Is there an epidemic of child or adolescent depression?

Emerging depression is associated with face memory deficits in adolescent girls

OBJECTIVE

To examine the association between memory for previously encoded emotional faces and depression symptoms assessed over 4 years in adolescent girls. Investigating the interface between memory deficits and depression in adolescent girls may provide clues about depression pathophysiology.

METHOD

Participants were 213 girls recruited from a longitudinal, community-based study; the majority were African American. Scores on depressive screening measures at age 8 were used to increase the base rate of depression. Depression symptoms and diagnoses were assessed annually for 4 years. In year 4, when the girls were 12 to 13 years old, a face emotion encoding task was administered during which ratings were generated in response to sad, fearful, angry, and happy faces. A surprise memory task followed whereby participants identified which of two faces, displaying neutral expressions, they had seen previously.

RESULTS

Girls with higher depression symptom levels from ages 9 to 12 years evidenced lower accuracy in identifying previously encoded emotional faces. Controlling for IQ, higher depression symptom level was associated with a memory deficit specific to previously encoded sad and happy faces. These effects were not moderated by race.

CONCLUSIONS

Individual differences in face memory deficits relate to individual differences in emerging, early adolescent depression, and may be vulnerability markers for depression.

Lifetime psychopathology among the offspring of Bipolar I parents

BACKGROUND

Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents.

METHOD

This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 ± 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated.

RESULTS

Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%).

CONCLUSIONS

Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.

Peer contagion in child and adolescent social and emotional development

In this article, we examine the construct of peer contagion in childhood and adolescence and review studies of child and adolescent development that have identified peer contagion influences. Evidence suggests that children's interactions with peers are tied to increases in aggression in early and middle childhood and amplification of problem behaviors such as drug use, delinquency, and violence in early to late adolescence. Deviancy training is one mechanism that accounts for peer contagion effects on problem behaviors from age 5 through adolescence. In addition, we discuss peer contagion relevant to depression in adolescence, and corumination as an interactive process that may account for these effects. Social network analyses suggest that peer contagion underlies the influence of friendship on obesity, unhealthy body images, and expectations. Literature is reviewed that suggests how peer contagion effects can undermine the goals of public education from elementary school through college and impair the goals of juvenile corrections systems. In particular, programs that "select" adolescents at risk for aggregated preventive interventions are particularly vulnerable to peer contagion effects. It appears that a history of peer rejection is a vulnerability factor for influence by peers, and adult monitoring, supervision, positive parenting, structure, and self-regulation serve as protective factors.

Specific coping behaviors in relation to adolescent depression and suicidal ideation

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories' associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors.

Recovery and recurrence following treatment for adolescent major depression

CONTEXT

Major depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence.

OBJECTIVES

To determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence.

DESIGN

Naturalistic follow-up study.

SETTING

Twelve academic sites in the United States.

PARTICIPANTS

One hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample).

MAIN OUTCOME MEASURES

Recovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery.

RESULTS

Almost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P < .001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were nonresponders (67.6%) (P = .03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P = .02).

CONCLUSIONS

Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.

Perceived physical appearance mediates the rumination and bulimic symptom link in adolescent girls

The prospective relationship between initial rumination and subsequent bulimic symptoms, and vice versa, was examined, and possible mediators were tested in a community sample of 191 adolescent girls (M age = 14.5) at 3 different assessment time points. Path analyses indicated that Time 1 rumination predicted Time 3 bulimic symptoms, and vice versa. Physical appearance competence (but not social competence) mediated both relationships. The results suggest that specific cognitive mechanisms, such as rumination, may play an etiological role in the development of bulimic symptoms. This may be especially true for adolescent girls who exhibit low competence beliefs about their physical appearance.

Can basic risk research help in the prevention of childhood and adolescent depression? Examining a cognitive and emotional regulation approach

This paper aims to highlight ways in which basic research findings in the field of childhood and adolescent depression can help to inform and refine preventive intervention efforts. We selectively review basic research evidence from community, clinical, and high-risk populations that identifies cognitive mechanisms (thought processes and reactions to negative affect) and emotional regulation as key processes involved in the onset and maintenance of depression. We focus on cognitive and emotional mechanisms in order to allow comparability with the majority of current preventive interventions. A range of basic research strategies and studies are then suggested that could be employed to help the development and refinement of prevention strategies. These include the need for prospective longitudinal studies to identify causal risk and protective factors, an integration of research approaches and methods, and a focus on understanding potential aetiological heterogeneity between childhood and adolescent depression.

