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

Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China

Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China.A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model.About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression.Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.

Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model

Anxiety and depressive symptoms frequently co-occur in adolescence and confer greater distress compared to experiencing either symptom alone. A causal model (anxiety symptoms predicting depressive symptoms), a correlated liabilities model (vulnerabilities interacting with stressors to predict both symptoms), and a diathesis-anxiety model (vulnerabilities interacting with anxiety symptoms to predict depressive symptoms) have all been proposed as explanations for the relation between depression and anxiety. To date, however, research has mostly examined these models among North American/Western European adolescents. In response, the present study sought to identify the best explanatory model concerning the relationship between anxiety and depressive symptoms among Chinese adolescents. 494 10^th grade students were assessed for their perceived levels of family cohesion and conflict, stressors, and depressive and anxiety symptoms. Every 3 months for 18 months, youth reported their symptoms and stressors. Symptoms and stressors were person-mean and grand-mean centered to compare nomothetic and idiographic conceptualizations of vulnerability. Overall, evidence suggested a reciprocal, versus causal, relation between anxiety and depressive symptoms. Further, while cohesion and conflict independently predicted anxiety and depressive symptoms, their interactions with stressors were not supported. Ultimately, strong support was found for a diathesis-anxiety model using an idiographic conceptualization of anxiety, such that low perceived family cohesion interacted with within-subject fluctuations of anxiety to predict prospective depressive symptoms. This study provides cross-cultural support for a diathesis-anxiety model and shows the importance of distinguishing between positive and negative family functioning when examining vulnerability in Chinese adolescents. Research and clinical implications of these findings are discussed.

Association of Mediterranean Diet Adherence, Functional Food Consumption and Anthropometric Characteristics with Anxiety and Depression Indexes in a Sample of Healthy Greek Adults: A Cross-Sectional Study

The purpose of this randomized, retrospective study was to investigate the possible association among levels of anxiety and depression and functional food consumption frequency, Mediterranean diet adoption and anthropometric indices in a sample of Greek, mainly young, adults. One hundred twenty healthy adults, 80% of whom were 18–35 years old, were randomly recruited from the North Aegean Islands, mainly from the Aegean University campus. The degree of anxiety was evaluated using the State-Trait Anxiety Inventory (STAI-X-1,2) whereas the degree of depression was assessed using the Beck Depression Inventory (BDI). Mediterranean diet adherence was evaluated using the Med Diet Score and functional foods consumption frequency by a validated food frequency questionnaire (FFQ). According to our results, the study did not show a statistically significant association between Mediterranean diet adherence and anxiety or depression levels (p > 0.05), and a trend association was observed only for the depression grouped score. In parallel, increased depression level was significantly correlated with an increased body mass index (BMI) (p = 0.019). In addition, the consumption of specific functional foods, such as beans, nuts, pomegranate, spinach and foods enriched with β-glucans, correlated with state-trait anxiety or depression levels, as well as with anthropometric indices (p < 0.05). The results of the study may contribute to the elucidation of the possible role of the Mediterranean diet and functional food consumption on self-esteem, anxiety and depression.

Reduced anxiety and changes in amygdala network properties in adolescents with training for awareness, resilience, and action (TARA)

Mindfulness-based approaches show promise to improve emotional health in youth and may help treat and prevent adolescent depression and anxiety. However, there is a fundamental gap in understanding the neural reorganization that takes place as a result of such interventions. The Training for Awareness, Resilience, and Action (TARA) program, initially developed for depressed adolescents, uses a framework drawn from neuroscience, mindfulness, yoga, and modern psychotherapeutic techniques to promote emotional health. The goal of this study was to assess the effects of the TARA training on emotional health and structural white matter brain networks in healthy youth. We analyzed data from 23 adolescents who underwent the 12-week TARA training in a controlled within-subject study design and whose brain networks were assessed using diffusion MRI connectomics. Compared to the control time period, adolescents showed a significant decrease in anxiety symptoms with TARA (Cohen's d = -0.961, p = 0.006); moreover, the node strength of the Right Amygdala decreased significantly after TARA (Cohen's d = -1.026, p = 0.004). Post-hoc analyses indicated that anxiety at baseline before TARA was positively correlated with Right Amygdala node strength (r = 0.672, p = 0.001). While change in Right Amygdala node strength with TARA was not correlated with change in anxiety (r = 0.146, p = 0.51), it was associated with change in depression subscale of Anhedonia / Negative Affect (r = 0.575, p = 0.004, exploratory analysis), possibly due to overlapping constructs captured in our anxiety and depression scales. Our results suggest that increased structural connectivity of Right Amygdala may underlie increased anxiety in adolescents and be lowered through anxiety-reducing training such as TARA. The results of this study contribute to our understanding of the neural mechanisms of TARA and may facilitate neuroscience-based prevention and treatment of adolescent anxiety and depression.

Changes in network centrality of psychopathology symptoms between the COVID-19 outbreak and after peak

The current study investigated the mechanism and changes in psychopathology symptoms throughout the COVID-19 outbreak and after peak. Two studies were conducted separately in China during outbreak and the after peak stages, with 2540 participants were recruited from February 6 to 16, 2020, and 2543 participants were recruited from April 25 to May 5, 2020. The network models were created to explore the relationship between psychopathology symptoms both within and across anxiety and depression, with anxiety measured by the Generalized Anxiety Disorder-7 and depression measured by the Patient Health Questionnaire-9. Symptom network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between the outbreak and after peak. Noticeably, psychomotor symptoms such as impaired motor skills, restlessness, and inability to relax exhibited high centrality during the outbreak, which still relatively high but showed substantial remission during after peak stage (in terms of strength, betweenness, or bridge centrality). Meanwhile, symptoms of irritability (strength, betweenness, or bridge centrality) and loss of energy (bridge centrality) played an important role in the network after the peak of the pandemic. This study provides novel insights into the changes in central features during the different COVID-19 stages and highlights motor-related symptoms as bridge symptoms, which could activate the connection between anxiety and depression. The results revealed that restrictions on movement were associated with worsen in psychomotor symptoms, indicating that future psychological interventions should target motor-related symptoms as priority.

