Common Etiological Sources of Anxiety, Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study

Cross-National Trends in Adolescents Psychological and Somatic Complaints Before and After the Onset of COVID-19 Pandemic

PURPOSE

Building on research suggesting that the COVID-19 pandemic may have led to an exacerbation of deteriorating trends in mental health among adolescents, this paper examined trends in adolescents' psychological and somatic complaints across 35 countries from 2010 to 2022, and tested trends in sociodemographic inequalities in these outcomes between 2018 and 2022.

METHODS

Using data from 792,606 adolescents from 35 countries (51% girls; mean age = 13.5; standard deviation 1.6) across four Health Behaviour in School-aged Children surveys (2010, 2014, 2018, 2022), hierarchical multilevel models estimated cross-national trends in adolescent psychological and somatic complaints. We tested whether observed values in 2022 were in line with predicted values based on 2010-2018 linear trends. Finally, moderation effects of age, family affluence, and family structures on the outcomes were tested (2018-2022).

RESULTS

Both girls and boys showed substantially higher levels of psychological complaints in 2022 compared with the predicted values. For somatic complaints, higher levels than predicted in 2022 were observed only in girls. Moderation analyses revealed an increase from 2018 to 2022 in age gaps and a narrowing in the socioeconomic gap for both outcomes. Also, there was a widening gap between adolescents living with 2 parents and those living in a single parent household in 2022 compared to 2018.

DISCUSSION

Cross-national increases in adolescent psychological and somatic complaints were higher than expected in 2022, based on previous trends. Magnitudes of change varied across different sociodemographics groups, with implications for pre-existing mental health inequalities.

Relationships Between Recent Adverse Childhood Experiences (ACEs) and Somatic Symptoms in Adolescence

Early identification and interventions are imperative for mitigating the harmful effects of adverse childhood experiences (ACEs). Nonetheless, a substantial barrier persists in identifying adolescents experiencing ACEs. One understudied avenue for early identification of ACEs is through the examination of somatic symptoms endorsed by adolescents. Understanding the relationship between recent ACEs exposure and somatic symptoms may serve as a useful indicator for identifying adolescents affected by ACEs. This study examines the relationships between recent exposure to ACEs (within the past one to two years) and somatic symptoms across adolescence (ages 12-16 years). Longitudinal prospective data of 1354 child and caregiver dyads from the Longitudinal Studies of Child Abuse and Neglect were used in this study. Data from three time points, when adolescents were 12, 14, and 16, were used to conduct longitudinal path analyses. Somatic symptoms- defined as physical symptoms without known medical causes- were measured using the caregiver-report subscale of the Child Behavior Checklist. Recent ACEs in the past one to two years were measured using an index score summing exposure to nine ACE variables. The results indicated a significant association between recent ACEs and increased somatic symptoms at age 12. However, there were no significant associations between recent ACEs and somatic symptoms at ages 14 and 16. The findings indicate a notably stronger relationship between recent ACEs exposure and the presence of increased somatic symptoms at the age of 12, in contrast to what is observed at ages 14 and 16. This finding suggests that somatic symptoms during early adolescence may suggest underlying issues, potentially stemming from stressors such as ACEs.

Physical symptoms and brain morphology: a population neuroimaging study in 12,286 pre-adolescents

Physical symptoms, also known as somatic symptoms, are those for which medical examinations do not reveal a sufficient underlying root cause (e.g., pain and fatigue). The extant literature of the neurobiological underpinnings of physical symptoms is largely inconsistent and primarily comprises of (clinical) case-control studies with small sample sizes. In this cross-sectional study, we studied the association between dimensionally measured physical symptoms and brain morphology in pre-adolescents from two population-based cohorts; the Generation R Study (n = 2649, 10.1 ± 0.6 years old) and ABCD Study (n = 9637, 9.9 ± 0.6 years old). Physical symptoms were evaluated using continuous scores from the somatic complaints syndrome scale from the parent-reported Child Behavior Checklist (CBCL). High-resolution structural magnetic resonance imaging (MRI) was collected using 3-Tesla MRI systems. Linear regression models were fitted for global brain metrics (cortical and subcortical grey matter and total white matter volume) and surface-based vertex-wise measures (surface area and cortical thickness). Results were meta-analysed. Symptoms of anxiety/depression were studied as a contrasting comorbidity. In the meta-analyses across cohorts, we found negative associations between physical symptoms and surface area in the (i) left hemisphere; in the lateral orbitofrontal cortex and pars triangularis and (ii) right hemisphere; in the pars triangularis, the pars orbitalis, insula, middle temporal gyrus and caudal anterior cingulate cortex. However, only a subset of regions (left lateral orbitofrontal cortex and right pars triangularis) were specifically associated with physical symptoms, while others were also related to symptoms of anxiety/depression. No significant associations were observed for cortical thickness. This study in preadolescents, the most representative and well-powered to date, showed that more physical symptoms are modestly related to less surface area of the prefrontal cortex mostly. While these effects are subtle, future prospective research is warranted to understand the longitudinal relationship of physical symptoms and brain changes over time. Particularly, to elucidate whether physical symptoms are a potential cause or consequence of distinct neurodevelopmental trajectories.

