Comorbidity of anxiety and depression in children and adolescents: 20 years after

Influence of Childhood Family Routines on Adult Depression: A Cross Sectional Study

In order to explore the influence of childhood family routines on adult depression and the mediating role of tolerance of uncertainty and rumination, the current study tested 818 participants by adopting four questionnaires. The results of structural equation modeling revealed that (1) family routines had a negative effect on depression among Chinese college students; (2) family routines were found to have a positive effect on tolerance of uncertainty, and tolerance of uncertainty was a bridge linking family routines and depression; (3) family routines had a significant effect on depression through rumination; (4) the relationship between family routines and depression was partially mediated by the chain of tolerance of uncertainty and rumination. The result reveals not only the fact that childhood family routines have significant influence on college students' depression but also the mechanism of childhood family routines that affect college students' depression. The limitations and implications of our study were also discussed.

A computational network perspective on pediatric anxiety symptoms

BACKGROUND

While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research.

METHODS

Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression.

RESULTS

The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains.

CONCLUSIONS

Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

COVID-19 worries and mental health: the moderating effect of age

BACKGROUND

Older age (60+ years) increases the risk of contracting and dying from coronavirus disease 2019 (COVID-19), which might suggest worse mental health for those in this age range during the pandemic. Indeed, greater worry about COVID-19 is associated with poorer mental health. However, older age is generally associated with better emotional well-being, despite increased likelihood of negative events (e.g. death of a spouse) with age. This study examined whether age moderated the relation between COVID-19 worries and mental health.

METHODS

A national sample of U.S. adults (N = 848; aged 18-85 years) completed an online survey from March 30 to April 5, 2020. The survey assessed anxiety, depression, general concern about COVID-19, perceived likelihood of contracting COVID-19, social distancing, self-quarantining, current mood, health, and demographics.

RESULTS

Older age was associated with better mental health (i.e. lower levels of anxiety and depression). Greater perceived likelihood of contracting COVID-19 was related to higher anxiety. However, this effect was moderated by age. At younger ages (18-49 years), the positive association between perceived likelihood of contracting COVID-19 and anxiety was significant, but the association was not significant at older ages (50+ years).

CONCLUSION

Older age may buffer against the negative impact of the COVID-19 pandemic on mental health. More research is necessary to understand the potential protective nature of age during the pandemic, as well as the recovery period.

The p Factor Consistently Predicts Long-Term Psychiatric and Functional Outcomes in Anxiety-Disordered Youth

OBJECTIVE

Pediatric anxiety disorders can have a chronic course and are considered gateway disorders to adult psychopathology, but no consistent predictors of long-term outcome have been identified. A single latent symptom dimension that reflects features shared by all mental health disorders, the p factor, is thought to reflect mechanisms that cut across mental disorders. Whether p predicts outcome in youth with psychiatric disorders has not been examined. We tested whether the p factor predicted long-term psychiatric and functional outcomes in a large, naturalistically followed-up cohort of anxiety-disordered youth.

METHOD

Children and adolescents enrolled in a randomized controlled treatment trial of pediatric anxiety were followed-up on average 6 years posttreatment and then annually for 4 years. Structural equation modeling was used to estimate p at baseline. Both p and previously established predictors were modeled as predictors of long-term outcome.

RESULTS

Higher levels of p at baseline were related to more mental health disorders, poorer functioning, and greater impairment across all measures at all follow-up time points. p Predicted outcome above and beyond previously identified predictors, including diagnostic comorbidity at baseline. Post hoc analyses showed that p predicted long-term anxiety outcome, but not acute treatment outcome, suggesting that p may be uniquely associated with long-term outcome.

CONCLUSION

Children and adolescents with anxiety disorders who present with a liability toward broad mental health problems may be at a higher risk for poor long-term outcome across mental health and functional domains. Efforts to assess and to address this broad liability may enhance long-term outcome.

Associations between cognitive and affective empathy and internalizing symptoms in late childhood

BACKGROUND

Empathy is a multidimensional construct, which includes cognitive and affective components. Studies in adults have demonstrated that both cognitive and affective empathy are associated with anxious and depressive symptoms. The aim of this study was to examine these associations in childhood.

METHODS

Participants were 127 9- and 10-year-old children, recruited from the community. Self-report measures of cognitive and affective empathy, and internalizing symptoms were administered, as well as a task-based measure of cognitive empathy.

RESULTS

Canonical correlation analysis demonstrated that components of affective empathy, specifically affective sharing and empathic distress, were associated with internalizing (particularly social anxiety) symptoms (R_c = 0.63, non-parametric p < .001). Cognitive empathy was not associated with internalizing symptoms.

LIMITATIONS

Most of our findings were based around self-report measures of empathy, which may not accurately reflect empathy ability.

CONCLUSIONS

Findings suggests that children who share each other's emotions strongly are more likely to experience anxiety, particularly of a social nature.

