victims of single-event traumas (n=156) were assessed on measures of PTSD and depression at 2, 4 and 12 weeks post-event.

RESULTS

A cross-lagged structural equation modeling (SEM) analysis provided results consistent with the synchronous change model and the depressogenic model.

CONCLUSIONS

Depressive symptoms may play an important role in the development of post-traumatic symptoms.

Long-Term Outcomes of an Australian Universal Prevention Trial of Anxiety and Depression Symptoms in Children and Youth: An Evaluation of the Friends Program

This study evaluated the long-term effectiveness of the FRIENDS Program in reducing anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison to a control condition. Longitudinal data for Lock and Barrett's (2003) universal prevention trial is presented, along with data from 12-month follow-up to 24- and 36-month follow-up. Results of this study indicate that intervention reductions in anxiety reported in Lock and Barrett were maintained for students in Grade 6, with the intervention group reporting significantly lower ratings of anxiety at long-term follow-up. A significant Time x Intervention Group x Gender Effect on Anxiety was found, with girls in the intervention group reporting significantly lower anxiety at 12-month and 24-month follow-up but not at 36-month follow-up in comparison to the control condition. Results demonstrated a prevention effect with significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition. Results are discussed within the context of prevention research.

Childhood anxiety and depressive symptoms: trajectories, relationship, and association with subsequent depression

The development of child anxiety and depressive symptoms from mean ages 5.3 to 9.3 years was examined in a community sample of 133 girls and 134 boys, using parent and teacher ratings. Reliable individual differences in anxiety and depressive symptoms at mean age 5.3 and in their change to mean age 9.3 were observed, with significant correlations between depressive and anxiety symptoms at mean age 5.3 years and between their changes with age. Positive cross-lagged correlations from anxiety to depressive symptoms and negative cross-lagged correlations from depressive to anxiety symptoms were apparent in teachers' ratings at 6- to 12-month intervals. Developmental changes in teacher-rated child anxiety symptoms were robust predictors of child self-reported depressive symptoms at mean age 9.3 years. These results suggest assessment and interventions for emotional problems may be usefully implemented during childhood in school and peer social environments.

Latent trajectory classes of depressive and anxiety disorders from adolescence to adulthood: descriptions of classes and associations with risk factors

This study used person-oriented analyses to identify subgroups of individuals who exhibit different patterns of depressive and anxiety disorders over the course of adolescence and young adulthood. Using latent class growth analysis, six trajectory classes were identified. Two classes were mainly characterized by depressive disorders; one class was mainly characterized by anxiety disorders; two classes were characterized by temporally different patterns of comorbidity; and one class was characterized by the absence of psychopathology. Classes characterized largely by depressive disorders differed in persistence and degree of comorbidity with anxiety disorders. Classes that were characterized by anxiety disorders differed in persistence, age of onset, and constellation of specific anxiety disorders. Female participants were more likely to belong to classes characterized by fluctuations in the course of depressive and anxiety disorders; sex differences were not observed in classes characterized by persistent depressive and anxiety disorders. Offspring of parents with depression were more likely to have a depressive course, whereas offspring of parents with anxiety disorders tended to have a course characterized by anxiety disorder. The findings indicate that several subgroups of adolescents exist with distinct longitudinal trajectories of depressive and anxiety disorders, and these trajectory classes are associated with different risk factors.

A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders

OBJECTIVE

To test two hypotheses of psychiatric comorbidity in bipolar disorder (BD): (i) comorbid disorders are independent of BD course, or (ii) comorbid disorders associate with mood.

METHODS

In the Jorvi Bipolar Study (JoBS), 191 secondary-care outpatients and inpatients with DSM-IV bipolar I disorder (BD-I) or bipolar II disorder (BD-II) were evaluated with the Structured Clinical Interview for DSM-IV Disorders, with psychotic screen, plus symptom scales, at intake and at 6 and 18 months. Three evaluations of comorbidity were available for 144 subjects (65 BD-I, 79 BD-II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity. A latent change model (LCM) was used to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Inventory (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM-IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM-IV-based scales of substance use and eating disorders.

RESULTS

In the SEM, depression and anxiety exhibited strong cross-sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both persisting over time. Substance use disorders covaried with manic symptoms (r = 0.16-0.20, p < 0.05), and eating disorders with depressive symptoms (r = 0.15-0.32, p < 0.05). In the LCM, longitudinal intraindividual improvements in BDI were associated with similar BAI improvement (r = 0.42, p < 0.001).