Personal identity, somatic symptoms, and symptom-related thoughts, feelings, and behaviors in adolescence: Examining between- and within-person associations and the role of depressive symptoms

Recent literature highlights the complex relationship between personal identity and body-related pathology, yet there is a lack of integrative longitudinal research on the relationship between identity and somatic symptoms. The present study investigated the longitudinal associations between identity functioning and (psychological characteristics of) somatic symptoms, and examined the role of depressive symptoms in this relationship. A total of 599 community adolescents (Time 1: 41.3% female; M_age = 14.93, SD = 1.77, range = 12-18 years) participated in three annual assessments. Using cross-lagged panel models, a bidirectional relationship between identity and (psychological characteristics of) somatic symptoms, mediated by depressive symptoms, emerged at the between-person level; whereas only a unidirectional relationship from psychological characteristics of somatic symptoms to identity functioning, mediated by depressive symptoms, emerged at the within-person level. Identity and depressive symptoms were bidirectionally related at both levels. The present study suggests that adolescent identity development is closely related to somatic and emotional distress.

Developmental competencies, temperament, parenting practices and psychosocial adversities in children with internalising disorders - A pilot study

Research on the aetiology of internalising disorders has focussed on biological and environmental factors, however, the role of developmental competencies that a child acquires has not been explored much. The current report aimed to understand the association among the developmental competencies, temperament, parenting practices and psychosocial adversities in internalising disorders. The sample consisted of 30 children and adolescents with internalising disorders belonging to the age group of six to 18, and one of their parents. All the participants were assessed for functional impairment, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events and family environment using standardised tools. The findings revealed that positive parenting shares a negative relationship with functional impairment(ρ=-0.62; p <.001). On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. In conclusion, the current study indicates that children with internalising disorders differ from control groups in specific developmental competences. These findings have specific implications for intervention and research in the area of internalising disorders in children and adolescents.

Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur

Aims

Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade.

Methods

This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult.

Results

The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria.

Conclusion

This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research.

Protocol PROSPERO registration number

CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents

INTRODUCTION

This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms.

METHODS

Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted.

RESULTS

The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms.

CONCLUSION

The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.

The Development of Somatic Symptom Disorder in Children: Psychological Characteristics and Psychiatric Comorbidity

BACKGROUND

Somatic symptom disorder (SSD) is one of the most common pediatric psychiatric disorders in adolescents, and several biological, psychological, and social factors have been considered to contribute to its development.

OBJECTIVE

The aim of the present study was to elucidate the link between psychological functioning (depression and anxiety), psychological characteristics (perfectionism and alexithymia), negative life events, and parental accommodation in children diagnosed with SSD.

METHODS

Fifty patients (age range 7-18 years) were diagnosed with SSD in an outpatient clinic and completed multiple self-report questionnaires on SSD symptoms, negative life events, and psychological factors. Linear regression models were used to indicate predictors of SSD symptoms. Cluster analysis was performed to identify gastrointestinal and abdominal complaints and their associations.