Integrating and differentiating personality and psychopathology: A psychodynamic perspective

Several strands of research converge to suggest that personality and psychopathology can be integrated in the form of a hierarchical model of individual differences. The notion that personality and psychopathology are intrinsically linked has a long tradition within psychodynamic approaches. In this article, we first summarize empirical evidence supporting two related key assumptions of psychodynamic approaches to personality and psychology: that a developmental, person-centered approach is needed to complement a static, disorder-centered approach in the conceptualization and treatment of psychopathology; and that personality and psychopathology are best conceptualized as dynamic attempts at adaptation. Research in each of these areas supports the notion that personality and psychopathology are difficult to separate and may be moderated by severity (i.e., general psychopathology) such that increasing levels of severity result in increased intrinsic coupling between the two. We then discuss these findings in the context of a newly emerging social-communicative approach to human development that suggests that personality and psychopathology are better conceptualized in terms of a disorder of social communication, and that the purported rigidity and stability typically attributed to them are largely explained by the stability of the environmental mechanisms that underpin them, rather than by stable intrapersonal traits. The implications of these new views for the future of the science of personality and psychopathology, and for treatment strategies, are discussed.

Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children

Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.

Bidirectional and transactional relationships between parenting styles and child symptoms of ADHD, ODD, depression, and anxiety over 6 years

It is well established that mothers' parenting impacts children's adjustment. However, much less is known about how children's psychopathology impacts their mothers' parenting and how parenting and child symptoms relate either bidirectionally (i.e., a relationship in both directions over two time points) or transactionally (i.e., a process that unfolds over time) to one another over a span of several years. In addition, relatively little research addresses the role of fathers' parenting in the development of children's symptoms and, conversely, how children may elicit certain types of parenting from fathers. In this study, data were collected from 491 families on mothers' and fathers' parenting styles (authoritarianism, authoritativeness, permissiveness, and overprotectiveness) and children's symptoms of psychopathology (attention deficit, oppositional defiant, depression, and anxiety) when children were age 3, 6, and 9 years old. Cross-lagged panel analyses revealed that parents and children affected one another in a bidirectional and transactional fashion over the course of the six years studied. Results suggest that children's symptoms may compound over time partially because they reduce exposure to adaptive and increase exposure to maladaptive parenting styles. Likewise, maladaptive parenting may persist over time due to the persistence of children's symptoms.

Who benefits most from an evidence-based program to reduce anxiety and depression in children? A latent profile analysis

Comorbidity between anxiety and depression symptoms is often high in children. Person-oriented statistical approaches are useful to detect heterogeneity of individuals and diverse patterns of response to treatment. This study aimed to explore the different profiles in a sample of Spanish children who received the Super Skills for Life (SSL) transdiagnostic program, to identify which profile of individuals benefited most from the intervention and the likelihood of transition of symptom patterns over time. Participants were 119 children (42.9% were female) aged 8-12 years old (M = 9.39; SD = 1.26). Children completed anxiety and depression measures at the baseline, postintervention, and 12-months follow-up. Results from latent transition analysis (LTA) revealed two groups depending on the severity of the anxiety and depression symptoms: low symptoms (LS) and high symptoms (HS). LS group remained stable and HS decreased by 25%, switching to the LS group. Children with greater social anxiety benefited most from the program over time. Furthermore, older children were more likely to improve rapidly one year after the intervention compared to younger children. This study provides information to consider when implementing preventive interventions for schoolchildren and to tailor them according to the target population characteristics to increase their effectiveness.

Altered hedonic, novelty-, stress- and D-amphetamine-induced response due to social isolation in peripuberty

Reduction in direct social contact with peers during early adolescence is thought to be a risk factor for an increase in depressive symptoms, but there is still no clear evidence to suggest early behavioral manifestations and their association with the later outcome of social distancing during this period. To address this question, we used social isolation paradigm in peripubertal rats as the rodent model of adolescence. The litter was an experimental unit. On postnatal day 29, each litter gave group-housed and single-housed males, which were reared and tested one week and two weeks thereafter. Psychomotor/emotional response to novelty in exploration-based tasks, behavioral and neuronal responses to the drug reward (D-amphetamine), motivation/hedonic behavior, physiological and response to physiological stress were examined. Social isolation in peripubertal rats manifested through: hyper-reactivity/agitation and the state anxiety/risk-taking at an early stage; reduced behavioral response to D-amphetamine and altered neural processing of this stimulus, at a later stage; consummatory hypohedonia that deepened over time without changing the motivation to eat; unchanged body weight gain and resting blood corticosterone, cortisol and glucose levels over time; altered blood biochemistry (silenced corticosterone and increased glucose) due to overnight fasting only at an early stage. Our results highlight that the outcome of reduced direct social contact with peers during peripuberty is dynamic, with the cluster of atypical early symptoms that evolve into the syndrome that is delicate for assessment through routinely measurable behavior and biomarkers of stress, but with progressive consummatory hypohedonia and unaffected motivation to eat as stable marks.

Is concentration an indirect link between social anxiety and educational achievement in adolescents?