Genetics of childhood and adolescent depression: insights into etiological heterogeneity and challenges for future genomic research

There is heterogeneity between depression in childhood, adolescence and adulthood in terms of the gender composition of affected cases, prevalence, rates of recurrence and risk factors. This raises complex questions for refining the phenotype for molecular genetic studies of depression and the selection of appropriate proband groups. This article aims to provide a review of issues arising from family, twin and adoption studies of relevance to molecular genetic studies, and to summarize molecular genetic findings on childhood/adolescent depression. While retrospective studies of adults suggest greater familial aggregation among those with an earlier age of onset, prospective studies do not confirm this association. In fact, taken together, evidence from family and twin studies suggests that prepubertal depression is more strongly associated with psychosocial adversity, is less heritable and shows lower levels of continuity with adult depression than either adolescent or adult depression. Adolescent depressive symptoms and disorder show similar levels of heritability to depression in adult life, although there is only one twin study of adolescent depressive disorder, and heritability estimates of depressive symptoms vary widely between studies. This variability in heritability estimates is partly attributable to age and informant effects. Adoption studies and other intergenerational transmission designs show that the transmission of depression between parents and children involves genetic and environmental processes, with converging evidence that environmental processes are most important. Molecular genetic studies of childhood/adolescent depression have to date used a candidate gene approach and focused on genes already examined in adult studies. Prospective longitudinal studies of community and high-risk samples are needed to clarify issues of etiological heterogeneity in depression, and these should in turn inform the planning of molecular genetic studies.

Development of sex differences in depressive and co-occurring anxious symptoms during adolescence: descriptive trajectories and potential explanations in a multiwave prospective study

This study investigated psychosocial mechanisms that may account for sex differences in internalizing symptoms of depression and anxiety during adolescence using data from a prospective, multiwave study with a sample of early and middle adolescents (N = 350, 6th to 10th graders; 57% female). Girls showed higher initial levels of only depressive symptoms, not anxious arousal, and increasing trajectories of depressive and anxious arousal symptoms over time compared with boys after controlling for age. Initial levels of depressive symptoms were mediated by a Rumination x Stressors interaction as well as a Negative Cognitive Style x Stressors interaction. The Negative Cognitive Style x Stressors interaction and Rumination x Stressors interaction partially accounted for girls' increasing trajectories of depressive and anxious arousal symptoms over time.

Corumination, interpersonal stress generation, and internalizing symptoms: accumulating effects and transactional influences in a multiwave study of adolescents

This multiwave longitudinal study investigated potential transactional and accumulating influences among corumination, interpersonal stressors, and internalizing symptoms among a sample of early and middle adolescents (N = 350; 6th-10th graders). Youth completed self-report measures of corumination at Times 1, 2, and 4, and negative life events, internalizing symptoms (general depressive, specific anhedonic depressive, anxious arousal, general internalizing), and externalizing problems at all four time points (5 weeks between each assessment across 4 months). Results supported hypotheses. First, baseline corumination predicted prospective trajectories of all forms of internalizing symptoms but not externalizing problems. Second, baseline corumination predicted generation of interpersonal-dependent, but not interpersonal-independent or noninterpersonal stressors. Third, interpersonal-dependent events partially mediated the longitudinal association between baseline corumination and prospective internalizing symptoms. Fourth, a transactional, bidirectional set of associations was supported in that initial internalizing symptoms and stressors predicted later elevations in corumination, and in turn, corumination predicted later symptoms through the mediating role of interpersonal stressors to complete both streams in the transactional chain of influence. Fifth, girls and older adolescents exhibited higher corumination, but neither age nor sex moderated any associations. These findings are discussed within a transactional, developmental cascade model.

Perceived social competence, negative social interactions, and negative cognitive style predict depressive symptoms during adolescence

The current study examined whether negative interactions with parents and peers would mediate the longitudinal association between perceived social competence and depressive symptoms and whether a negative cognitive style would moderate the longitudinal association between negative interactions with parents and increases in depressive symptoms. Youth (N = 350; 6th-10th graders) completed self-report measures of perceived social competence, negative interactions with parents and peers, negative cognitive style, and depressive symptoms at three time points. Results indicated that the relationship between perceived social competence and depressive symptoms was partially mediated by negative interactions with parents but not peers. Further, baseline negative cognitive style interacted with greater negative parent interactions to predict later depressive symptoms.