RESULTS

Association with SSD symptoms was strongest for state anxiety (standardized β = 0.85, 95% confidence interval [CI] = 0.44, 1.27, P = 0.0006), depression (β = 0.72, 95% CI = 0.38, 1.06, P = 0.0006), trait anxiety (β = 0.60, 95% CI = 0.22, 0.98, P = 0.0005), and family accommodation (β = 0. 49, 95% CI = 0.23, 0.75, P = 0.001). These factors were associated with gastrointestinal but not with neurological complaints. Family accommodation was associated with somatic complaints among children younger than 12 years (r = 0.57, P = 0.007), while state anxiety (r = 0.69, P = 0.007) and depression (r = 0.65, P = 0.007) were significantly associated among older children.

CONCLUSIONS

Several psychological factors may result in a somatic response. The phenotypic expression of these factors may vary among different ages. Somatic complaints were related to parental accommodation among young children, while it was strongly associated with anxiety and depression among adolescents.

["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]

OBJECTIVES

Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern "Somatic Symptom and Related Disorders" according to the DSM-5 (Diagnostic and Statistical Manual - 5th Edition) among adolescents.

METHODS

The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items "somatoform disorders" or "somatic symptom disorders". An age filter was applied for "adolescents", and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis.

RESULTS

A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these "somatic symptom disorders" were varied, such as "somatization", "somatic complaints/symptoms", "functional disorder", "unexplained symptoms" and "somatoform disorders". Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about "functional neurological symptom disorder", "factitious disorder" and "somatic symptom disorder" with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented.

CONCLUSIONS

Only nine articles included "somatic symptom disorder" in their titles, despite a terminology valued by many authors (compared to "somatoform disorders" from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.

The Differential Heritability of Social Adjustment by Sex

Sex differences in social adjustment are frequently observed; however, there has been very little research on adaptability in the individual and social domains. The aim of this study was to investigate the sex difference in social abilities, such as high self-appeal, sociability, school adaptation, and home adaptation between school-age males and females. The sample for this study included both same-sex and opposite-sex twin pairs: a total of 467 twin pairs. We classified them into three groups: a group of those in lower classes of elementary school, a group of those in higher classes of elementary school, and a group of those in junior high school. The heritability of school adaptation was estimated to be 95% in males and 54% in females in the junior high school group. The full sex-limitation model showed a better fit in this group, and this means that a qualitative genetic difference exists. For school adaptation, there was no sex difference in lower elementary school classes; however, a quantitative difference appeared in higher classes of elementary school. Moreover, a qualitative difference appeared in junior high school. From this research, it became clear that sex differences in heritability exist for school adaptation, and there was a marked increase from the elementary school children to the junior high school children.

Internalized psychopathology dimensions in middle childhood: Cross-sectional and temporal associations

BACKGROUND

Anxiety, depression, and obsessive-compulsive symptoms often onset during middle childhood and are major causes of disability in young individuals. A better understanding of how these symptoms are linked and unfold over time is important to develop valid etiological models and effective prevention and treatment.

METHODS

In the present study, 950 community children (8-14 years) reported on a broad range of internalised symptoms at three time points over the course of a year. First, factor analysis was used to examine the overarching dimensions of these symptoms. Second, network analysis was used to examine unique cross-sectional associations among these empirically supported symptom dimensions. Last, longitudinal structural equation models (SEMs) were used to examine temporal associations among the symptom dimensions.

RESULTS

Six broad symptom dimensions fitted the self-report data well at all time points. These dimensions were conceptualized as depression, general anxiety, situational fears, compulsivity, intrusive thoughts, and somatic anxiety. Network analysis showed that these dimensions formed a highly interconnected network with general anxiety and somatic anxiety being most central (i.e., most strongly associated with other dimensions) at all time points. Longitudinal SEMs supported the central role played by general anxiety in the temporal associations among these dimensions.

CONCLUSIONS

Overarching expressions of internalized psychopathology are highly interconnected in middle childhood with possible central roles played by general and somatic anxiety. Interventions aimed at a general proneness for anxiety may be warranted in preventing and treating internalizing symptoms in middle childhood.

The role of childhood generalized anxiety in the internalizing cluster

BACKGROUND

Anxiety, depression and somatization (the internalizing cluster) are highly comorbid, prevalent and associated with significant individual and societal costs. Although prior studies have examined their natural course, there has been a little investigation into how symptoms unfold at the individual level. We examined the intraindividual (within-person) temporal patterning of symptom development and the impact of risk factors (sex, ethnicity, socioeconomic indicators, bullying victimization, child maltreatment) on symptom means and trajectories (between-person), comparing youth and parent reports.