Social anxiety is associated with reduced educational achievement. Given that concentration is a predictor of educational achievement, and social anxiety symptoms are associated with reduced concentration in class, this prospective study examined the possibility that social anxiety may impair educational achievement through reduced classroom concentration. A sample of 509 participants (53.8% female; M age: 12.77 years [SD = 0.81]) recruited from secondary schools completed questionnaires assessing social anxiety symptoms, depressive symptoms, and concentration in class. Educational achievement was assessed by internal grades within schools. An indirect effect of social anxiety on later educational achievement via concentration was observed, over and above baseline achievement and depression symptoms; adolescents with higher levels of social anxiety tend to have more difficulties concentrating in class, which in turn is associated with poorer academic outcomes. Findings underscore the challenges socially anxious adolescents will face trying to learn in school, and the need for education providers and clinicians to consider the effect of social anxiety symptoms on concentration and learning.

The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials

BACKGROUND

Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes.

METHOD

Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators.

RESULTS

Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms.

CONCLUSION

The relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology.

Left superior temporal sulcus morphometry mediates the impact of anxiety and depressive symptoms on sleep quality in healthy adults

Anxiety and depressive symptoms may predispose individuals to sleep disturbance. Understanding how these emotional symptoms affect sleep quality, especially the underlying neural basis, could support the development of effective treatment. The aims of the present study were therefore to investigate potential changes in brain morphometry associated with poor sleep quality and whether this structure played a mediating role between the emotional symptoms and sleep quality. One hundred and forty-one healthy adults (69 women, mean age = 26.06 years, SD = 6.36 years) were recruited. A structural magnetic resonance imaging investigation was performed, and self-reported measures of anxiety, depressive symptoms and sleep quality were obtained for each participant. Whole-brain regression analysis revealed that worse sleep quality was associated with thinner cortex in left superior temporal sulcus (STS). Furthermore, the thickness of left STS mediated the association between the emotional symptoms and sleep quality. A subsequent commonality analysis showed that physiological component of the depressive symptoms had the greatest influence on sleep quality. In conclusion, thinner cortex in left STS may represent a neural substrate for the association between anxiety and depressive symptoms and poor sleep quality and may thus serve as a potential target for neuromodulatory treatment of sleep problems.

Distinguishing Transdiagnostic versus Disorder-Specific Pathways between Ruminative Brooding and Internalizing Psychopathology in Adolescents: A Latent Variable Modeling Approach

Rumination is correlated with diverse types of internalizing problems, but the extent to which it relates to a higher-order internalizing spectrum versus disorder-specific pathology is unclear. Using a quantitative model of the internalizing dimension, we compared the strength of transdiagnostic versus diagnosis-specific pathways from brooding-the most depressogenic component of rumination-to major depressive disorder (MDD) in adolescents. Community-recruited mid-adolescents (N = 241, M_age = 15.90 years, 53% female) completed semi-structured interviews of anxiety and depressive conditions and a self-report brooding measure. Confirmatory factor analysis revealed good fit for a one-factor model of internalizing conditions. Results revealed a large, significant factor correlation between brooding and the internalizing factor (r = 0.55), with some evidence for a more modest specific link between brooding and the unique component of the MDD diagnosis (r = 0.17; approximately one-third as large as the transdiagnostic pathway). These cross-sectional associations were generally consistent across two assessment waves separated by 19 months. We concluded that brooding is better conceptualized as a common characteristic of all internalizing problems in adolescence, rather than a specific feature of MDD. Preregistered hypotheses, data analysis code, and correlation matrices for this study are posted at https://osf.io/dax7u/ .

Psychometric propierties of the Selective Mutism Questionnaire in Spanish children

Research on selective mutism (SM) has been limited by the absence of standardised, psychometrically sound and cross-culturally valid assessment measures. Our aim is to present the results of a study of the factor structure and the reliability and concurrent validity of the scores of the Selective Mutism Questionnaire (SMQ), translated and adapted into Spanish. The SMQ contains 17 items about children's difficulty in speaking adequately in the family, school and social environment (out-of-school and out-of-family), each of which is answered according to a Likert scale with four response alternatives on speech frequency. Method: The study involved 110 pairs of parents of children diagnosed with SM whose ages ranged from 3 to 10 years. Results: The results show that the data from the Spanish sample fit the factorial model obtained by Bergman et al., and that data on its reliability and validity are robust and confirm that it as a good instrument for assessing SM in Spanish-speaking children. Conclusions: Therefore, we can affirm that the SMQ is a good instrument to assess SM in Spanish-speaking children.

Fear of missing out (FOMO): overview, theoretical underpinnings, and literature review on relations with severity of negative affectivity and problematic technology use

This article discusses the fear of missing out (FOMO) on rewarding experiences, an important psychological construct in contemporary times. We present an overview of the FOMO construct and its operational definition and measurement. Then, we review recent empirical research on FOMO’s relationship with levels of online social engagement, problematic technology and internet communication use, negative affectivity, and sociodemographic variables. Additionally, we discuss theoretical conceptualizations regarding possible causes of FOMO and how FOMO may drive problematic internet technology use. Finally, we discuss future directions for the empirical study of FOMO.

Spanish version of Super Skills for Life in individual modality: Improvement of children's emotional well-being from a transdiagnostic approach

OBJECTIVE(S)

This study analyzed the short-term effects of the Super Skills for Life (SSL) program in its individual format from the parents' perspective.