CONCLUSIONS

Depression and anxiety covary strongly cross-sectionally and longitudinally in BD. Substance use disorders are moderately associated with manic symptoms, and eating disorders with depressive mood.

Cultural Model of Vulnerability to Distress: The Role of Self-Construal and Sociotropy on Anxiety and Depression Among Asian Americans and European Americans

The present study tested a structural equation model of the association between self-construal, sociotropy, anxiety, and depression across two ethnic groups ( n = 212 for Asian Americans and n = 202 for European Americans). The results provided support for a unified model that was applicable in explaining distress experiences among both ethnic groups. Interdependent self-construal predisposes a person to develop sociotropy and consequent depression via a heightened level of anxiety. Despite this indirect pathway from interdependent self-construal to depression, however, interdependent self-construal in and of itself was found to be negatively related to depression. On the other hand, independent self-construal protects a person from developing sociotropy and subsequent distress experiences. The findings provided support to the link between anxiety and depression. Implications to person-environment fit are discussed.

Prodromal symptoms and atypical affectivity as predictors of major depression in juveniles: implications for prevention

BACKGROUND

Given the long-term morbidity of juvenile-onset major depressive disorder (MDD), it is timely to consider whether more effort should be dedicated to its primary and secondary prevention.

METHODS

We reviewed studies of prodromal symptoms that may herald a first episode pediatric MDD and considered whether that literature has made an impact on secondary prevention (efforts to prevent progression from symptoms to full disorder). We also reviewed studies of children at familial risk for MDD that addressed atypical affectivity and the regulation of sad, dysphoric affect (mood repair) and related physiological systems, and considered whether research in those areas has made an impact on primary prevention of pediatric MDD (efforts to prevent the disorder).

RESULTS

A compelling body of literature indicates that depressive symptoms in youngsters predict subsequent MDD across the juvenile (and early adult) years and that any combination of several symptoms for at least one week is informative in that regard. These findings are echoed in the case selection criteria used by many secondary prevention programs. Convergent findings also indicate that (compared to typical peers) young offspring at familial risk for depression manifest low positive affectivity and compromised mood repair, along with signs of dysfunction in three intertwined physiological systems that contribute to affectivity and mood repair (the hypothalamic-pituitary-adrenal (HPA) axis, cerebral hemispheric asymmetry, and cardiac vagal control). While all these affect-related parameters are suitable for case selection and as intervention targets, they have not yet made an impact on primary prevention programs.

CONCLUSIONS

According to recent meta-analyses, attempts to prevent pediatric depression have not lived up to expectations. Based on our review, possible reasons for this include: (a) the use of case selection criteria that yield samples heterogeneous with regard to whether the symptoms are truly prodromal to an episode of MDD or are trait-like (which could affect response to the intervention), (b) failure to fully capitalize on the broad-ranging literature on vulnerability to pediatric MDD, as evidenced by the infrequent use of family history of depression (a robust index of vulnerability) or combined indices of vulnerability for case selection, and (c) lack of synchrony between dimensions of vulnerability and the content of the prevention program, as indicated by the overwhelming use of cognitive-behavioral interventions, irrespective of subjects' age, developmental readiness, and whether or not they evidenced the relevant cognitive vulnerability. Prevention trials of pediatric MDD could benefit from new approaches to case selection that combine various indices of vulnerability, more effective use of existing findings, and new or modified interventions that are developmentally sensitive.

The temporal relation between depression and comorbid psychopathology in adolescents at varied risk for depression

BACKGROUND

This study examined the temporal comorbidity of depressive disorders with anxiety, externalizing, and substance use disorders in adolescents who varied in risk for depression.

METHODS

Participants were 240 adolescents and their mothers who had either a history of depression (high-risk, n = 185) or were lifetime-free of psychiatric disorders (low-risk, n = 55). Children (54.2% females) were first evaluated in 6th grade (mean age = 11.86, SD = .57) with the K-SADS-PL to assess current and lifetime diagnoses, and then annually through 12th grade with the A-LIFE to assess diagnoses since the previous evaluation.

RESULTS

For girls, the rate of depression was high regardless of prior anxiety, whereas for boys, the odds that those with prior subthreshold anxiety would have subsequent subthreshold depression were 1.5 times those of boys with no prior subthreshold anxiety, controlling for risk. In addition, the odds that girls with prior substance use disorders would have a threshold depressive disorder subsequently were three times those of girls with no prior substance use disorders, controlling for risk.