METHOD

Over a 7-year interval from age 11 to 17, children (n = 669; 54% girls; 79% White) and parents (89% mothers) reported on symptoms of anxiety and depression from age 11 and somatization from age 13. Autoregressive latent trajectory models with structured residuals were used to uncouple within- and between-person sources of variance.

RESULTS

According to self-reports, generalized anxiety consistently predicted depression, while anxiety and depression consistently predicted somatization. Anxiety also had an indirect effect on somatization via depression. According to parent reports, there were several bidirectional effects between anxiety and depression and between depression and somatization. Experiences of abuse were consistent risk factors for self-reported internalizing symptoms, and across informants, girls had higher symptom means and rising trajectories compared to boys.

CONCLUSION

Generalized anxiety plays an important role in adolescent depressive and somatic symptoms. Primary prevention of anxiety may be warranted to curb symptom continuity and the development of comorbidity. Research is needed to determine whether self-reports of anxiety should be prioritized over parent reports and continued efforts are needed to reduce bullying and child maltreatment.

Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations

BACKGROUND AND OBJECTIVES

According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents.

METHODS

Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires.

RESULTS

MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR² = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01).

LIMITATIONS

Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending.

CONCLUSIONS

A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.

Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Relationship of Major Depression with Body Mass Index and Salivary Cortisol

Introduction Depression is one of the most incapacitating psychiatric diseases that disturb life of millions of people round the globe. Its major causes include stressful life events, bereavement, social abuses or certain biological and genetic factors with complex causal mechanisms. Higher salivary cortisol levels for a long period lead to dyslipidemias which increase body mass index (BMI), elevate adiposity and waist-to-hip ratio (WHR). Such individuals with high quartiles of BMI have considerably higher risk of major depressive disorder. The aim of this study was to establish a correlation between major depression, BMI and salivary cortisol. Methods This cross-sectional analysis was accomplished in the Physiology Department, Sheikh Zayed Federal Postgraduate Medical Institute, Lahore as well as in Punjab Institute of Mental Health, Lahore, Pakistan, over a period of six months. A total of 60 participants aged between 18 and 60 years were included in this study; they were divided equally into two groups as normal healthy individuals with no physical or mental illness and severely depressed groups. The patients were categorized as cases of severe depression on outdoor clinical assessment and further confirmed by ICD-10. Patient's BMI was estimated by measuring height in meters (m) and weight in kilograms (kg), and then dividing weight with square height. Early morning saliva samples were collected. Estimation of cortisol levels in saliva was done through ELISA. SPSS version 20.0 (IBM Corp., Armonk, NY) was used to analyze the data and p ≤ 0.05 was considered statistically significant. Results The mean BMI in normal healthy group was 22.02 ± 4.21, while the mean BMI in severely depressive group was 24.64 ± 3.58. The difference was statistically significant (p = 0.012). The mean salivary cortisol level was significantly raised in patients with major depression (2.23 ± 1.69 nmol/L) in contrast to healthy normal individuals (1.46 ± 0.91 nmol/L), with p-value = 0.031. Conclusion BMI and depression has a very noteworthy correlation and there is a remarkable link between raised salivary cortisol, greater BMI and development of major depression.

Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence

OBJECTIVE

Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples.

METHODS

304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis.

RESULTS

Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents.

CONCLUSIONS

Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders.

Early maladaptive schemas in patients with somatoform disorders and somatization

Maladaptive schemas are stable relational patterns that develop through harmful childhood experiences with primary caregivers. Schemas within somatoform disorders are rarely explored even though these disorders are clinically important due to high prevalence, co-morbidity, and cost for the health care system. This study investigates schemas according to Young's schema theory in patients with somatoform disorders in comparison with healthy controls and patients with depressive or anxiety disorders. Further associations between schemas and somatization were explored. We included 134 patients with a somatoform disorder and 39 age-matched healthy controls, 83 patients with a unipolar depression, and 34 patients with an anxiety disorder. The clinical sample consists of day care patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but without a personality disorder. Primary measures were the Young Schema Questionnaire (YSQ-S2), the Screening for Somatoform Disorders (SOMS-7T), the Beck Depression Inventory, Second Edition, and the Childhood Trauma Questionnaire. Analyses of variance indicated that somatoform patients scored higher on almost all schemas than do healthy controls (p < 0.001, η²  = 0.148). The highest mean scores were reached for the schemas "self-sacrifice" and "unrelenting standards," with significant higher values in the patient sample. However, when compared with patients with depressive or anxiety disorders, somatoform patients scored equally or even lower. High somatization was associated with generally higher schema activation. This effect was to a great extent mediated by depressive symptoms. Only the schema "vulnerability to harm or illness" was exclusively related to somatization. These findings suggest that schemas should be systematically assessed within psychotherapy of somatoform patients.

