A Direct Method of Assessing Underlying Cognitive Risk for Adolescent Depression

Characterising depression trajectories in young people at high familial risk of depression

BACKGROUND

Parental depression is a common and potent risk factor for depression in offspring. However, the developmental course of depression from childhood to early-adulthood has not been characterized in this high-risk group.

METHODS

Using longitudinal data from 337 young people who had a parent with a history of recurrent major depressive disorder (MDD), we characterized trajectories of broadly defined depressive disorder using latent class growth analysis. We used clinical descriptions to further characterise trajectory classes.

RESULTS

Two trajectory classes were identified: childhood-emerging (25 %) and adulthood-emerging (75 %). The childhood-emerging class showed high rates of depressive disorder from age 12.5, which persisted through the study period. The adulthood-emerging class showed low rates of depressive disorder until age 26. Individual factors (IQ and ADHD symptoms) and parent depression severity (comorbidity, persistence and impairment) differentiated the classes but there were no differences in family history score or polygenic scores associated with psychiatric disorder. Clinical descriptions indicated functional impairment in both classes, but more severe symptomatology and impairment in the childhood-emerging class.

LIMITATIONS

Attrition particularly affected participation in young adulthood. Factors associated with attrition were low family income, single parent household status and low parental education.

CONCLUSIONS

The developmental course of depressive disorder in children of depressed parents is variable. When followed up to adult life, most individuals exhibited some functional impairment. An earlier age-of-onset was associated with a more persistent and impairing course of depression. Access to effective prevention strategies is particularly warranted for at-risk young people showing early-onsetting and persistent depressive symptoms.

Cognitive and attentional vulnerability to depression in youth: A review

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

A multimethod screening approach for pediatric depression onset: An incremental validity study

OBJECTIVE

Screening protocols that rely on a single informant are inadequate in predicting pediatric depression. Multi-informant and risk factor screening approaches are potentially more sensitive methods for identifying depression risk, but the incremental validity of these protocols has not been adequately tested. Using a translational analytic approach and multimethod, longitudinal study design, we simultaneously tested several multi-indicator approaches to depression screening to identify an optimal algorithm for predicting depression onset in youth.

METHOD

Participants were 222 never-depressed children and adolescents (M_age = 10.75 years old, SD_age = 1.85; female = 50.45%; 82.88% White), who completed baseline questionnaires for depressive symptoms and cognitive vulnerabilities, in addition to a morphed face task to assess pupil dilation. Mothers, meanwhile, completed baseline questionnaires and a semistructured interview to assess maternal and pediatric depression. Follow-up depression diagnostic assessments with both the mother and youth occurred every 6 months for 2 years. Receiver operating characteristics and reclassification analyses were used to test our aims.

RESULTS

Overall, we found moderate support for a multi-informant approach, and convincing evidence that individual differences in pupil dilation uniquely predicted depression onset. Youth with subthreshold depressive symptoms and elevated pupil dilation were over twice as likely to develop a first lifetime episode of depression compared to one's risk rate based on sex and age.

CONCLUSIONS

Our study provides one of the first screening batteries for detecting first lifetime episodes of depression in youth. The unique and incremental validity provided by pupil dilation suggests feasible biological indicators of depression risk can improve primary prevention efforts that target depression, such as universal pediatric depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The association between paternal depressogenic cognitive styles during pregnancy and offspring depressogenic cognitive styles: an 18-year prospective cohort study

BACKGROUND

Preventing the development of depressogenic or negative cognitive styles could also prevent the development of depression, a leading public health problem worldwide. Maternal negative cognitive styles are a modifiable risk factor for the development of negative cognitive styles in offspring. However, evidence on the role of paternal negative cognitive styles is inconclusive and there have only been a few small studies, which may also have lacked statistical power.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate the association between paternal negative cognitive styles, measured when mothers were 18 weeks pregnant, and offspring negative cognitive styles 18 years later (N = 6,123). Associations were calculated using linear regression models, before and after adjustment for confounders including maternal negative cognitive styles. We compared associations before and after controlling for depression in parents and offspring, and used multiple imputation to reduce biases that may have arisen due to missing data.

RESULTS

A two-standard deviation increase in paternal negative cognitive style was associated with a 3-point increase in offspring negative cognitive style (95% CI 1.36-4.37). This association remained after adjustment for confounders and was independent of depression in both parents and offspring. The effect size was equivalent to that of maternal negative cognitive style, and was also independent of maternal negative cognitive style.

CONCLUSIONS

Our results suggest that fathers should be included in individual- and family-based interventions designed to prevent the development of depressogenic cognitive styles in adolescent offspring. This could possibly also prevent the development of depression.