CONCLUSIONS

These results highlight the importance of early detection of various forms of psychopathology in youth who then can be targeted for intervention. The prospective paths to comorbidity differed by sex, thus suggesting that interventions need to be constructed with sensitivity to these distinct diagnostic trajectories.

Childhood fears, neurobehavioral functioning and behavior problems in school-age children

The objective is to examine underlying associations between childhood fears, behavior problems and neurobehavioral functioning (NBF) in school-age children. Healthy, regular school children (N = 135), from second, fourth and sixth grade classes were assessed. Data regarding children's fears and behavioral problems were obtained with the Revised Fear Survey Schedule for Children, the Child Behavior Checklist, and NBF was assessed using a computerized neurobehavioral evaluation system. Significant correlations between childhood fears and NBF measures and somatic complaints were found. Children who reported higher levels of fears demonstrated lower working memory span (r = 0.24, p < 0.05), lower motor speed (r = -0.23, p < 0.05), and had more somatic complaints (r = 0.20, p < 0.05). Furthermore, younger children reported less fears than older ones and girls reported more fears than boys. These results highlight significant association between childhood fears, NBF and behavior problems in a non-clinical group children. Lower working memory span is an important component of executive control that may be an underlying factor in fears and anxiety in children.

Clinical and cognitive correlates of depressive symptoms among youth with obsessive compulsive disorder

Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range of depressive symptoms, with 21% scoring at or above the clinical cutoff on the self-report measure of depression. Higher levels of depressive symptoms were associated with higher levels of cognitive distortions assessed on measures of insight, perceived control, competence, and contingencies. Depressive symptoms were also linked to older age and more severe OCD. Low perceived control and self-competence and high OCD severity independently predicted depression scores.

Anxious solitude and clinical disorder in middle childhood: bridging developmental and clinical approaches to childhood social anxiety

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. 192 children provided self reports of social anxiety disorder symptoms on a questionnaire, and 76 of these children and their parent participated in clinical interviews. Results indicate that children identified by their peers as anxious solitary in the fall of 4th grade, compared to control children, were significantly more likely to receive diagnoses of social anxiety disorder, specific phobia, and selective mutism based on parent clinical interviews. Additionally, there was a tendency for these children to be diagnosed with generalized anxiety disorder and post traumatic stress disorder based on parent clinical interviews. Furthermore, children who had been identified as anxious solitary at any time in the 3rd or 4th grades were more likely than control children to report symptoms of social anxiety disorder that fell in the clinical range and to receive diagnoses of social anxiety disorder and dysthymia (both trends) and major depression (a significant effect) according to parental clinical interview.

One factor or two parallel processes? Comorbidity and development of adolescent anxiety and depressive disorder symptoms

BACKGROUND

This study investigates whether anxiety and depressive disorder symptoms of adolescents from the general community are best described by a model that assumes they are indicative of one general factor or by a model that assumes they are two distinct disorders with parallel growth processes. Additional analyses were conducted to explore the comorbidity of adolescent anxiety and depressive disorder symptoms and the effects that adolescent anxiety and depressive disorder symptoms have on each other's symptom severity growth.

METHODS

Two cohorts of early (N = 923; Age range 10-15 years; Mean age = 12.4, SD = .59; Girls = 49%) and middle adolescent (N = 390; Age range 16-20 years; Mean age = 16.7, SD = .80; Girls = 57%) boys and girls from the general community were prospectively studied annually for five years. These two adolescent cohorts were divided into five groups: one group at-risk for developing a specific anxiety disorder and four additional groups of healthy adolescents that differed in age and sex. Self-reported anxiety and depressive disorder symptoms were analyzed with latent growth modeling.

RESULTS

Comparison of the fit statistics of the two models clearly demonstrates the superiority of the distinct disorders with parallel growth processes model above the one factor model. It was also demonstrated that the initial symptom severity of either anxiety or depression is predictive of the development of the other, though in different ways for the at-risk and healthy adolescent groups.

CONCLUSIONS

The results of this study established that the development of anxiety and depressive disorder symptoms of adolescents from the general community occurs as two distinct disorders with parallel growth processes, each with their own unique growth characteristics.