DNA methylation in adolescents with anxiety disorder: a longitudinal study

Anxiety disorders (AD) typically manifest in children and adolescents and might persist into adulthood. However, there are still few data concerning epigenetic mechanisms associated with onset, persistence or remission of AD over time. We investigated a cohort of adolescents and young adults at baseline (age; 13.19 ± 2.38) and after 5 years and classified them according to the AD diagnosis and their longitudinal trajectories into 4 groups: (1) Typically Developing Comparisons (TDC; control group, n = 14); (2) Incident (AD in the second evaluation only, n = 11); (3) Persistent (AD in both evaluations, n = 14) and (4) Remittent (AD in the first evaluation only, n = 8). DNA methylation was evaluated with the Infinium HumanMethylation450 BeadChip from saliva samples collected at both evaluations. Gene set enrichment analysis was applied to consider biological pathways. We found decreased DNA methylation in TDC group while the chronic cases of AD presented hypermethylation in central nervous system development pathways. Moreover, we showed that this persistent group also presented hypermethylation while the other three groups were associated with hypomethylation in nervous system development pathway. Incidence and remission groups were associated with increased and decreased methylation in neuron development pathways, respectively. Larger studies are likely to detect specific genes relevant to AD.

Early-Life Somatic Complaints: Longitudinal Associations with Maternal and Child Psychopathology

OBJECTIVE

Somatic complaints, often associated with concurrent and future internalizing symptoms and disorders in adult samples, were examined longitudinally from preschool to school age in a sample of children at an increased familial risk for psychopathology. The behavioral correlates and sex differences of somatic complaints and the persistence of these complaints across early childhood were examined.

METHOD

A longitudinal sample of 185 mothers completed a laboratory visit when children were preschool aged and an online follow-up when children were school aged. Mothers were assessed for psychopathology, and mothers and secondary caregivers reported on children's somatic complaints, anxiety, and depression at both time points.

RESULTS

A high rate of child's somatic complaints was noted in this sample, with similar rates in males and females. Regression analyses revealed that somatic complaints at preschool predicted somatic complaints, anxiety, and depression at school age, and sex did not moderate these relationships. Overall, maternal psychopathology predicted somatic complaints, but findings were inconsistent across reporters, time points, and types of maternal psychopathology. Evidence for maternal reporting bias was mixed.

CONCLUSION

The association between preschool-age somatic complaints and school-age internalizing symptoms suggests the potential utility of early detection and treatment of somatic complaints, particularly for young children at an increased familial risk for developing internalizing disorders. Pediatric primary care is an ideal setting for these early intervention efforts.

Time-varying and time-invariant dimensions of depression in children and adolescents: Implications for cross-informant agreement

The longitudinal structure of depression in children and adolescents was examined by applying a Trait-State-Occasion structural equation model to 4 waves of self, teacher, peer, and parent reports in 2 age groups (9 to 13 and 13 to 16 years old). Analyses revealed that the depression latent variable consisted of 2 longitudinal factors: a time-invariant dimension that was completely stable over time and a time-varying dimension that was not perfectly stable over time. Different sources of information were differentially sensitive to these 2 dimensions. Among adolescents, self- and parent reports better reflected the time-invariant aspects. For children and adolescents, peer and teacher reports better reflected the time-varying aspects. Relatively high cross-informant agreement emerged for the time-invariant dimension in both children and adolescents. Cross-informant agreement for the time-varying dimension was high for adolescents but very low for children. Implications emerge for theoretical models of depression and for its measurement, especially when attempting to predict changes in depression in the context of longitudinal studies. (PsycINFO Database Record