Neuroendocrine-related adverse events associated with antidepressant treatment in children and adolescents

There is only limited community-based practice safety information available regarding antidepressant use in pediatric patients. This study identifies the factors associated with incident neuroendocrine-related metabolic, digestive, and sexual/reproductive adverse events in children and adolescents treated with antidepressants. A retrospective cohort design evaluating Medicaid medical and pharmacy claims between January, 1996 and December, 2005 was employed for 11970 children and adolescents prescribed an antidepressant medication, and a random sample of 4500 children not treated with psychotropic medications. Incident obesity/weight gain, Type 2 diabetes mellitus, and dyslipidemia were more likely for those prescribed selective serotonin reuptake inhibitors (SSRIs) (OR = 1.49; 1.37; 1.44), whereas Type 2 diabetes mellitus and dyslipidemia were more likely for those prescribed weight-inducing antidepressants (ORs = 1.26; 1.24), and those with pre-existing endocrinopathies (ORs = 3.96; 1.90), controlling for the effects of co-prescribed mood stabilizers or antipsychotics. Incident nausea/vomiting was less likely for those taking SSRIs (OR = 0.78). Females and children under 12 years of age were more likely to develop these adverse effects. Practitioners need to carefully consider the neuroendocrine- related adverse effects of SSRI antidepressant agents in particular, especially in individuals with comorbid endocrine conditions, and those co-prescribed other classes of psychotropic medications.

Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence

This study extends the existing adult literature on insecure attachment as a predictor of depression and anxiety by examining these pathways in a sample of adolescents. In addition, dysfunctional attitudes and low self-esteem were tested as mediators of the association between insecure attachment and symptoms of depression and anxiety. Youth (N = 350; 6th-10th graders) completed self-report measures of attachment, dysfunctional attitudes, self-esteem, and symptoms of depression and anxiety in a 4-wave prospective study. Results indicate that anxious and avoidant attachment each predicted changes in both depression and anxiety (after controlling for initial symptom levels). The association between anxious attachment, but not avoidant attachment, and later internalizing symptoms was mediated by dysfunctional attitudes and low self-esteem. Effects remained even after controlling for initial co-occurring symptoms.

GHQ increases among Scottish 15 year olds 1987-2006

BACKGROUND

Increases in a number of psychosocial disorders have been identified among Western youth in the second half of the Twentieth century. However findings are not consistent, trends are complex, and comparisons over time are hampered by methodological problems.

METHODS

Data were drawn from three samples identical in respect of age (15 years), school year (final year of statutory schooling) and geographical location (the West of Scotland). Each sample was administered the 12-item General Health Questionnaire, a measure of self-report psychological distress, in 1987 (N = 505), 1999 (N = 2,196) and 2006 (N = 3,194). Analyses were conducted to examine changes in: GHQ 'caseness'; individual items; and factors, derived via confirmatory factor analysis representing (a) 'negative' and 'positive' items, and (b) 'anxiety and depression', 'loss of confidence or self-esteem' and 'anhedonia and social dysfunction'.

RESULTS

Based on the standard (2/3) cut-off, 'caseness' rates in 1987, 1999 and 2006 were 12.7, 15.1 and 21.5% (males) and 18.8, 32.5 and 44.1% (females). Similar increases were observed with more stringent 'caseness' cut-offs. Examination of individual items showed some to have increased much more markedly over time than others. There were larger increases among females for all except two items and some evidence, among both genders, of steeper increases among 'negative' items compared with 'positive' ones. However, the differences in slope were very small compared with the overall increases in both types.

CONCLUSIONS

Data from three samples identical in respect of age, school year and geographical location, show marked increases in GHQ-12 'caseness' among females between 1987 and 1999 and among both males and females between 1999 and 2006. Although slightly steeper increases in 'negative' items raise the possibility that endorsing such symptoms may have become more acceptable, these were small in comparison with increases in all dimensions of psychological distress. The next step is to identify causal explanations for the increases reported here.

Rumination and depression in adolescence: investigating symptom specificity in a multiwave prospective study

A ruminative response style has been shown to predict depressive symptoms among youth and adults, but it is unclear whether rumination is associated specifically with depression compared with co-occurring symptoms of anxiety and externalizing behaviors. This prospective, multiwave study investigated whether baseline rumination predicted prospective elevations in depressive symptoms specifically. Rumination was assessed at baseline in a sample of early and middle adolescents (N = 350, 6-10th graders). Symptom measures of depression, anxious arousal, general internalizing, and conduct/externalizing problems with good discriminant validity were assessed at four time points over a 5-month period. Results using hierarchical linear modeling show that rumination predicted prospective fluctuations in symptoms of depression and general internalizing problems specifically but not anxious arousal or externalizing problems. Rumination predicted increasing prospective trajectories of general internalizing symptoms. Baseline rumination interacted with prospective co-occurring fluctuations of anxious arousal and externalizing behaviors over time to predict the highest levels of prospective depressive symptoms. Rumination partly mediated the sex difference (girls > boys) in depressive and internalizing symptoms.