METHODS

Parents of 70 Spanish children aged 8-11 years (M = 9.31; SD = 1.16) completed assessment instruments about their children's emotional state at the baseline and postintervention.

RESULTS

Analyses revealed significantly lower scores in depression (The Mood and Feelings Questionnaire), anxiety, and specific disorders (The Spence Children's Anxiety Scale) (i.e., panic attack/agoraphobia, separation anxiety, social phobia, and generalized anxiety). Significant improvements were also found in anxiety life interference at home (The Child Anxiety Life Interference Scale), total difficulties, internalized and externalized problems, emotional symptoms, peer problems, and hyperactivity/inattention (The Strengths and Difficulties Questionnaire) at posttest. SSL was effective in reducing psychopathological symptoms similarly in both girls and boys.

CONCLUSIONS

These promising results provide preliminary support for the usefulness of the SSL program in individual format for the indicated prevention of children's emotional problems. This study provides a valuable resource for research and clinical practice.

Understanding Youth's Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Living with anxiety can be a complex, biopsychosocial experience that is unique to each person and embedded in their contexts and lived worlds. Scales and questionnaires are necessary to quantify anxiety, yet these approaches are not always able to reflect the lived experience of psychological distress experienced by youth. Guided by hermeneutic phenomenology, our research aimed to amplify the voices of youth living with anxiety. Fifty-eight youth living with anxiety took part in in-depth, open-ended interviews and participatory arts-based methods (photovoice and ecomaps). Analysis was informed by van Manen's method of data analysis with attention to lived space, lived body, lived time, and lived relationships, as well as the meanings of living with anxiety. Youth relied on the following metaphors to describe their experiences: A shrinking world; The heavy, heavy backpack; Play, pause, rewind, forward; and A fine balance. Overall, youth described their anxiety as a monster, contributing to feelings of fear, loss, and pain, but also hope. The findings from this study can contribute to the reduction of barriers in knowledge translation by encouraging the use of narrative and visual metaphors as a communicative tool to convey youth's lived experience of anxiety to researchers, clinicians, and the public.

The combination of fluoxetine and environmental enrichment reduces postpartum stress-related behaviors through the oxytocinergic system and HPA axis in mice

Gestational stress can increase postpartum depression in women. To treat maternal depression, fluoxetine (FLX) is most commonly prescribed. While FLX may be effective for the mother, at high doses it may have adverse effects on the fetus. As environmental enrichment (EE) can reduce maternal stress effects, we hypothesized that a subthreshold dose of FLX increases the impact of EE to reduce anxiety and depression-like behavior in postpartum dams exposed to gestational stress. We evaluated this hypothesis in mice and to assess underlying mechanisms we additionally measured hypothalamic-pituitary-adrenal (HPA) axis function and brain levels of the hormone oxytocin, which are thought to be implicated in postpartum depression. Gestational stress increased anxiety- and depression-like behavior in postpartum dams. This was accompanied by an increase in HPA axis function and a decrease in whole-brain oxytocin levels in dams. A combination of FLX and EE remediated the behavioral, HPA axis and oxytocin changes induced by gestational stress. Central administration of an oxytocin receptor antagonist prevented the remediating effect of FLX + EE, indicating that brain oxytocin contributes to the effect of FLX + EE. These findings suggest that oxytocin is causally involved in FLX + EE mediated remediation of postpartum stress-related behaviors, and HPA axis function in postpartum dams.

[Discrimination of anxiety disorders by parent ratings: A study based on the Questionnaire for Anxiety and Obsessive-Compulsive Disorders (FBB-ANZ)]

Discrimination of anxiety disorders by parent ratings: A study based on the Questionnaire for Anxiety and Obsessive-Compulsive Disorders (FBB-ANZ) Abstract. Parent ratings are often used for screening during the diagnostic evaluation of anxiety disorders. Clinically, it is important to correctly differentiate between anxiety and other psychiatric disorders and to distinguish specific anxiety disorders. The present study examined the validity of the screening results obtained by the Parent Questionnaire for Anxiety and Obsessive-Compulsive Disorders (FBB-ANZ). We examined whether the FBB-ANZ discriminated (1) anxiety and other psychiatric disorders and (2) specific anxiety disorders in children and adolescents using ROC analyses. 972 parents of 4;00-11;11-year-old children and 12;00-17;11-year-old adolescents with anxiety disorders, depressive episodes, or externalizing disorders completed the FBB-ANZ. Discrimination of anxiety disorders and externalizing disorders in children (AUC = .72) and adolescents (AUC = .76) as well as depressive episodes in children (AUC = .77) was moderate. Good discrimination of different anxiety disorders was found only for separation anxiety in children (AUC = .84) and adolescents (AUC = .87). The results indicate the limited diagnostic benefit of parent ratings for discriminating different anxiety disorders in children and adolescents. Potential explanations for the results are critically discussed.