Anxiety, mood, and substance use disorders in parents of children with anxiety disorders

Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in parents of AD children relative to NPD children. Specific child-mother relationships were found between child separation anxiety and panic disorder and maternal panic disorder, as were child and maternal social phobia, obsessive compulsive disorder, and specific phobias. Findings are discussed with reference to theory, clinical implications, and future research needs.

Internalizing disorders in early childhood: a review of depressive and anxiety disorders

This article reviews the use of the broad category of internalizing disorders and data on young children using this definition. It also reviews the emerging support for more specific internalizing diagnoses in very young children. The current empiric database on nosology and treatment of mood and anxiety disorders in young children is examined, and a clinical case example is included. Identification of recent advances in the understanding and treatment of anxiety disorders in young children and areas in which future studies are needed also are explored.

Common and specific emotion-related predictors of anxious and depressive symptoms in youth

This study examined whether specific emotion-related constructs may be uniquely related to anxious or depressive symptoms in youth. Although anxiety and depression are comorbid in both youth and adult populations, delineation of these disorders is a worthwhile endeavor given that such differentiation may lead to a clearer conceptualization of the disorders that in turn may facilitate more efficient diagnosis and effective treatment. Children in the 4th and 5th grades (N = 187; M age = 10 years, 3 months) completed measures to assess symptoms of anxiety and depression and emotion-related functioning. Using structural equation modeling, emotion-related variables were identified that were common to both anxiety and depression (poor emotion awareness, emotion dysregulation, poor emotion regulation coping, high frequency of negative affect), most strongly related to depression (low frequency of positive affect), and most distinctly associated with anxiety (frequency of emotion experience, somatic response to emotion activation). The findings suggest that comprehensive theoretical formulations of anxiety and depression in youth should consider emotion-related variables. The results also suggest potential avenues that may facilitate more efficient assessment and treatment of such youth.

Parent Depression and Child Anxiety: An Overview of the Literature with Clinical Implications

The association of parental depression with child anxiety has received relatively little attention in the literature. In this paper we initially present several reasons for examining this relationship. We then summarize the empirical support for a link between these two variables. Finally, we discuss directions for future research and clinical implications of an association of parental depression with child anxiety.

Gender, Anxiety, and Depressive Symptoms: A Longitudinal Study of Early Adolescents

Does anxiety lead to depression more for girls than for boys? This study prospectively examines gender differences in the relationship between anxiety and depressive symptoms in early adolescence. One hundred thirteen 11- to 14-year-old middle school students complete questionnaires assessing depressive symptoms and three dimensions of anxiety (worry and oversensitivity, social concerns and concentration, and physiological anxiety) as well as total anxiety symptoms at an initial assessment and 1 year later. Total anxiety and worry and oversensitivity symptoms are found to predict later depressive symptoms more strongly for girls than for boys. There is a similar pattern of results for social concerns and concentration symptoms, although this does not reach statistical significance. Physiological anxiety predicts later depressive symptoms for both boys and girls. These findings highlight the importance of anxiety for the development of depression in adolescence, particularly worry and oversensitivity among girls.

A critical review of the empirical literature on the relation between anxiety and puberty

The current paper critically reviews the empirical literature focused on the association between puberty and anxiety. A detailed review of more than 45 empirical articles is provided. There is some evidence that among girls, but not boys, a more advanced pubertal status (controlling for age) is associated with higher reported anxiety symptoms. Also among girls, earlier pubertal timing is linked to higher anxiety scores. It is unclear whether early puberty may lead to increased anxiety or if high anxiety influences pubertal timing. With respect to hormones, there were relatively few significant associations for girls, although this literature is very small. Among boys, several studies reported positive associations between both gonadal and adrenal hormones and anxiety. The direction of effect for these finding is also unstudied. The primary limitation of the hormone-anxiety literature pertains to the absence of pubertal measures in samples of youth in which hormones are measured. The paper concludes with a comprehensive examination of the methodological strengths and weaknesses of the literature and recommendations for future work.

Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety

A systematic review was conducted of school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%). Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher delivery.

The role of fear and anxiety in the familial risk for major depression: a three-generation study

BACKGROUND

The overlap between anxiety and major depressive disorder (MDD), the increased risk for depression and anxiety in offspring of depressed parents, the sequence of onset with anxiety preceding MDD, and anxiety as a predictor of depression are well established. The specificity of anxiety disorders in these relationships is unclear. This study, using a longitudinal high-risk design, examined whether anxiety disorders associated with the emotions fear and anxiety mediate the association between parental and offspring depression.