Parent and adolescent depressive symptoms: the role of parental attributions

This study examined whether negative parental attributions for adolescent behaviour mediate the association between parental and adolescent depressive symptoms, and whether this relationship is moderated by adolescent gender. Mothers and fathers and 124 adolescents (76 girls and 48 boys; ages 14 to 18) participated. Adolescents were primarily Caucasian, and varied in the level of depressive symptoms (with 27% of the sample meeting diagnostic criteria for a current unipolar depressive disorder). Parents and adolescents completed measures of depressive symptoms, and participated in a videotaped problem-solving discussion. After the discussion, each parent watched the videotape and, at 20 s intervals, offered attributions for their adolescent's behaviour. Adolescent gender moderated the relation between parental attributions and adolescent depressive symptoms, with stronger associations for female adolescents. For both mothers and fathers, both parental depressive symptoms and negative attributions about the adolescent's behaviour made unique contributions to the prediction of depressive symptoms in adolescent females. There also was evidence that negative attributions partially mediated the link between depressive symptoms in mothers and adolescent daughters. The results are interpreted as consistent with parenting as a partial mediator between parental and adolescent depressive symptoms, and suggest that adolescent girls may be particularly sensitive to parents' negative interpretations of their behaviour.

Using epidemiologic methods to test hypotheses regarding causal influences on child and adolescent mental disorders

Epidemiology uses strong sampling methods and study designs to test refutable hypotheses regarding the causes of important health, mental health, and social outcomes. Epidemiologic methods are increasingly being used to move developmental psychopathology from studies that catalogue correlates of child and adolescent mental health to designs that can test rival hypotheses regarding causal genetic and environmental influences. A two-part strategy is proposed for the next phase of epidemiologic research. First, to facilitate the most informed tests of causal hypotheses, it is necessary to develop and test models of the structure of hypothesized genetic and environmental influences on mental health phenotypes. This will involve testing the related hypotheses that there are both (a) dimensions of psychopathology that are distinct in the sense of having at least some unique genetic and/or environmental influences, and (b) higher-order domains of correlated dimensions that are all apparently influenced in part by the same genetic and/or environmental factors. The resulting causal taxonomy would organize tests of causal hypotheses regarding both factors that may broadly increase risk for multiple dimensions of psychopathology and factors that may specifically increase risk for each individual dimension. Second, it is necessary to make greater use of a number of powerful epidemiologic designs that allow rigorous tests of rival hypotheses regarding genetic and environmental causes.

A prospective study of the cognitive-stress model of depressive symptoms in adolescents

This prospective study investigated a cognitive diathesis-stress model of depression in adolescents across the transition from 6th to 7th grade using individual, additive, weakest link, and keystone approaches to operationalizing the cognitive vulnerability. Participants were 240 young adolescents (mean age = 11.87 years, SD = 0.57) who differed in risk for mood disorders based on their mother's history of depression. Results of the hierarchical multiple regression analyses indicated some support for the individual, additive, weakest link, and keystone diatheses. In particular, the weakest link diathesis interacted with stress and gender to predict increases in depressive symptoms in 7th grade; the form of this interaction was consistent with the cognitive diathesis-stress model for boys, whereas for girls the pattern of relations reflected more of a dual-vulnerability model. That is, high levels of depressive symptoms were found for all girls except those with more positive cognitive styles and low stress levels. These findings highlight the utility of examining different approaches to combining measures of cognitive vulnerability in conjunction with stress in predicting depressive symptoms, and the importance of exploring gender differences with regard to the cognitive diathesis-stress model.

Psychiatric diagnosis - is it universal or relative to culture?

BACKGROUND

There is little consensus on the extent to which psychiatric disorders or syndromes are universal or the extent to which they differ on their core definitions and constellation of symptoms as a result of cultural or contextual factors. This controversy continues due to the lack of biological markers, imprecise measurement and the lack of a gold standard for validating most psychiatric conditions.

METHOD

Empirical studies were used to present evidence in favor of or against a universalist or relativistic view of child psychiatric disorders using a model developed by Robins and Guze to determine the validity of psychiatric disorders.

RESULTS

The prevalence of some of the most common specific disorders and syndromes as well as its risk and protective factors vary across cultures, yet comorbid patterns and response to treatments vary little across cultures. Cross-cultural longitudinal data on outcomes is equivocal.

CONCLUSIONS

The cross-cultural validity of child disorders may vary drastically depending on the disorder, but empirical evidence that attests for the cross-cultural validity of diagnostic criteria for each child disorder is lacking. There is a need for studies that investigate the extent to which gene-environment interactions are related to specific disorders across cultures. Clinicians are urged to consider culture and context in determining the way in which children's psychopathology may be manifested independent of their views. Recommendations for the upcoming classificatory system are provided so that practical or theoretical considerations are addressed about how culture and ethnic issues affect the assessment or treatment of specific disorders in children.