Back to Basics: The Importance of Measurement Properties in Biological Psychiatry

Biological psychiatry is a major funding priority for organizations that fund mental health research (e.g., National Institutes of Health). Despite this, some have argued that the field has fallen short of its considerable promise to meaningfully impact the classification, diagnosis, and treatment of psychopathology. This may be attributable in part to a paucity of research about key measurement properties ("physiometrics") of biological variables as they are commonly used in biological psychiatry research. Specifically, study designs informed by physiometrics are more likely to be replicable, avoid poor measurement that results in misestimation, and maximize efficiency in terms of time, money, and the number of analyses conducted. This review describes five key physiometric principles (internal consistency, dimensionality, method-specific variance, temporal stability, and temporal specificity), illustrates how lack of understanding about these characteristics imposes meaningful limitations on research, and reviews examples of physiometric studies featuring a variety of popular biological variables to illustrate how this research can be done and substantive conclusions drawn about the variables of interest.

Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents

The purpose of this study was to identify items from the Revised Children's Anxiety and Depression Scale - RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire - MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire - SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents - a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.

The proportion and associated factors of anxiety in Chinese adolescents with depression during the COVID-19 outbreak

BACKGROUND

Given the serious impact of the COVID-19 outbreak on the mental health of Chinese adolescents, this study aimed to examine the proportion of anxiety and its correlates among Chinese adolescents with depression during the pandemic.

METHODS

This cross-sectional online survey was conducted from February 20th to February 27, 2020 in China. Symptoms of depression and anxiety were assessed by the 20-item Center for Epidemiological Studies-Depression (CES-D) and 7-item Generalized Anxiety Disorder (GAD-7), respectively.

RESULTS

In this study, 3,498 adolescents with depression were identified. Of them, the proportion of anxiety was 45.1% (95% confidence interval [CI]=43.5%-46.8%). Multiple logistic regression analysis revealed that being concerned about graduation (OR=1.25, P=0.002, 95% CI=1.09-1.43), sleep duration <6hr/day (OR=1.80, P<0.001, 95% CI=1.38-2.34), study duration >8hr/day (OR=1.21, P=0.02, 95% CI=1.03-1.42), and quantity of homework higher than before (OR=1.68, P<0.001, 95% CI=1.40-2.02) were positively associated with anxiety; the number of confirmed COVID-19 cases at a provincial level of 100-999 (OR=0.70, P<0.001, 95% CI=0.59-0.83) and 1,000-9,999 (OR=0.69, P=0.001, 95% CI=0.55-0.87) were negatively related to anxiety in adolescents with depression.

LIMITATIONS

Because this was a cross-sectional online study, the causality between variables and anxiety could not be examined among depressed adolescents. The use of self-reported scales may lead to an underestimation of the proportion of anxiety among adolescents with depression.

CONCLUSIONS

The symptoms of anxiety were common in adolescents with depression during the COVID-19 outbreak. Timing screening and targeted interventions are necessary to mitigate the risks of mental illness of adolescents.

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n = 3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression ("feeling unhappy", "feeling lonely") and anxiety symptoms ("worrying about past", "worrying about future"). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10862-021-09880-5.

Electronic Mental Health Screening in a Pediatric Heart Failure and Transplant Clinic

Adults with heart failure and transplant are at increased risk for psychiatric comorbidities. The prevalence and impact of psychiatric comorbidities have not been well studied in pediatric heart failure and transplant. This quality improvement project sought to evaluate the feasibility of utilizing electronic mental health screening measures during pediatric heart failure and transplant clinics and to explore the prevalence and severity of self-reported depressive, anxiety, and suicidal ideation symptoms. Patients aged 11 years and older who presented to a pediatric heart failure and transplant clinic were administered the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Medical chart review and a survey were used to examine additional variables of interest. There were no significant differences in moderate and severe mental health symptoms between gender, medical diagnoses, or those with recent hospitalizations. Pediatric patients with heart failure or transplant reported higher prevalence of anxiety and depressive symptoms, and similar suicidal ideation compared to the general adolescent population. Moreover, rates of depression and anxiety symptoms as well as suicidal ideation were comparable to pediatric patients with diabetes, lupus, inflammatory bowel disease, and cystic fibrosis. Results suggest electronic mental health screening is feasible for use during outpatient cardiology clinic visits and provides valuable mental health information.

Intelligence and academic achievement in inpatient adolescents with comorbid anxiety and depression

Few studies have investigated the relationship between comorbid depression and anxiety and cognitive and academic functioning. To understand this relationship, this study used a retrospective chart review from an inpatient facility for 42 adolescents diagnosed with a comorbid anxiety and depressive disorder. Multiple regression was used to determine whether anxiety and depression predicted academic achievement, as well as whether intelligence predicted current levels of anxiety and depression. Results indicated that higher severity of depression was associated with lower reading (β = -0.39) and writing (β = -0.40) achievement, while higher severity of anxiety was associated with higher scores on reading (β = 0.41) and writing (β = 0.36). Full-scale IQ was not significantly predictive of anxiety severity (β = 0.08) or depression severity (β = -0.24). Results are discussed in terms of identifying risk factors and improving outcomes for adolescents with severe comorbid anxiety and depression psychopathology.

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study

OBJECTIVE

Few studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms).

METHODS

This longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire.

RESULTS

The current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80-0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77-0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms.

CONCLUSIONS

The health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents' mental disorders are highly recommended.