Increasing the Role of Phenomenology in Psychiatric Diagnosis-The Clinical Staging Approach

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.

mPFC GABAergic transmission mediated the role of BDNF signaling in cognitive impairment but not anxiety induced by adolescent social stress

Depression with comorbid anxiety or cognitive symptoms can vary in terms of symptoms, pathophysiology and antidepressant efficacy, but the underlying neurobiological mechanisms remain to be elucidated. Previous studies from our group and others have shown that as a classic animal model of depression, adolescent social stress (ASS) could stably induce a variety of emotional and cognitive alterations in adult animals, and accompanied by transcriptional decrease in brain-derived neurotrophic factor (BDNF) total and promoter IV levels in the medial prefrontal cortex (mPFC). The present study further identified the GABAergic synaptic and molecular changes downstream of BDNF signaling impairment in the mPFC and roles in various behavioral phenotypes induced by ASS. We found that ASS induced a set of emotional and cognitive symptoms, including decreased social interest, impaired cognitive function, and increased anxiety-like behavior, as well as decreased GABAergic transmission in the mPFC. The specific deletion of BDNF promoter IV directly caused impairments in social interest, cognitive function, and inhibition of GABAergic transmission, but no changes in anxiety-like behavior. Acute microinjections of tropomyosin-related kinase B (TrkB) agonists into the mPFC and chronic antidepressant treatment ameliorated the changes in social behavior and cognition, as well as the reduction in GABAergic synaptic transmission in the mPFC, but not anxiety in previously stressed adult mice. These results suggest that the downstream GABAergic transmission of BDNF signaling in the mPFC involved in depression with comorbid cognitive dysfunction induced by ASS and can be used as a therapeutic target for the treatment of cognitive dysfunction in depression. This article is part of the special issue on Stress, Addiction and Plasticity.

Spanish Adaptation and Psychometric Properties of the Parent Version of the Short Mood and Feelings Questionnaire (SMFQ-P) in a Non-Clinical Sample of Young School-Aged Children

The parent version of the Short Mood and Feelings Questionnaire (SMFQ-P) is a brief 13-item tool for the screening of depression in children from the age of 6 years. Despite the wide use of the SMFQ-P, its psychometric properties and factor structure remain understudied, with few data available for young school-aged children. The objective of this study was to examine for the first time the factorial structure and psychometric properties of the SMFQ-P in a non-clinical sample of Spanish-speaking children aged 6-8 years. Participants were 181 children whose parents completed the Spanish-adapted version of the SMFQ-P along with the parent version of other measures of anxiety and general difficulties and positive attributes. The SMFQ-P demonstrated adequate internal consistency (α = .83) and test-retest reliability over an eight-week period (ICC = .80), and good convergent and divergent validity. Factor analysis confirmed the original 13-item model, thus supporting the unidimensionality of the measure in the Spanish sample. Overall, this study provides initial empirical evidence for the utility of the SMFQ-P with Spanish-speaking children from early school ages, and extends the international support of the measure.

The explanatory role of anxiety sensitivity in the association between effortful control and child anxiety and depressive symptoms

The present study examined the underlying role of anxiety sensitivity in the association between effortful control and anxiety and depressive symptoms in a sample of clinically anxious children. It was hypothesized that effortful control would exert an indirect effect through anxiety sensitivity in relation to child anxiety and depressive symptoms. Clinically anxious children (N= 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 61% ethnic minority) and their mothers completed a diagnostic interview and a battery of questionnaires that included self- and mother-ratings of child effortful control, anxiety sensitivity, and anxiety and depressive symptoms. The indirect effect of effortful control via anxiety sensitivity on child anxiety and depressive symptoms was significant across child- and mother-completed measures. Among clinically anxious youth, greater effortful control was related to lower anxiety sensitivity, which was related to lower anxiety and depressive symptoms. Future work should evaluate whether targeting effortful control leads to clinically meaningful reductions in anxiety sensitivity and child anxiety and depressive symptoms.

Internalizing Problems in Adolescence: Linking Loneliness, Social Anxiety Symptoms, and Depressive Symptoms Over Time

Adolescents are particularly vulnerable to experiencing loneliness, social anxiety symptoms, and depressive symptoms. These internalizing problems often co-occur but, until now, it remains unclear how they are associated over time. Insight in these temporal sequences is important to enhance our understanding of how internalizing problems arise and may reinforce each other over time. To examine these temporal sequences, three samples of adolescents were used: Sample 1 consisted of 1,116 adolescents (48.97% girls, M_age = 13.59), Sample 2 of 1,423 adolescents (52.42% girls, M_age = 13.79), and Sample 3 of 549 adolescents (62.66% girls, M_age = 14.82). Adolescents filled out well-established self-report measures of loneliness, social anxiety symptoms, and depressive symptoms during regular school hours at three measurement occasions with a 1-year interval. Meta-analytic techniques were used to estimate the average true effects across three-variable autoregressive cross-lagged models in the three samples. In addition, indirect effects and gender differences in the temporal associations were explored in all three samples. The results suggest that social anxiety symptoms play a crucial role as potential antecedent of emerging feelings of loneliness and depression in adolescence. In addition, in line with theoretical expectations, our results suggest the presence of a vicious cycle between adolescents' feelings of loneliness and social anxiety symptoms. The indirect effects were inconsistent across samples and no gender differences were found. These findings shed more light on the unique temporal relationships among different internalizing problems. Clinical interventions should target social anxiety symptoms to prevent feelings of loneliness and vice versa.

Parent-Youth Divergence (and Convergence) in Reports of Youth Internalizing Problems in Psychiatric Inpatient Care

When compared to one another, multiple informants' reports of adolescent internalizing problems often reveal low convergence. This creates challenges in the delivery of clinical services, particularly for severe outcomes linked to internalizing problems, namely suicidal thoughts and behaviors. Clinicians would benefit from methods that facilitate interpretation of multi-informant reports, particularly in inpatient settings typified by high-cost care and high-stakes decision-making. 765 adolescent inpatients (70.3% female; M_age = 14.7) and their parents completed measures of adolescent internalizing problems. We obtained baseline clinical and treatment characteristics from electronic medical records. Latent class analysis revealed four reporting patterns: Parent-Adolescent Low (LL; 49.0%), Parent Low-Adolescent High (PL-AH; 11.5%), Parent High-Adolescent Low (PH-AL; 21.8%), Parent-Adolescent High (HH; 17.6%). Relative to the LL class, adolescents in the PH-AL and PL-AH classes were more likely to be admitted with suicidality. In terms of treatment characteristics and relative to the LL class, HH and PH-AL adolescents were more likely to receive standing antipsychotics, PH-AL adolescents were more likely to be in seclusion, and HH adolescents had longer hospital stays. At discharge and relative to the LL class, HH, PH-AL, and PL-AH adolescents were more likely to receive an anxiety disorder diagnosis. Further, HH, PH-AL, and PL-AH adolescents were more likely to receive partial hospitalization or care in another restrictive environment after inpatient treatment, relative to the LL class. This naturalistic study informs clinical decision-making by aiding our understanding of how multi-informant reports facilitate interpretations of adolescents' clinical presentations as well as predictions about treatment characteristics.

Self-reported sleep patterns and quality amongst adolescents: cross-sectional and prospective associations with anxiety and depression

BACKGROUND

Sleep problems are common in adolescence, and frequently comorbid with both anxiety and depression. Research studies have suggested a bidirectional relationship between sleep and psychopathology, which includes evidence that sleep interventions can alleviate symptoms of anxiety and depression. However, little is known about the nature of sleep problems amongst adolescents with anxiety and depression, and whether specific sleeping difficulties are involved in the longitudinal relationship between sleep, anxiety and depression.