Dysregulated behavioral responses to hedonic probes among youth with depression histories and their high-risk siblings

Affect dysregulation in response to rewarding stimuli has been proposed as a vulnerability factor for major depressive disorder (MDD). However, it remains unclear how affective behavioral dynamics may be altered among individuals who are at high risk for depression but not currently depressed. We examined the dynamics of affective facial behavior during hedonic probes among 3 groups of adolescents: remitted probands who had histories of childhood-onset MDD (n = 187), never-depressed siblings of probands (high familial risk; n = 207), and healthy controls (n = 166). Participants' happy and sad facial expressions were coded during 3 hedonic laboratory tasks: receiving a preferred prize, describing a positive autobiographical memory, and watching a humorous film. Happy and sad behavioral dynamics were indexed by mean level- and time-dependent reactivity, variability (mean of the squared successive differences), and inertia (autocorrelation). Relative to controls, probands and siblings exhibited a more rapid decrease in happy behaviors, and probands exhibited higher inertia of sad behaviors during hedonic probes. Both probands and siblings exhibited lower inertia of sad behaviors while receiving a desired prize, which highlights the importance of context variation in testing hypotheses. Overall, our study provides new evidence that hedonic behavioral dysregulation, as reflected in dynamic facial behavior, may highlight depression vulnerability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining reward-seeking, negative self-beliefs and over-general autobiographical memory as mechanisms of change in classroom prevention programs for adolescent depression

BACKGROUND

Effective methods to prevent adolescent depressive symptoms could reduce suffering and burden across the lifespan. However, psychological interventions delivered to adolescents show efficacy only in symptomatic or high-risk youth. Targeting causal risk factors and assessing mechanistic change can help devise efficacious universal or classroom based prevention programs.

METHODS

A non-randomized longitudinal design was used to compare three classroom-based prevention programs for adolescent depression (Behavioral Activation with Reward Processing, "Thinking about Reward in Young People" (TRY); Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT)), and determine cognitive mechanisms of change in these programs. Cognitive mechanisms examined were reward-seeking, negative self-beliefs (assessed with behavioral tasks) and over-general autobiographical memory. 256 healthy adolescents aged 13-14 participated with 236 (92%) and 227 (89%) completing the pre- and post-assessments.

RESULTS

TRY was the only intervention associated with a reduction in depressive symptoms at follow-up. Reward-seeking increased following TRY. In the other programs there were non-significant changes in cognitive mechanisms, with more reflective negative self-beliefs in CBT and fewer over-general autobiographical memories in MBCT In the TRY program, which focused on increasing sensitivity to rewarding activities, reward seeking increased and this was associated with decreased depressive symptoms.

LIMITATIONS

Due to the infeasibility of a cluster randomized controlled trial, a non-randomized design was used.

CONCLUSIONS

Increased reward-seeking was associated with decreased depressive symptoms and may be a mechanism of depressive symptom change in the intervention with a focus on enhancing sensitivity and awareness of reward. This study provides preliminary evidence to suggest that incorporating activities to enhance reward sensitivity may be fruitful in randomized controlled trials of universal prevention programs for depression.

Negative automatic thoughts as a mediator of the relationship between depression and suicidal behaviour in an at-risk sample of Malaysian adolescents

BACKGROUND

This study examined the mediating role of negative automatic thoughts in the relationship between depression and suicidal behaviour in a sample of at-risk Malaysian adolescents.

METHOD

A total of 1441 adolescents were initially recruited via multistage cluster sampling. Subsequently, 294 at-risk adolescents were selected for further analyses through a specified cut-off score.

RESULTS

The results showed significant positive relationships among the study variables. Specifically, negative automatic thoughts emerged as a significant mediator in the relation between depression and suicidal behaviour (z = 7.15, p < .001).

CONCLUSIONS

The findings suggest that depressed adolescents are at high risk for a host of negative thought processes which in turn lead to suicidal behaviour. The study limitations and recommendations for further research are discussed.

Genetic and environmental etiologies of adolescent dysfunctional attitudes: a twin study

Despite the importance of dysfunctional attitudes in the development and maintenance of depression, little is known about the etiological origin of dysfunctional attitudes. The Dysfunctional Attitudes Scale for Children was administered to 674 adolescent twins derived from the Beijing Twin Study (BeTwiSt). Four hundred and thirty-nine monozygotic and 235 same-gender dizygotic twin pairs were included. Approximately 54% were females. The age range of the twins was 11-17 years. Model-fitting analyses were conducted. Biometric genetic model-fitting estimates indicated that additive genetic factors accounted for 31% (95% CI: 11%, 45%) of variance in adolescent dysfunctional attitude. The influence of shared environmental factors was small and negligible (9% [95% CI: 0%, 27%]). Non-shared environmental factors explained 60% (95% CI: 55%, 66%) of variance. Equating the estimate parameters across gender or age groups resulted in a non-significant difference of model fit, but there were trends suggesting higher heritability in females and older adolescents. Our results provide evidence for moderate heritability of dysfunctional attitudes in adolescents. Dysfunctional attitudes can be used as an endophenotype to identify risk genes for depression.