DetectaWeb-Distress Scale: A Global and Multidimensional Web-Based Screener for Emotional Disorder Symptoms in Children and Adolescents

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for emotional disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood (major depression and dysthymic disorder), anxiety (separation anxiety, generalized anxiety, social phobia, panic disorder/agoraphobia, and specific phobia), obsessive-compulsive disorder, post-traumatic stress disorder, suicidality (suicidal ideation, plans, and attempts), and global distress. A total of 1,499 participants (aged 8-18) completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency (McDonald's ω ranging from 0.65 to 0.94); and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive-compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents.

Interpretation biases and depressive symptoms among anxiety-disordered children: The role of individual differences in respiratory sinus arrhythmia

Individual differences in interpretation biases-the tendency to interpret ambiguous stimuli as threatening-partially explain the presence of comorbid depressive symptoms among anxious youth. Increasing efforts have examined physiological processes that influence the association between interpretation biases and depressive symptoms in this population, and potential gender differences in this relationship. This study examined the moderating role of respiratory sinus arrhythmia (RSA) suppression (i.e., decrease from baseline)-an index of parasympathetic nervous system reactivity-in the association between interpretation biases and depressive symptoms in clinically anxious youth. One-hundred-and-five clinically anxious children (Mage  = 10.09 years, SD = 1.22; 56.7% female; 61.9% racial/ethnic minority) completed measures of self-reported and behaviorally indexed interpretation biases, reported anxiety/depression symptom severity, and participated in a speech task. RSA suppression during the task moderated the association between interpretation biases and depressive symptom severity in the total sample. Separate exploratory moderation analyses were conducted among girls and boys. Among girls, RSA suppression moderated the association between behaviorally indexed interpretation biases and depressive symptoms, and marginally moderated (p = .067) the association between self-reported interpretation biases and depressive symptoms. Among boys, RSA suppression was not a significant moderator. These findings may help identify clinically anxious youth most at-risk for comorbid depressive symptoms.

A Network Model of Positive Resources, Temperament, Childhood Trauma, and Comorbid Symptoms for Patient with Depressive Disorders

OBJECTIVE

Temperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders.

METHODS

Patients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns.

RESULTS

Deficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms.

CONCLUSION

Network pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.

Fibroblast Growth Factor 2 Implicated in Childhood Anxiety and Depression Symptoms

BACKGROUND

Research links fibroblast growth factor 2 (FGF2) to anxiety and depression in rodents and human adults. Our study is the first to examine FGF2 levels in a pediatric population.

METHODS

We assayed serum FGF2 in 163 children with a broad range of anxiety and depressive symptoms; 111 were clinic-referred anxious and depressed children; 52 were non-referred children. We examined associations between FGF2 and anxiety and depression symptoms, and between each of the three facets of behavioral activation (Reward-Responsiveness, Drive, Fun-Seeking) and behavioral avoidance. We used confirmatory factor analysis (CFA) to determine the relative contribution of anxiety and depression indicators and of FGF2 to a latent variable of Anxiety/Depression. We also examined stability of FGF2 levels.

RESULTS

FGF2 levels in clinic-referred children were significantly lower compared with non-referred children. Bivariate correlations and CFA showed negative associations between FGF2 and anxiety, depression and behavioral avoidance. FGF2 levels were positively correlated with the Reward-Responsiveness facet of behavioral activation, implicated in depression. FGF2 levels were stable over six months.

LIMITATIONS

We did not have data on behavioral avoidance and stability of FGF2 in the entire sample.

CONCLUSIONS

Our results implicate FGF2 in anxiety and depression in children, providing an important first step in showing FGF2 may serve as a stable biomarker for these prevalent and impairing problems.

The Relationship between Life Events and Personality Style to the Development of Depressive and Anxiety Disorders Among Adolescents

Background::

The separation of anxiety disorder and depressive disorder as two distinct disorders is often questioned. The aim of the current study is to examine whether there is a different profile of life events and personality characteristics for anxiety and depression disorders in adolescents.

Methods::

One hundred forty-six adolescents participated in the study; 57 boys and 89 girls, ranging in age from 11-18 years (mean=15.08+1.97). The study group included 92 adolescents with a clinical diagnosis of depression or anxiety, and the comparison group included 54 teenagers with no known psychopathology.

Results::

Multinomial logistic regression produced different predictive profiles for anxiety disorder and depressive disorders. Life event variables, especially minor life events and early traumas, were found to be predictors for depression. Furthermore, an interaction was found between early trauma and minor life events in the prediction of depression, such that the existence of trauma weakened the statistical correlation between minor life events and the onset of depression.

:

In addition, contrary to the literature regarding adults, it was found that during adolescence, personality variables have a unique contribution as predictive factors for vulnerability to the onset of anxiety and depression, thus reducing the significance of life events.

Conclusion::

Our findings suggest that different profiles of life events and personality characteristics can be identified for the two disorders. In addition, it appears that early traumas are a dominant factor that overshadow more recent life events at the onset of depression among adolescents.