METHOD

The sample was derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective, birth cohort study of children born in 1991-1992. Data were explored from a subset of participants who took part in a clinical assessment at age 15, on self-report sleep patterns and quality, and diagnostic outcomes of anxiety and depression (N = 5,033). Subsequent diagnostic and symptom severity data on anxiety and depression at ages 17, 21 and 24 were also examined.

RESULTS

Cross-sectional and longitudinal analyses were conducted to explore the relationship between sleep problems, anxiety and depression. Results revealed that adolescents aged 15 with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only reported problems with sleep quality. A range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and the diagnoses of anxiety and depressive disorders at age 17, 21 and 24 years.

CONCLUSIONS

The results provide further insight into the nature of sleep problems amongst adolescents with anxiety and depression, and the prospective relationship between sleep disturbance and future psychopathology. These data suggest that targeting sleep difficulties during adolescence may have long-term mental health benefits.

The Temporal Precedence of Peer Rejection, Rejection Sensitivity, Depression, and Aggression Across Adolescence

We examined the temporal precedence between perceived peer rejection, rejection sensitivity, depression, and aggression in a sample of 544 adolescents (55.7% girls; M_age = 14.96 years at the first measured time point) assessed yearly from Grade 9 to Grade 12. Using developmental cascade modelling to analyze the data, our study supported the symptoms-driven and social process models, in that perceived rejection was preceded by either depression or aggression at different times across adolescence. Similarly, rejection sensitivity was also preceded by depression and/or aggression. Although depression initiated the cascade leading to rejection sensitivity, our model also supported a bidirectional relation across late adolescence as rejection sensitivity also predicted future depression. Overall, our findings provide support that internalizing and externalizing problems lead to interpersonal difficulties with peers, such as perceived rejection and demonstrate the unique role of rejection sensitivity with regard to depression and aggression independent from perceived peer rejection.

Reciprocal effects of maternal and child internalizing symptoms before and after a natural disaster

After natural disasters, mothers and children are vulnerable to internalizing symptoms, such as depression and anxiety, and levels of mothers' and children's symptoms are significantly associated. However, the disaster literature has rarely examined reciprocal effects within families. The present study capitalizes on the occurrence of Hurricane Sandy during the course of an ongoing longitudinal study to address this gap. Three-hundred and 47 children (54.2% male, 84.7% Caucasian) and their mothers completed measures of internalizing symptoms when the children were 9-years-old. Hurricane Sandy occurred an average of 1 year later. Eight weeks after the hurricane, mothers and children completed the same measures again. Mothers also reported on their family's stress exposure from Hurricane Sandy. After controlling for predisaster symptoms, longitudinal actor-partner interdependence models indicated that mother's and children's internalizing symptoms were linked. Mothers' prehurricane depression symptoms also predicted increases in children's depression symptoms over time independent of hurricane-related stress. Children's prehurricane anxiety symptoms predicted increases in mothers' depression symptoms only at low levels of hurricane-related stress. Rather than the emergence of reciprocal effects, mother's depression symptoms and children's internalizing symptoms changed in tandem after Hurricane Sandy. High levels of Hurricane Sandy stress did not produce symptom spillover effects, but rather may have interrupted the unfolding of normative developmental parent-child reciprocal symptom processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adaptation of the Screen for Child Anxiety Related Emotional Disorders in Spanish with Nonspecific Intellectual Disability

Anxiety continues to be one of the most frequent disorders with typically developing children and youth. However, people with intellectual disability (ID) lack validated diagnostic tests backed by sufficient methodological rigor. Analyze the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in this clinical population, specifically in children and young Spanish with Nonspecific Intellectual Disability. Descriptive statistics and item analysis (N = 542), exploratory factorial analysis (n = 245) and confirmatory (n = 297) and scale reliability analyses were performed and evaluated the internal consistency with various indices (Cronbach's alpha and omega) and the stability of the measurement (test-retest) of the resulting scale with better goodness-of-adjustment indices. A new scale called SCARED-DI was obtained in this clinical sample with three factors and a smaller number of items (22), offering important goodness-of-fit indices (RMSEA [95% CI] 03[0.01; .04]; CFI = 0.99; TLI = 0.98; GFI = 0.88; AGFI = 0.89) and high internal consistency (α = 0.91; ω = 0.93) and adequate measurement stability (r_xx = 0.92). The importance of validating psychopathological anxiety tests for children and youth with ID in order to build good mental health is discussed, emphasizing the need to provide easy, short-duration tests on both cognitive and emotional aspects in this clinical sub-population. In addition, the results are assessed in terms of future research and practical implications. This new version of SCARED-ID represents a valid and reliable tool to evaluate the anxiety in people with intellectual disabilities.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

Anxiety disorders are among the most common psychiatric disorders in children and adolescents. As reviewed in this guideline, both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. Serotonin norepinephrine reuptake inhibitor (SNRI) medication has some empirical support as an additional treatment option. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, research demonstrating convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatments for child and adolescent anxiety disorders is an urgent priority. The comparative effectiveness of anxiety treatments, delineation of mediators and moderators of effective anxiety treatments, long-term effects of SSRI and SNRI use in children and adolescents, and additional evaluation of the degree of suicide risk associated with SSRIs and SNRIs remain other key research needs.

Anxiety and Depressive Symptom Trajectories in Adolescence and the Co-Occurring Development of Cognitive Biases: Evidence from the CogBIAS Longitudinal Study

The development of negative cognitive biases, together with symptoms of anxiety and depression, has yet to be investigated longitudinally. Using a three-wave design, the present study examined developmental trajectories of anxiety and depressive symptoms and the co-occurrence of cognitive biases, in a large normative sample of adolescents (N = 504). Data was drawn from the CogBIAS Longitudinal Study (CogBIAS-L-S), which assessed a wide range of psychological variables, including cognitive biases and self-reported anxiety and depressive symptoms, when adolescents were approximately 13, 14.5, and 16 years of age. The results showed that overall levels of anxiety were low and stable, while levels of depression were low but increased slightly at each wave. Growth mixture modeling identified four distinct developmental classes with regard to anxiety and depressive symptoms. Multiple group analysis further showed that class membership was related to the development of cognitive biases. The majority of the sample (75%) was characterised by ‘Low symptoms’ of anxiety and depression and showed low interpretation and memory biases for negative stimuli at each wave. A second class (11%) displayed ‘Decreasing anxiety symptoms’ and showed decreasing interpretation bias, but increasing memory bias. A third class (8%) displayed ‘Comorbid increasing symptoms’ and showed increasing interpretation and memory biases. While the fourth class (6%) displayed ‘Comorbid decreasing symptoms’ and showed decreasing interpretation and memory biases. This longitudinal study sheds light on healthy and psychopathological emotional development in adolescence and highlights cognitive mechanisms that may be useful targets for prevention and early interventions.