METHOD

Two hundred and twenty-four second-generation and 155 third-generation descendants at high and low risk for depression because of MDD in the first generation were interviewed over 20 years. Probit and Cox proportional hazard models were fitted with generation 2 (G2) or G3 depression as the outcome and parental MDD as the predictor. In G2 and G3, fear- (phobia or panic) and anxiety-related [overanxious or generalized anxiety disorder (GAD)] disorders were examined as potential mediators of increased risk for offspring depression, due to parental MDD.

RESULTS

In G2, fear-related disorders met criteria for mediating the association between parental MDD and offspring MDD whereas anxiety-related disorders did not. These results were consistent, regardless of the analytic methods used. Further investigation of the mediating effect of fear-related disorders by age of onset of offspring MDD suggests that the mediating effect occurs primarily in adolescent onset MDD. The results for G3 appear to follow similar patterns.

CONCLUSIONS

These findings support the separation of anxiety disorders into at least two distinct forms, particularly when examining their role in the etiology of depression.

Disorders of childhood and adolescence: gender and psychopathology

Early-onset disorders (e.g., conduct problems, autism) show a marked male preponderance, whereas adolescent-onset disorders (e.g., depression, anxiety) show a marked female preponderance. A developmental psychopathology framework provides a means to investigate complex gender-related etiologies of these different disorders. This review focuses on biological and environmental factors implicated in the development of conduct problems and depression in boys and girls. Boys and girls showed certain differences in types, rates, comorbidities, antecedents, correlates, and trajectories of these problems. Origins of male and female preponderant problems are likely to be rooted, in part, in biological, physical, cognitive, and social-emotional differences in boys and girls that can precede the expression of clinical problems. These male-like and female-like characteristics are considered regarding conduct problems and depression to explore how they inform biological and environmental theories about gender and psychopathology. At the same time, because boys and girls also show many similarities, it is important to avoid sex-stereotyping mental health problems.

Family climate of routine asthma care: associating perceived burden and mother-child interaction patterns to child well-being

This preliminary report links the literatures on family asthma management practices and on the characteristics of family interaction patterns thought to influence children's adjustment to a chronic physical illness. Specifically, this study of 60 families with a child with asthma examined the extent to which perceived burden of routine asthma care affected child mental health via its influence on parent-child interaction patterns. Mothers completed a measure of asthma management routine burden, mother and child were observed in a 15-minute interaction task, and children completed measures of child anxiety and asthma quality of life (QOL). Perceived routine burden significantly predicted child anxiety and QOL through its effect on mother-child rejection/criticism. The same pattern did not hold for mother intrusiveness/control. The results are discussed in terms of how overall family climate and regulation of routines affects child well-being. Implications for clinical practice and limitations of the study are provided.

Developmental trajectories of anxiety symptoms among boys across early and middle childhood

This study examined the developmental trajectory of anxiety symptoms among 290 boys and evaluated the association of trajectory groups with child and family risk factors and children's internalizing disorders. Anxiety symptoms were measured using maternal reports from the Child Behavior Checklist (T. M. Achenbach, 1991, 1992) for boys between the ages of 2 and 10. A group-based trajectory analysis revealed 4 distinct trajectories in the development of anxiety symptoms: low, low increasing, high declining, and high-increasing trajectories. Child shy temperament tended to differentiate between initial high and low groups, whereas maternal negative control and maternal depression were associated with increasing trajectories and elevated anxiety symptoms in middle childhood. Follow-up analyses to diagnoses of preadolescent depression and/or anxiety disorders revealed different patterns on the basis of trajectory group membership. The results are discussed in terms of the mechanisms of risk factors and implications for early identification and prevention.

RELATION OF GUILT, SHAME, BEHAVIORAL AND CHARACTEROLOGICAL SELF-BLAME TO DEPRESSIVE SYMPTOMS IN ADOLESCENTS OVER TIME

In a two-wave, longitudinal study, 221 nonreferred adolescents completed measures of guilt, shame, Behavioral self-blame (BSB), Characterological self-blame (CSB), depressive symptoms measures, and attributional style. Goals were to examine similarities between Tangney's (1996) conceptualization of guilt and shame and Janoff-Bulman's (1979) conceptualization of BSB and CSB in adolescents. Specific aims were (1) to examine the relation of depressive symptoms and depressive cognitions to shame, guilt, CSB, and BSB, (2) to estimate the longitudinal relations between depressive symptoms and measures of guilt, shame, BSB, and CSB, and (3) to assess the convergent and discriminant validity of shame/CSB measures and guilt/BSB measures. Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.

Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: pilot randomized controlled trial

OBJECTIVE

The aim of the present study was to compare the relative effectiveness of group and individual formats of a family-focused cognitive-behavioural intervention, for the treatment of childhood anxiety disorders.

METHOD

Twenty-nine clinically anxious children aged between 7 and 12 years were randomly allocated to either individual cognitive-behaviour therapy (ICBT) or group cognitive-behaviour therapy (GCBT).

RESULTS

At post-treatment assessment 57% of children in the ICBT condition no longer met criteria for any anxiety disorder, compared to 47% of children in the GCBT condition. At 3 month follow up these improvements were retained with some weakening. By the 6 month follow up 50% of children in the ICBT compared to 53% of children in the GCBT condition were anxiety diagnosis free. In terms of questionnaire data, no significant differences were detected between the ICBT and GCBT conditions at any of the follow-up points. However, a significant treatment effect for time was found, with both self-reports and parent reports indicating a significant reduction over time in anxiety symptoms.

CONCLUSION

Overall, results suggest that children with anxiety disorders appear to improve following a family-focused cognitive behavioural intervention, regardless of individual or group administration. The interpretation and potential clinical implications of these findings are discussed, together with the limitations of this study and suggestions for future research.

Prevention of depression in youth: a qualitative review and future suggestions

Since 1990, significant efforts have been made towards developing interventions to prevent depression in youth. Meta-analyses of preventive interventions have consistently yielded small but significant effect sizes in the short-term prevention of depression. However, the maintenance of intervention effects over extended follow-ups ranging from 6 months to 3 years has not been consistently demonstrated. In this qualitative review, significant methodological issues that continue to be of concern are discussed. Illustrative studies are described to highlight the accomplishments and limitations of interventions to date. Particular areas in need of attention include the implementation of booster sessions, use of appropriate statistical analyses, examination of multiple outcome variables, augmentation of protective factors, and exploration of mediators and moderators of intervention effects. Future directions for the field of depression prevention are outlined.

Prevention of Childhood Emotional Disorders: Reducing the Burden of Suffering Associated with Anxiety and Depression

Anxiety and depression are the most common mental health problems affecting young people today. This review presents a description of the prevalence and impact of these emotional disorders in children and youth. While treatment offers one approach to intervening, research indicates that most sufferers will not actually receive clinical intervention, and of the minority who do, many will terminate prematurely, fail to respond, or experience recurrent difficulties despite treatment. Prevention approaches offer an alternative and adjunct to treatment, and have become a priority for governments, offering a cost effective and efficient means of providing services to children and youth prior to the onset of psychopathology. This review describes current practises in prevention research and provides an overview of an Australian developed cognitive-behavioural programme that has acquired a solid evidence-base as well as popularity in schools as one approach to building emotional resilience in children and youth, whilst effectively reducing the burden associated with emotional disturbances of anxiety and depression. Future directions for prevention practice and research are highlighted.

Do anxiety and depression cluster into distinct groups?: a test of tripartite model predictions in a community sample of youth

Because of their high comorbidity and strong associations, the distinctiveness of anxiety and depression in youth continues to be debated. In this study we used cluster analysis in a community sample (n=225) of youth to test tripartite model predictions regarding the grouping of individuals based on their levels of anxiety and depression symptoms. Findings were consistent with tripartite model predictions that four groups would emerge (primarily elevated on anxiety symptoms only, elevated on depression symptoms only, elevated on both anxiety and depression symptoms, and a low symptom group). Analyses using specific tripartite model variables and parent report of internalizing symptoms provided additional support for the groupings and tripartite model predictions. Across age groupings, the clustering of anxiety and depression symptoms was consistent with some hypothesized developmental differences in the expression of internalizing symptoms in youth. Findings add support for the tripartite model in youth, and support the idea that anxiety and depression do represent unique syndromes in youth. Depression and Anxiety 23:453-460, 2006. Published 2006 Wiley-Liss, Inc.