Depression and Anxiety-Free Life Expectancy by Sex and Urban-Rural Areas in Jiangxi, China in 2013 and 2018

Objective: To quantitatively estimate life expectancy (LE) and depression and anxiety-free life expectancy (DAFLE) for the years 2013 and 2018 in Jiangxi Province, China, by sex and urban–rural areas. Additionally, to compare the discrepancy of DAFLE/LE of different sexes and urban-rural areas over various years. Methods: Based on the summary of the health statistics of Jiangxi Province in 2013 and 2018 and the results of the 5th and 6th National Health Service Surveys in Jiangxi Province, the model life table is used to estimate the age-specific mortality rate by sex and urban–rural areas. Sullivan’s method was used to calculate DAFLE. Results: Data from 2013 indicate that those aged 15 can expect to live 56.20 years without depression and anxiety for men and 59.67 years without depression and anxiety for women. Compared to 2013, DAFLE had not fluctuated significantly in 2018. The proportion of life expectancy without depression and anxiety (DAFLE/LE) declined between 2013 and 2018. DAFLE/LE in urban areas was higher than in rural areas. Men had higher DAFLE/LE than women. From 2013 to 2018, the DAFLE aged 15 decreased by 0.18 years for urban men and decreased by 0.52 years for urban women, rural areas also decreased to varying degrees. Conclusions: Even if women had a longer life span than men, they would spend more time with depression or anxiety. DAFLE did not increase with the increase in LE from 2013 to 2018, suggesting an absolute expansion of the burden, especially in rural areas. Depression and anxiety health services in Jiangxi, China will face more serious obstacles and challenges, which may lead to more disability. This requires more attention and more effective measures from the public, medical departments and the government.

The use of acceptance and commitment therapy (ACT) in addressing family accommodation (FA) for child anxiety

Many parents of children with anxiety tend to engage in varying levels of family accommodation (FA) in order to alleviate anxiety symptoms. This can exacerbate anxiety symptoms and have adverse effects for psychological treatments. A small number of general and specific interventions have been developed for FA but treatment research is at a nascent stage. Acceptance and commitment therapy (ACT) may be an effective treatment for FA. This article reviews the potential advantages and uses of ACT and how ACT’s six core processes can help target particular features of FA. The theoretical support for ACT is reviewed relevant to FA. The article concludes by conjecturing how ACT may be a useful and adaptive treatment in targeting FA.

Key learning aims

(1)

Parental internalizing symptoms as predictors of anxiety symptoms in clinic-referred children

Background:

Mothers’ and fathers’ internalizing symptoms may influence children’s anxiety symptoms differently.

Objective:

To explore the relationship between parental internalizing symptoms and children’s anxiety symptoms in a clinical sample of children with anxiety disorders.

Method:

The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children’s anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (M_age = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models.

Results:

Both mother and father rated internalizing symptoms predicted children’s self-rated anxiety levels (adj. R² = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R² = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children.

Conclusions:

Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations.

Prediction of state anxiety by machine learning applied to photoplethysmography data

Background

As the human behavior is influenced by both cognition and emotion, affective computing plays a central role in human-machine interaction. Algorithms for emotions recognition are usually based on behavioral analysis or on physiological measurements (e.g., heart rate, blood pressure). Among these physiological signals, pulse wave propagation in the circulatory tree can be assessed through photoplethysmography (PPG), a non-invasive optical technique. Since pulse wave characteristics are influenced by the cardiovascular status, which is affected by the autonomic nervous activity and hence by the psychophysiological state, PPG might encode information about emotional conditions. The capability of a multivariate data-driven approach to estimate state anxiety (SA) of healthy participants from PPG features acquired on the brachial and radial artery was investigated.

Methods

The machine learning method was based on General Linear Model and supervised learning. PPG was measured employing a custom-made system and SA of the participants was assessed through the State-Trait Anxiety Inventory (STAI-Y) test.

Results

A leave-one-out cross-validation framework showed a good correlation between STAI-Y score and the SA predicted by the machine learning algorithm (r = 0.81; p = 1.87∙10⁻⁹). The preliminary results suggested that PPG can be a promising tool for emotions recognition, convenient for human-machine interaction applications.

Anxiety as a risk factor for cardiovascular disease independent of depression: a prospective examination of community-dwelling men (the MrOS study)

OBJECTIVE

Anxiety and depression have been linked to increased risk of cardiovascular disease (CVD). Whether anxiety is a risk factor independent from depression, and if associations are limited to specific CVD outcomes remains unclear. Design: Participants (N = 3135) of the prospective Osteoporotic Fracturs in Men Sleep ancillary study were community-dwelling men (age ≥ 65) living in the US. Main outcome measures: The Goldberg Anxiety and Depression Scales, coronary heart disease (CHD) and cerebrovascular disease (CER). We used Cox proportional hazards models to calculate adjusted hazard ratios and 95% confidence intervals. Results: During 12 years of follow-up, we accrued 612 cases of CHD and 291 cases of CER (incident or repeat-event). Overall, we observed no association between anxiety or depression and CER. Anxiety was significantly associated with CHD, but this effect was attenuated after controlling for depression and covariates. Depression was significantly associated with CHD after similar adjustments. For men without prior history of CVD, neither anxiety nor depression were associated with incident CHD. Conclusions: Anxiety was not a significant independent predictor of CHD or CER, suggesting that previous findings of anxiety as a risk factor of CVD might be attributed to failure to control for the effect of depression.