Loneliness, Social Anxiety Symptoms, and Depressive Symptoms in Adolescence: Longitudinal Distinctiveness and Correlated Change

Loneliness, social anxiety symptoms, and depressive symptoms are internalizing problems that are highly intertwined and often co-occur during adolescence. This overlap and co-occurrence raises the question whether three different labels are used for the same underlying phenomenon. The present study adopts a comprehensive approach to this issue by investigating the development of the three phenomena simultaneously. Specifically, this study aimed to investigate (1) the developmental trend for all three internalizing problems separately, (2) whether they are best described by a single developmental trend, (3) how they co-develop across adolescence, and (4) gender differences in this co-development. The analyses were run in three three-wave longitudinal samples of adolescents with one-year intervals in order to verify the robustness of the findings. Sample 1 (roughly ages 15, 16, and 17) comprised 549 adolescents (63% girls), and Samples 2 and 3 (roughly ages 13, 14, and 15) comprised 811 adolescents (46% girls) and 1101 adolescents (52% girls), respectively. Latent growth curve modeling for the three phenomena separately showed either small increases or stable patterns. A comparison of a Multiple Indicator Latent Growth Model (MILGM) with a Parallel Process Latent Growth Curve Modeling (PPLGCM) showed that the three internalizing problems followed unique, but related, developmental trends across adolescence. The intercepts of the three phenomena were positively correlated with one another in all samples and increases in loneliness were associated consistently with increases in social anxiety symptoms. Only in Sample 3 evidence was found for a similar association between loneliness and depressive symptoms and between social anxiety symptoms and depressive symptoms. Except for differences in initial levels, gender differences in the development of the three problems were limited. Overall, the results of the present study clearly indicate that the three internalizing problems are longitudinally distinct from one another, but co-develop across adolescence.

Orbitofrontal cortex grey matter volume is related to children's depressive symptoms

Adults with a history of depression show distinct patterns of grey matter volume (GMV) in frontal cortical (e.g., prefrontal cortex, orbitofrontal cortex) and limbic (e.g., anterior cingulate, amygdala, hippocampus, dorsal striatum) structures, regions relevant to the processing and regulation of reward, which is impaired in the context of depression. However, it is unclear whether these GMV associations with depression precede depressive disorder onset or whether GMV is related to early emerging symptoms or familial depression. To address these questions, we used voxel-based morphometry (VBM) to examine GMV in 85 community-dwelling children (M = 11.12 years, SD = 0.63 years) screened for current and lifetime depression. Associations between children's depressive symptoms (self- and mother-report of children's symptoms), children's maternal depression history, and GMV were examined. Although maternal depression history was unrelated to children's GMV, child GMV in the orbitofrontal cortex (OFC) was negatively related to children's self-reported depressive symptoms, using both a priori ROI and whole-brain analyses. Moderated regression analyses indicated that girls' GMV was negatively related to girls' depressive symptoms (as indexed by both self- and mother-report of girls' symptoms), whereas boys' symptoms were positively related to GMV. Our findings suggest that brain morphology in the OFC, a region with functional roles in processes relevant to depressive symptoms (i.e., reward-based learning and reward processing), is associated with early depressive symptoms prior to the development of clinically significant depression.

Anxiety in Early Adolescence: Heterogeneous Developmental Trajectories, Associations with Risk Factors and Depressive Symptoms

This study aimed: (1) to identify heterogeneous trajectories of anxiety symptoms in early adolescence; (2) to analyze the relationships between risk factors and identified trajectories; (3) to study the association between anxiety symptom trajectories and depression symptom course. Anxiety and depressive symptoms of 825 participants (44.40% boys; mean initial age = 13.01, SD = 0.56) was assessed every 6 months over an 18-month period. Trajectory identification relied on latent-variable approach. As a result, 2-4 trajectories were identified for social phobia (SP), generalized anxiety (GA) and panic symptoms, revealing at least a low-symptom course and a trajectory of elevated symptoms (at-risk trajectory). Being girl and sibling cohabitation were related to at-risk trajectories, and a course of low effortful control and heightened negative affectivity. Finally, SP and GA symptoms were related to heightened depressive symptom courses. Relevant implications towards tailored prevention and intervention are highlighted to promote a healthy development across adolescence.

Incidence of diagnosed pediatric anxiety disorders and use of prescription drugs: a nation-wide registry study

The aim of this study was to calculate time trends in incidence of diagnosed anxiety disorders, including obsessive-compulsive disorder, and post-traumatic stress disorder, and to examine changes in use of prescribed drugs in the Norwegian pediatric population. Furthermore, we aimed to investigate whether comorbid mental disorders are associated with the use of prescribed drugs. Nation-wide registries with data from 2008 to 2015 were used, covering diagnostic data from primary health care [the Norwegian database for the control and reimbursement of health expenses (KUHR)] and secondary health care [the Norwegian Patient registry (NPR)], and data on prescribed drugs [the Norwegian prescription database, (NorPD)]. Data from the two latter were linked. During the period 2010-2015, 19,154 children and adolescents (61% girls) received a first diagnosis of anxiety disorders in primary care. The corresponding number from secondary care was 17,115 (61% girls). The incidence of diagnosed anxiety disorders increased over time, especially in girls, with an overall raise of ~ 2 per 1000 children across 2010-2015. Anti-anxiety drugs were used by < 12% of diagnosed children and < 25% of diagnosed adolescents, mainly by those with several contacts with the specialist health care system. There was no strong indications of an increase over time. Of other drugs, the most frequently prescribed were hypnotics and psychostimulants. Psychiatric comorbidity (33-55%) contributed to the use of drugs, including anti-anxiety drugs. The incidence of diagnosed anxiety disorders increased from 2010 to 2015, but the percentage using anti-anxiety drugs was stable. Drug use appears to be in line with the Norwegian guidelines.

Sex Differences in Internalizing Symptoms and Amygdala Functional Connectivity in Neurotypical Youth

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Internalizing symptoms in neurotypical youth relate to amygdala connectivity.

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Greater modulation is observed in females than in males.

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Connectivity might be a symptom of or a risk factor for disorders.

Amygdala resting-state functional connectivity (rsFC) is altered in adolescents with internalizing disorders, though the relationship between rsFC and subclinical symptomatology in neurotypical youth remains unclear. Here we examined whether amygdala rsFC varied across a continuum of internalizing symptoms in 110 typically-developing (TD) youths 8 to 17 years old using functional magnetic resonance imaging (fMRI). We assessed overall internalizing symptoms, as well as anxious-depressed, withdrawn-depressed, and somatic complaints. Given known sex differences in the prevalence of internalizing disorders, we compared connectivity between males and females. As compared to males, females with greater internalizing, anxious-depressed, and somatic symptoms displayed greater connectivity with the cingulate gyrus, insula, and somatosensory cortices. In contrast, males with greater anxious-depressed symptoms demonstrated weaker connectivity with the subcallosal prefrontal cortex. Sex differences in rsFC in relation to symptom severity were evident for the whole amygdala and for two of its subnuclei (centromedial and superficial amygdala). Overall, results suggest that, for females, higher internalizing symptoms are associated with greater rsFC between the amygdala and regions implicated in emotional and somatosensory processing, salience detection, and action selection. Future longitudinal investigations are needed to determine whether this hyperconnectivity may confer resilience to, or pose risk for, the development of internalizing disorders.

Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety

PURPOSE OF REVIEW

After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention.

RECENT FINDINGS

Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.

Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status

In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.

Altitude and latitude variations in trait-impulsivity, depression, anxiety, suicidal risk, and negative alcohol-related consequences in Argentinean adolescents

The aims of this research were threefold: 1) to analyze mental health state both general (GMHS, i.e., self-perceived health and psychological distress) and specific (SMHS; i.e., depression, trait-anxiety, negative alcohol-related consequences, and suicidal risk), and impulsivity-related traits (i.e., negative urgency, positive urgency, [lack of] perseverance, [lack of] premeditation, and sensation seeking) in a sample of Argentinean adolescent college students, in function of sex (women, men) and three different altitude-latitude regions (high-north, middle-center, low-south), for identifying common and specific features; 2) to analyze relationships between impulsivity-related traits and indicators of GMHS and SMHS, in the entire sample and in each altitude-latitude region, for understanding the importance of impulsivity-related traits in these forms of mental disorders; and 3) to analyze bivariate relationships between depression, trait-anxiety, negative alcohol-related consequences, and suicidal risk, in the entire sample and considering the three altitude-latitude regions, for testing two-disorder comorbidities. Scores on impulsivity-related traits differed by sex and by altitude-latitude region. GMHS and SMHS differed by sex but not by altitude-latitude region. Several relationships were found between impulsivity-related traits, GMHS, and SMHS as well as between indicators of SMHS. Some of these relationships were dependent on altitude-latitude regions, and implications of these findings were discussed.

Prospective associations between social anxiety and depression in youth: The moderating role of maternal major depressive disorder

INTRODUCTION

Although social anxiety symptoms and exposure to maternal major depressive disorder (MDD) have each been conceptualized as key contributors to the development of depression symptoms in youth, these risk factors have not been integrated into a single model of risk. The current study evaluated a two-hit model of risk to determine whether the impact of social anxiety on prospective changes in youth depressive symptoms is stronger among youth exposed to maternal MDD than among those of never-depressed mothers.

METHODS

Participants were youth (aged 8-14 at baseline, 50.4% girls, 80.9% Caucasian) and their biological mothers recruited from the community in the United States. Of the mothers, 129 had a history of MDD during their youth's lifetime and 117 had no lifetime history of MDD. At the initial assessment, mothers completed diagnostic interviews and youth completed self-report measures of social anxiety and depressive symptoms. Participants were reassessed every 6 months for 2 years during which youth again completed the symptom measures.

RESULTS

Results of hierarchical linear modeling revealed that levels of social anxiety predicted prospective increases in depressive symptoms among offspring of mothers with a history of MDD, but not among those of never-depressed mothers. Depressive symptoms did not predict prospective changes in social anxiety (alone or in interaction with maternal MDD).

CONCLUSIONS

These results provide preliminary evidence for an integrated model of risk such that social anxiety symptoms may be a particularly strong risk factor for the subsequent development of depression symptoms among youth with exposure to maternal MDD.

Convergent and Ecological Validity of Mother and Child Reports of Children’s Depressive Symptoms: Evidence from a Diverse Sample of Mother–Child Dyads

This study investigated the convergent and ecological validity of a multi-informant approach through retrospective measures and ecological momentary assessment (EMA) from mother–child dyads. In 202 mother–child dyads, mothers completed parent-proxy retrospective measures of their child’s depressive symptoms and their own depressive symptoms. Children completed self-report retrospective measures of their own depressive symptoms, self-esteem, and sleep quality; and self-report EMA of affect across 8 days. Results showed that parent-proxy and child self-report retrospective measures of depressive symptoms were weakly positively correlated (r = 0.23); this association was stronger for non-Hispanic mothers compared to Hispanic mothers (p = 0.048). Parent-proxy retrospective measures were moderately positively associated with the mothers’ own retrospectively reported level of depressive symptoms (r = 0.33). Parent-proxy and child self-report retrospective measures were negatively associated with the children’s average EMA happiness (p = 0.001 and p = 0.003, respectively), but only the children’s retrospective measures were positively associated with EMA sadness (p = 0.001). In multivariable models, the children’s retrospectively reported depressive symptoms were significantly associated with lower self-esteem and reduced sleep quality, while parent-proxy retrospective reports were only associated with the mother’s own depressive symptoms. Overall, the current study provides evidence for the convergent and ecological validity of children’s self-reports of depressive symptoms. However, there was limited validity for parent-proxy reports, and parent-proxy reports may be highly influenced by the mothers’ depression.

Temperament and Symptom Pathways to the Development of Adolescent Depression

This study examined the associations between internalizing and externalizing symptoms during early adolescence and the subsequent development of Major Depressive Disorder. The role that temperament plays in predisposing individuals to these particular pathways was also examined. Temperament at approximately age 12 was used to produce a risk-enriched subsample of 243 (124 female) participants. Data was collected in four waves over 6-7 years roughly corresponding to ages 13, 15, 17 and 19. Participants were excluded from the study, prior to the first wave, based on current or prior depressive, substance-use, or eating disorders. Logistic regression analyses revealed that internalizing symptoms and social-externalizing problems were significant risk pathways to the development of depression. Moreover, mediation analyses revealed that high temperamental negative emotionality, high affiliation, low effortful control, and low surgency were significant vulnerability factors for depression via the internalizing symptom pathway, whereas low effortful control was the only significant predictor for depression via the social-externalizing problem pathway. As such, high levels of effortful control acted as a protective factor for the development of depression across both symptom pathways, suggesting that is may be an important target for prevention strategies.

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.

Anxiety and depression in adolescents with a visible difference: A systematic review and meta-analysis

Living with a visible difference can entail challenging social situations, associated with psychosocial symptoms. However, it is not clear whether adolescents with a visible difference experience more anxiety and depression than unaffected peers. We aim to determine whether adolescents with a visible difference experience more symptoms of anxiety and depression than unaffected peers. A literature search was conducted in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, PsycINFO Ovid, and Google Scholar. Meta-analyses were done using random-effects models to calculate a standardised mean difference. Analyses for subgroups were used to study causes of visible difference. Eleven studies were identified (n = 1075, weighted mean age = 15.80). Compared to unaffected peers, adolescents with a visible difference experience more symptoms of anxiety (SMD = 0.253, 95 % CI [0.024, 0.482], p = .030), but not depression (SMD = 0.236, 95 % CI [-0.126, 0.599], p = .202). Adolescents with a skin condition did not experience more symptoms of anxiety (SMD = 0.149, 95 % CI [-0.070, 0.369], p = .182) or depression (SMD = 0.090, 95 % CI [-0.082, 0.262], p = .305) when compared to unaffected peers. Overall, more symptoms of anxiety are found in adolescents with a visible difference compared to peers. No differences in anxiety or depression were found for skin differences. Screening for anxiety is recommended.

Different Shades of Beauty: Adolescents' Perspectives on Drawing From Observation

Background

Drawing from observation (DFO) is an art therapy method that entails drawing an object, along with guided reflections on process and outcome. In this qualitative study, we explored adolescents’ perspectives on their DFO experience, and how they perceive it as having influenced their emotional well-being.

Methods

We interviewed 10 adolescents who participated in a DFO group, regarding their perspectives on DFO. Participants were asked to refer to their experience, as well as to provide examples of their drawings. Through a thematic analysis we integrated data from interviews and drawings.

Results

Adolescents experienced three lines of tension in DFO: Between self-acceptance and self-judgment, between merging and separation, and between similarities and differences. Processing these tensions has the potential to increase their emotional well-being.

Conclusion

DFO could make a meaningful contribution to adolescents’ emotional well-being. The unique intersection between object, observation, and drawing in art-therapy addresses adolescents’ emotional-developmental challenges.

Systematic Review: Anxiety in Children and Adolescents With Chronic Medical Conditions

OBJECTIVE

Youth with chronic medical conditions (CMCs) have been reported to be at increased risk for developing anxiety disorders. Importantly, suffering from anxiety may also have an impact on their disease-related outcomes. This study set out to systematically review the literature on anxiety and seven CMCs (asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease) among youth.

METHOD

A systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, PsycNET, Embase, and reference lists of the included studies (1990-2018). Three independent reviewers screened titles and abstracts and conducted full-text assessment. Studies were included if they reported the prevalence of anxiety or the association of anxiety on disease-related outcomes in children and/or adolescents with the focal CMCs.

RESULTS

A total of 53 studies met the predetermined inclusion criteria. Across the CMCs, the prevalence of anxiety disorder was increased in youths with CMCs compared to the general population. Evidence for a relationship between anxiety and adverse disease-related outcomes was limited. For asthma, inflammatory bowel disease, and sickle cell disease, there was some evidence indicating that anxiety was associated with adverse outcomes; supported by two longitudinal studies, one in asthma and one in inflammatory bowel disease. For diabetes, results were inconsistent; with some studies indicating that anxiety was associated with worse and others with better treatment adherence.

CONCLUSION

The prevalence of anxiety disorders in youth with CMCs is higher than that in the general population. Anxiety may also be associated with adverse disease-related outcomes for youths, but it is not possible to draw definitive conclusions. Longitudinal studies making use of parent/youth composite anxiety measures and a combination of parent/youth reported and objective measures of disease-related outcomes are needed. Given the burden of disease of anxiety disorders, regardless of the impact on the disease outcomes, screening for and treatment of anxiety is recommended in youths with CMCs.

School-based targeted prevention compared to specialist mental health treatment for youth anxiety

BACKGROUND

The 'FRIENDS for life' program (FRIENDS) is a 10-session cognitive behavioral therapy (CBT) program used for prevention and treatment of youth anxiety. There is discussion about whether FRIENDS is best applied as prevention or as treatment.

METHODS

We compared FRIENDS delivered in schools as targeted prevention to a previous specialist mental health clinic trial. The targeted prevention sample (N = 82; M_age  = 11.6 years, SD = 2.1; 75.0% girls) was identified and recruited by school nurses in collaboration with a community psychologist. The clinical sample (N = 88, M_age  = 11.7 years, SD = 2.1; 54.5% girls) was recruited for a randomized controlled trial from community child- and adolescent psychiatric outpatient clinics and was diagnosed with anxiety disorders.

RESULTS

Both samples showed significantly reduced anxiety symptoms from baseline to postintervention, with medium mean effect sizes across raters (youths and parents) and timepoints (post; 12-months follow-up). Baseline youth-reported anxiety symptom levels were similar between the samples, whereas parent-reported youth anxiety was higher in the clinical sample.

CONCLUSIONS

The study suggests that self-reported anxiety levels may not differ between youth recruited in schools and in clinic settings. The results indicate promising results of the FRIENDS program when delivered in schools by less specialized health personnel from the school health services, as well as when delivered in clinics by trained mental health professionals.

Pre-school mental health disorders: a review

Preschoolers are presenting in increasing numbers to primary care providers and mental health clinics with emotional and behavioural impairment. Preschoolers in the US have the highest rates of school expulsion of all age groups. Because young children are limited in their capacity to convey distress and internal states, impairment is most often expressed behaviourally. Disruptive behaviour, frequently in the form of aggression or dysregulation, is a final common pathway for many disorders in this age group. Tools and training to diagnose pre-school disorders are limited, and while some effective non-medication interventions exist, the evidence base for medication use in this age group is extremely limited. This article reviews approaches to assessing common pre-school disorders including attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorders, anxiety and mood disorders, perceptual disturbances and psychosis, and trauma related disorders. The evidence base for both therapeutic and psychopharmacologic interventions for these disorders is discussed.

Applying a Transdiagnostic Cognitive-Behavioral Treatment to Adolescents at High Risk for Serious Mental Illness: Rationale and Preliminary Findings

Given the chronic and deleterious course of serious mental illness (SMI; schizophrenia and bipolar disorder), significant efforts have been undertaken to improve prediction of SMI and provide treatment for adolescents in the early, putatively prodromal stage of these illnesses. While risk assessments and disorder-specific treatments for adolescents at risk for SMI have shown some efficacy, significant issues remain around disorder-specific treatments for these youth. There is substantial heterogeneity of psychopathology within adolescents at high risk for SMI that leads to many false-positives and varying diagnostic outcomes. As a result, initial treatment focusing on broad symptoms and skills has been proposed in place of disorder-specific treatments. We discuss the rationale for providing an already-developed and empirically supported transdiagnostic treatment for emotional disorders (termed the Unified Protocol) as a first-line staging of treatment for adolescents experiencing early SMI symptoms. Additionally, we outline the open trial we are piloting using this transdiagnostic treatment in adolescents between the ages of 13 - 17 who have begun experiencing distressing yet subsyndromal psychosis or bipolar mood symptoms. Preliminary findings suggest feasibility and acceptability as well as initial efficacy in improving psychiatric symptoms, quality of life, and difficulties regulating emotions. We also present case studies from our open trial. A unified, cognitive-behavioral treatment for early presentations of SMI has important clinical and public health benefits, including streamlining treatment and providing broad skills that are applicable to a wide range of psychopathology.