Stress sensitization and adolescent depressive severity as a function of childhood adversity: a link to anxiety disorders

The goal of the present study was to determine whether exposure to adversity in childhood contributes to a differential threshold at which stressful life events provoke depressive reactions in adolescence. In addition, to address empirical and conceptual questions about stress effects, the moderating effect of anxiety disorder history was also explored. This examination was conducted in a sample of 816 children of depressed and nondepressed mothers, who were followed from birth to age 15. Information on adversities experienced in childhood was collected both from mothers during the first five years of their youth's life and from the youths themselves at age 15, and included information on the mother's relationship with her partner, maternal psychopathology, as well as youth-reported abuse. Results indicated that youths with both greater exposure to adversity in childhood and a history of an anxiety disorder displayed increased depressive severity following low levels of episodic stress compared to youths with only one or neither of these risk factors. The results are speculated to reflect the possibility that early anxiety disorders associated with exposure to adversity in childhood may be a marker of dysregulated stress responses, and may help to account for the comorbidity of depression and anxiety in some individuals.

Psychosocial and pharmacological treatment for pediatric anxiety disorders

Anxiety disorders in children and adolescents are highly prevalent and associated with long-term impairment. This article reviews the main diagnostic features of the most common pediatric anxiety disorders, including specific phobia, separation anxiety disorder, generalized anxiety disorder and social anxiety disorder, and highlights the state-of-the-art treatments for these diagnoses. The most recent evidence for empirically supported treatments is described, namely cognitive-behavioral therapy and selective serotonin-reuptake inhibitors. The review concludes by providing practitioners with recommendations for treating pediatric anxiety and highlighting areas for further investigation.

Depression in children and adolescents: linking risk research and prevention

The National Institute of Mental Health has called for translational research linking basic knowledge about vulnerabilities that underlie mood disorders to the development of effective preventive interventions. This paper highlights research about risk factors for depression in children and adolescents and links it to current knowledge about interventions aimed at preventing depression in youth. Basic epidemiologic and clinical research indicates that increased risk for depression is associated with being female; a family history of depression, particularly in a parent; subclinical depressive symptoms; anxiety; stressful life events; neurobiological dysregulation; temperament/personality (e.g., neuroticism); negative cognitions; problems in self-regulation and coping; and interpersonal dysfunction. These vulnerabilities both increase individuals' chances of encountering stress and decrease their ability to deal with the stress once it occurs. Although several existing depression-prevention studies have targeted one or more of these risk factors, the efficacy of these various prevention programs for youth with different combinations of these risk factors needs to be investigated further. Most existing depression-prevention programs in youth have used cognitive-behavioral techniques, with some success. Other depression-prevention strategies have included training in coping, social problem solving, social skills, communication skills, and parenting. A comprehensive prevention program is recommended that includes multiple intervention components, each of which addresses risk and protective factors across different domains and levels of analysis.

Is behavioral inhibition a risk factor for depression?

BACKGROUND

Several studies have reported an observed relationship between a behaviorally inhibited temperament early in life and subsequent clinical anxiety, but few have explored the relationship between early inhibition and depression.

METHODS

In a cross-sectional survey of non-clinical adults we examined the relationship between retrospectively reported childhood behavioral inhibition and lifetime depression. We then examined the mediating role of social anxiety and childhood relational stress factors.

RESULTS

Subjects who qualified for a lifetime episode of depression also reported significantly more childhood inhibition, particularly if they had a juvenile onset depression (i.e., by age 16). Further analyses revealed that social anxiety mediated the link between reported childhood inhibition and later depression, and highlighted the additional meditating effect of parental influences.

CONCLUSION

Any relationship between an early inhibited temperament and later depression, may in fact be dependent upon the presence of clinically meaningful social anxiety.

Evaluating models of the personality–psychopathology relationship in children and adolescents

Connections between personality traits and psychopathology in children and adolescents have frequently been reported in research studies. However, despite the occurrence of significant and systematic relationships between personality and mental disorders in childhood, a thorough understanding of the cause, nature, and implications of these relationships is lacking. In this paper, a comprehensive taxonomy of childhood personality is used to link research on children with that on adults, as well as provide a framework for discussing the personality-psychopathology relationship. Next, research on children and adolescents is integrated into various proposed models of the personality-psychopathology relationship. Finally, clinical implications and future directions are proposed for research on personality and psychopathology in children.