Bridging Anxiety and Depression: A Network Approach in Anxious Adolescents

BACKGROUND

The phenomenology and neurobiology of depressive symptoms in anxious youth is poorly understood.

METHODS

Association networks of anxiety and depressive symptoms were developed in adolescents with generalized anxiety disorder (GAD; N=52, mean age: 15.4±1.6 years) who had not yet developed major depressive disorder. Community analyses were used to create consensus clusters of depressive and anxiety symptoms and to identify "bridge" symptoms between the clusters. In a subset of this sample (n=39), correlations between cortical thickness and depressive symptom severity was examined.

RESULTS

Ten symptoms clustered into an anxious community, 5 clustered into a depressive community and 5 bridged the two communities: impaired schoolwork, excessive weeping, low self-esteem, disturbed appetite, and physical symptoms of depression. Patients with more depressive cluster burden had altered cortical thickness in prefrontal, inferior and medial parietal (e.g., precuneus, supramarginal) regions and had decreases in cortical thickness-age relationships in prefrontal, temporal and parietal cortices.

LIMITATIONS

Data are cross-sectional and observational. Limited sample size precluded secondary analysis of comorbidities and demographics.

CONCLUSIONS

In youth with GAD, a sub-set of symptoms not directly related to anxiety bridge anxiety and depression. Youth with greater depressive cluster burden had altered cortical thickness in cortical structures within the default mode and central executive networks. These alternations in cortical thickness may represent a distinct neurostructural fingerprint in anxious youth with early depressive symptoms. Finally, youth with GAD and high depressive symptoms had reduced age-cortical thickness correlations. The emergence of depressive symptoms in early GAD and cortical development may have bidirectional, neurobiological relationships.

Chinese adolescents' mindfulness and internalizing symptoms: The mediating role of rumination and acceptance

BACKGROUND

Internalizing problems during adolescence are common psychiatric symptoms. Previous research has demonstrated that mindfulness was significantly and negatively associated with and mindfulness-based interventions would be efficacious for aiming at adolescents' internalizing problems. However, research about how mindfulness could improve internalizing symptoms among Chinese adolescents is sparse and its potential mechanism is still unclear. The present study adopted rumination and acceptance to examine their mediation effects between Chinese adolescents' mindfulness and internalizing symptoms.

METHODS

A final sample of 1,554 adolescents (aged from 10 to 18 years old, M = 15.58, SD =1.25) were recruited from schools in South China. Participants were asked to complete a package of questionnaires measuring mindfulness, internalizing problems (indicated by generalized anxiety and depression), rumination, and acceptance.

RESULTS

Structural equation model confirmed our hypothesis and showed that rumination, as well as acceptance, significantly mediated the relationship between Chinese adolescents' mindfulness level and internalizing symptoms (generalized anxiety and depression).

LIMITATIONS

a) only cross-sectional design was employed in the study; b) most of participants were normal adolescent students, without a diagnosis of any psychiatric disorder; c) all the measures were self-reported by adolescents.

CONCLUSIONS

Mindfulness not only directly impacted on adolescents' internalizing problems, but also indirectly improved their anxious and depression emotions via the reduction of rumination and the increase of acceptance. Hence, mindfulness training as well as the application of emotion regulation skills may be useful for adolescents exposed to the likelihood of suffering from internalizing problems.

Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Paternal Sensitivity and Children's Cognitive and Socioemotional Outcomes: A Meta-Analytic Review

In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.

Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren?

BACKGROUND

Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains.

METHODS

The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables.

RESULTS

Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression.

CONCLUSIONS

Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Depression in Adolescence: A Systematic Review

BACKGROUND

There is evidence that repetitive transcranial magnetic stimulation (rTMS) is effective for treating adult depression. However, it remains unclear whether rTMS is an effective treatment for adolescent depression. This systematic review examines the existing literature on the effectiveness and acceptability of rTMS in the treatment of adolescent depression.

METHODS

After protocol registration (PROSPERO), we searched PubMed, Embase, PsycINFO, WoS and CENTRAL databases and the grey literature. We included studies that used rTMS in adolescents aged 12-25 years old who had a clinical diagnosis of depression. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Fourteen studies were identified, which included 8 open-trial studies (N = 142 participants) and six studies which performed further post-hoc/follow-up analyses on these open-trial datasets. All studies suffered from multiple biases but reported that rTMS treatment reduced depression scores in adolescents. A single study on theta burst stimulation also found a positive effect. No study to date includes a sham control. Reported side effects of rTMS included scalp pain, headache and dizziness.

LIMITATIONS

Study methodologies precluded a meta-analysis.

CONCLUSIONS

The current literature signals that rTMS could reduce adolescent depressive symptoms. However, sham controlled randomized trials are needed. These findings suggest that rTMS may be a promising treatment option for adolescents with depression.

Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

BACKGROUND

The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment.

METHODS

The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention.

RESULTS

Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC.

LIMITATIONS

The small sample size and lack of an active control group were the major limitations of this study.

CONCLUSIONS

This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country.