Serotonergic influence on depressive symptoms and trait anxiety is mediated by negative life events and frontal activation in children and adolescents

Depression and anxiety are common in childhood and adolescence. Even though cardinal symptoms differ, there is a considerable overlap regarding the pathogenic influence of serotonergic innervation, negative life experience, disturbed emotion perception/affect regulation, and impaired neural functioning in the fronto-limbic circuit. In this study, we examined the effect of the 5-HTTLPR/rs25531 genotype on depressive symptoms and trait anxiety under the consideration of the amount of negative life events in healthy children and adolescents (N = 389). In a subsample of 49 subjects, we performed fMRI to add fronto-limbic brain activation as a second interacting factor. Across all subjects, negative life events moderated the influence of the 5-HTTLPR/rs25531 genotype on both depressive symptoms and trait anxiety. In the fMRI subsample, 5-HTTLPR/rs25531 S + S/L_G + S/L_A + L_GL_A + L_GL_G genotype-associated left middle frontal gyrus (MFG) activation mediated the influence of 5-HTTLPR/rs25531 genotype on depressive symptoms, however, only in combination with negative life events. Genetic influence on trait anxiety was predominantly mediated by negative life events; only L_AL_A genotype-specific activation in the right MFG worked as a mediator in combination with negative life events. The present findings hint towards distinct mechanisms mediating the influence of 5-HTTLPR/rs25531 genotype on depressive symptoms and anxiety, with negative life events playing a crucial role in both phenotypes. With regard to depressive symptoms, however, this influence was only visible in combination with MFG activation, whereas, in anxiety, it was independent of brain activation.

Co-Rumination Moderates the Relation between Emotional Competencies and Depressive Symptoms in Adolescents: a Longitudinal Examination

Research suggests co-rumination during adolescence has developmental tradeoffs that result in elevated self-disclosure and intimacy between friends but also can be associated with increases in depression (Rose et al. 2007; Rose 2002). The current study further examined this paradox by assessing the role of emotional competencies in co-rumination as they predict depressive symptoms over a 2-year period. We tested whether co-rumination moderated the relation between emotional awareness and emotion regulation and depressive symptoms in reciprocated best friend dyads. At Time 1, 202 adolescents (101 same-sex best friend dyads; M_age = 12.68, 52.5% girls, 76.6% White, middle-class) reported on their emotional competencies (i.e., emotional awareness and perceptions of their friend's anger and sadness regulation), and depressive symptoms as well as engaged in a discussion task where co-rumination was observed. Multilevel modeling (Actor-Partner Interdependence Modeling) was used to account for similarity within friend dyads. The results indicated that when girls engaged in high levels of co-rumination, poor emotional awareness was related to greater depressive symptoms in their friend. Regarding the analyses of emotion regulation, at high levels of co-rumination, Friend A's perceptions of stronger anger regulation by Friend B predicted fewer depressive symptoms in Friend A. Stronger sadness regulation in Friend B at high levels of co-rumination predicted fewer depressive symptoms in Friend B. Our findings highlight the potentially adaptive nature of emotional competencies that may ameliorate the negative sequelae of co-rumination as adolescents are afforded the opportunity to discuss problems, better understand their emotions, skills that are then associated with fewer depressive symptoms over time.

Intolerance of uncertainty in youth: Psychometrics of the Intolerance of Uncertainty Index-A for Children

Intolerance of uncertainty (IU) is a cognitive vulnerability for pathological anxiety. The current study adapted the Intolerance of Uncertainty Index-A for Children (IUI-A-C), and created a single-item Intolerance of Uncertainty Clinician-Rated Index (IUCR), both of which assess a youth's general inability to endure uncertainty. Psychometric properties of these two measures were evaluated. Participants were 146 youth aged 7-17 years seeking treatment for anxiety. The IUI-A-C evidenced individual item performance (i.e., correlations between each item and the total remainder score > .40, ps <.001), internal consistency, convergent validity with the IUCR and self-report measures of anxiety and functional impairment, divergent validity with ADHD severity, and retest reliability with a mean interval of over four weeks. The IUCR also evidenced convergent validity with the IUI-A-C and self-report measures of anxiety and functional impairment and divergent validity with ADHD severity. The IUI-A-C predicted composite principal diagnosis severity but did not predict composite GAD diagnosis severity. The IUI-A-C and IUCR have utility as measures of IU in youth. The role of IU in specific anxiety disorders and future research are discussed.

Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury

BACKGROUND

The dimensionality of depression and anxiety instruments have recently been a source of controversy.

OBJECTIVES AND DESIGN

In a European-wide sample of patients after Traumatic Brain Injury (TBI), we aim to examine the factorial structure, validity, and association of the Patient Health Questionnaire for depression (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) instruments. This study is based on longitudinal observational data. We conducted analyses of factorial structure and discriminant validity of outcomes six-months after TBI. We also examined the prevalence, co-occurrence, and changes of scores on the PHQ-9 and GAD-7 at 3-, 6-, and 12-month post-TBI assessments.

PARTICIPANTS

At six-months post-TBI assessment, 2137 (738 (34.5%) women) participants completed the PHQ-9 and GAD-7 questionnaires. For the longitudinal analysis, we had 1922 participants (672 (35.0%) women).

RESULTS

The results of exploratory factor analysis suggested a general latent construct underlying both PHQ-9 and GAD-7 measures. Confirmatory factor analyses showed a slight improvement in the fit indices for the bifactorial model. The Omega hierarchical test clearly differentiated two subfactors of PHQ-9 and GAD-7 items over and above the underlying general factor; however, most of the variance (85.0%) was explained by the general factor and the explained variance of the subfactors was small. The PHQ-9 and GAD-7 performed similarly in detecting post-traumatic stress disorder (PTSD). As defined by conventional cut-offs, depression and anxiety have different prevalence rates in the sample. The scales also differed in their relationships with the short form of health survey (SF-36v2) subscales. The longitudinal analysis showed high stability of depression and anxiety symptoms: 49-67% of the post-TBI patients with comorbid depression and anxiety reported the persistence of the symptoms over time.

DISCUSSION

The factorial structure analysis favors a general latent construct underlying both depression and anxiety scales among patients after TBI. We discuss the implications our findings and future research directions.

Co-Occurring Trajectories of Depression and Social Anxiety in Childhood and Adolescence: Interactive Effects of Positive Emotionality and Domains of Chronic Interpersonal Stress

Deficits in positive emotionality (PE) have been implicated in the etiology of both social anxiety and depression; however, factors that contribute to divergent social anxiety and depression outcomes among youth low in PE remain unknown. Extant research suggests that parent-child stress and peer stress demonstrate differential patterns of associations with social anxiety and depression. Thus, the present study examined prospective interactive effects of PE and chronic parent-child and peer stress on simultaneously developing trajectories of social anxiety and depression symptoms among 543 boys and girls (age 8-16 at baseline, M[SD] = 11.94[2.32] 55.6% female). Parents reported on youth PE at baseline. Domains of chronic interpersonal (parent-child and peer) stress occurring between baseline and 18-months were assessed via child-report by trained interviews using the Youth Life Stress Interview (Rudolph and Flynn Development and Psychopathology, 19(2), 497-521, 2007). Youth completed self-report measures of depression and social anxiety every three months from 18- to 36- months (7 assessments). Conditional bivariate latent growth curve models indicated that main effects of parent-child stress, but not peer stress, predicted trajectories of depression in boys and girls. In girls, high levels of chronic interpersonal stress in both domains predicted stable, elevated trajectories of social anxiety symptoms regardless of PE. In boys, PE contributed to a pattern of differential susceptibility whereby boys high in PE were particularly susceptible to the effects of chronic interpersonal stress, for better or worse.

A randomized controlled trial of a six-session cognitive behavioral treatment of emotional disorders in adolescents 14-17 years old in child and adolescent mental health services (CAMHS)

Background

This study aims to investigate effectiveness of a 6-week, transdiagnostic cognitive behavioral therapy (CBT) for anxiety and depression in adolescents, the Structured Material for Therapy (SMART), in naturalistic settings of child and adolescent mental health outpatient services (CAMHS).

Methods

A randomized controlled trial with waiting list control (WLC) was performed at three community CAMHS in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% girls) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to SMART or to WLC.

Results

In the treatment group (CBT), 32.9% improved in the main outcome measure (SDQ), compared to 11.6% in the WLC. Clinically significant and reliable change was experienced by 17.7% in the CBT condition, compared to 5.8% in the WLC. No patients deteriorated. Statistically significant treatment effects were achieved for internalization symptoms, anxiety symptoms and general functioning.

Conclusions

These promising findings indicate that SMART may be considered as a first step in a stepped care model for anxiety and/or depression treatment in CAMHS. The recovery rates imply that further investigations into the effectiveness of brief treatments should be made. Furthermore, there is a need for more comprehensive second-stage treatments for some of these patients.

Trial registration

ClinicalTrials.gov Identifier: NCT02150265. First registered May 292,014.

Psychiatric disorders in children and adolescents in a middle-income Latin American country

BACKGROUND

Child and adolescent mental health has scarcely been studied in developing countries, though it is an important aspect of health. Mental health problems in youth often continue into adulthood if not diagnosed or treated in time.

METHODS

The Sistema de Evaluación de Niños y Adolescentes (SENA) [Child and Adolescent Evaluation System] was used to evaluate mental health indicators in a sample of students in Northern Chile. Two age-appropriate versions of the assessment were applied to a total sample of 5043 students, which included an elementary education sample of 1953 schoolchildren from fourth grade through sixth grade (ages 8 to 13 years), and a Secondary School sample of 3090 schoolchildren from seventh grade (the last year of elementary school) through the last year of Secondary school (senior high school) (ages 12 to 19 years). For each group, the version of the assessment used was determined by the students' grade level. Both samples included municipal, government-subsidized, and private schools.

RESULTS

In this student population, depression, anxiety, and behavioral disorders were the main mental health problems identified, and indicators revealed a progressive increase in cases over the years, coinciding with the global epidemiological scenario. Males showed a greater presence of externalizing behaviors related to mental health problems associated with aggression and defiant behavior. However, females showed the highest number of mental health issues overall, especially regarding problems related to internalization. There are significant differences between school types.

CONCLUSIONS

Our sample population analysis indicates that early intervention is necessary for the diagnosis and treatment of youth, with the goal of reducing the probability that psychiatric disorders will be prolonged, evolving, and worsening in adulthood.

Adolescent Internalizing Symptoms and the "Tightknittedness" of Friendship Groups

Adolescents with depression have lower peer status overall, but tend to befriend each other. We examined the "tightknittedness" of their friendship groups by testing whether adolescent friendship groups' average levels of or variability in internalizing symptoms predict group cohesiveness. We used four waves (9th-12th grades) of survey and social network data on 3,013 friendship groups from the PROmoting School-Community-University Partnerships to Enhance Resilience study. Friendship groups with higher average depressive symptoms were less cohesive; groups with higher average anxiety symptoms had greater reciprocity. Groups with greater variability in depressive symptoms had greater density; variability in anxiety symptoms was not consistently associated with cohesion. The friendship groups of depressed adolescents appear less cohesive than the "typical" adolescent friendship group.

Antidepressant resistance in adolescents with major depressive disorder: A nationwide longitudinal study

BACKGROUND

Studies have suggested that psychiatric comorbidities have major effects on antidepressant resistance in adult patients with major depressive disorder (MDD). However, the association between psychiatric comorbidities and antidepressant resistance remains unclear in adolescents with MDD.

METHODS

A total of 10,624 adolescents with MDD were selected from the Taiwan National Health Insurance Research Database between 2001 and 2010 and followed for one year. Treatment-resistant depression (TRD) was defined as unresponsiveness to at least two antidepressants, and treatment resistant tendency was defined as unresponsiveness to the first antidepressant. Psychiatric comorbidities, such as anxiety disorders, substance use disorders, and attention deficit hyperactivity disorder (ADHD), were assessed as confounding factors.

RESULTS

In our study, only 1.7% (n = 184) of adolescents with MDD met the TRD criteria but 23.3% (n = 2480) were classified as exhibiting treatment resistant tendency. Anxiety disorders (OR: 2.34, 95% CI: 1.73-3.16) and substance use disorders (OR: 2.41, 95% CI: 1.28-4.54) exhibited a correlation with TRD, and ADHD (OR: 1.34, 95% CI: 1.08-1.66) was associated with treatment resistant tendency.

CONCLUSIONS

Approximately one-fourth of adolescents with MDD respond poorly to the first antidepressant treatment. The psychiatric comorbidities of anxiety disorders, substance use disorders, and ADHD may increase the risk of treatment resistance in adolescents with MDD.

Scared to Trust? - Predicting Trust in Highly Automated Driving by Depressiveness, Negative Self-Evaluations and State Anxiety

The advantages of automated driving can only come fully into play if these systems are used in an appropriate way, which means that they are neither used in situations they are not designed for (misuse) nor used in a too restricted manner (disuse). Trust in automation has been found to be an essential psychological basis for appropriate interaction with automated systems. Well-balanced system use requires a calibrated level of trust in correspondence with the actual ability of an automated system. As for these far-reaching implications of trust for safe and efficient system use, the psychological processes, in which trust is dynamically calibrated prior and during the use of automated technology, need to be understood. At this point, only a restricted body of research investigated the role of personality and emotional states for the formation of trust in automated systems. In this research, the role of the personality variables depressiveness, self-efficacy, self-esteem, and locus of control for the experience of anxiety before the first experience with a highly automated driving system were investigated. Additionally, the relationship of the investigated personality variables and anxiety to subsequent formation of trust in automation was investigated. In a driving simulator study, personality variables and anxiety were measured before the interaction with an automated system. Trust in the system was measured after participants drove with the system for a while. Trust in the system was significantly predicted by state anxiety and the personality characteristics self-esteem and self-efficacy. The relationships of self-esteem and self-efficacy were mediated by state anxiety as supported by significant specific indirect effects. While for depression the direct relationship with trust in automation was not found to be significant, an indirect effect through the experience of anxiety was supported. Locus of control did not show a significant association to trust in automation. The reported findings support the importance of considering individual differences in negative self-evaluations and anxiety when being introduced to a new automated system for individual differences in trust in automation. Implications for future research as well as implications for the design of automated technology in general and automated driving systems are discussed.