Adolescent depression: description, causes, and interventions

Depression is one of the most prevalent of the psychiatric disorders and is common among individuals with epilepsy. Depression often begins in adolescence. The present review focuses on adolescent depression. In particular, this review first summarizes the definition, description, and classification of adolescent depression. Next, potential causes of adolescent depression are reviewed from a vulnerability-stress perspective. This part of the review focuses on the role of stressors and how stressors interact with genetic, biological, cognitive, personality, and interpersonal vulnerabilities to predict adolescent depression. Last, clinical aspects of adolescent depression are reviewed, including treatment and prevention of depression and the relation to epileptic disorders in adolescence. In sum, a substantial percentage of youth with epilepsy and seizures exhibit depression, and many are not diagnosed or treated in a timely manner. The present review shows that there are valid, empirically based assessments, treatments, and preventions for depression in adolescence that hold promise for reducing the significant burden associated with depression.

Effects of psychotherapy for depression in children and adolescents: a meta-analysis

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

Toward guidelines for evidence-based assessment of depression in children and adolescents

We aim to provide a starting point toward the development of an evidence-based assessment of depression in children and adolescents. We begin by discussing issues relevant to the diagnosis and classification of child and adolescent depression. Next, we review the prevalence, selected clinical correlates, course, and treatment of juvenile depression. Along with some general considerations in assessment, we discuss specific approaches to assessing depression in youth (i.e., interviews, rating scales) and briefly summarize evidence on the reliability and validity of a few selected instruments. In addition, we touch on the assessment of several other constructs that are important in a comprehensive evaluation of depression (i.e., social functioning, life stress, and family history of psychopathology). Last, we highlight areas in which further research is necessary and conclude with some broad recommendations for clinical practice given the current state of the knowledge.

Temperament and anxiety disorders

Recently, multidisciplinary research teams have come together to assess the emergence, course, and treatment of anxiety disorders in young children and adolescents. A number of researchers have suggested that early temperament traits may play a significant role in the causes and maintenance of early anxiety. This article reviews the current understanding of temperament and anxiety as separate constructs and then attempts to examine the developmental links between the two constructs. The authors examine the outstanding issues that must be addressed before the benefits of bridging these traditionally independent fields of study can be fully exploited.

A comparison between socially anxious and depressive symptomatology in youth: a focus on perceived family environment

The current study employed present-oriented self-report measures to compare groups of socially anxious, depressed, mixed socially anxious and depressed, and comparison youth on perceptions of the family environment, as assessed via the Family Environment Questionnaire (FEQ). Results indicated that the mixed and depressed groups rated their parents as being overly concerned with others' opinions, feeling ashamed of their performance, and restricting family sociability more than the socially anxious and comparison groups. With respect to the latter two groups, the socially anxious group rated their family environment more negatively than the comparison group on each of these variables. Implications of the findings and directions for future research are discussed.

Prevention and Early Intervention of Anxiety Disorders in Inhibited Preschool Children

This article reports results from an early intervention program aimed at preventing the development of anxiety in preschool children. Children were selected if they exhibited a high number of withdrawn/inhibited behaviors--one of the best identified risk factors for later anxiety disorders--and were randomly allocated to either a 6-session parent-education program or no intervention. The education program was group based and especially brief to allow the potential for public health application. Children whose parents were allocated to the education condition showed a significantly greater decrease in anxiety diagnoses at 12 months relative to those whose parents received no intervention. However, there were no significant effects demonstrated on measures of inhibition/withdrawal. The results demonstrate the value of (even brief) very early intervention for anxiety disorders, although these effects do not appear to be mediated through alterations of temperament.

Generalized Anxiety Disorder and major depressive disorder comorbidity in the National Survey of Mental Health and Well-Being

We report population data on DSM-IV Generalized Anxiety Disorder (GAD) from the Australian National Survey of Mental Health and Well-Being, obtained from a nationwide household survey of adults using a stratified multistage sampling process. A response rate of 78.1% resulted in 10,641 persons being interviewed. Diagnoses were made using the Composite International Diagnostic Interview. The interview was computerised and conducted by trained lay interviewers. We investigated comorbidity between GAD and major depressive disorder (MDD). The results indicate that sociodemographic correlates of GAD, and associated disablement and service use, are influenced by the presence of a comorbid depressive disorder but cannot be fully explained by the presence of that disorder. In addition, GAD was confirmed as significantly disabling, even as a single disorder. We conclude that the results are consistent with the view that GAD has a significant and independent impact on the burden of mental disorders.

The structure of child and adolescent psychopathology: generating new hypotheses

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension.