The Mediating Role of Rumination in the Relation Between Quality of Attachment Relations and Depressive Symptoms in Non-Clinical Adolescents

The Relationship Between Overparenting and Social Avoidance Among Emerging Adults: Mediating Role of Peer Attachment and Gender Differences

Purpose

We aim to explore the relationship between overparenting and social avoidance among emerging adults, and the mediating effects of peer attachment and gender differences.

Participants and Methods

A total of 1161 Chinese college students completed the questionnaire. The structural equation model was established to validate the main effect model and the mediation model.

Results

The results found that both paternal and maternal overparenting positively predicted social avoidance among emerging adults. Both attachment avoidance and attachment anxiety played a significant mediating role in the relationship between paternal overparenting and social avoidance. Attachment anxiety played a significant mediating role in the relationship between maternal overparenting and social avoidance, while, the mediating effect of attachment avoidance was not significant. In addition, gender differences were found in the mediating effects of peer attachment. The mediating effect of attachment anxiety in males' families had an opposite-gender matching effect, while in females' families, the mediating effect of attachment avoidance had an opposite-gender matching effect.

Conclusion

This study contributes to the understanding of the effects of overparenting on emerging adults, enriching empirical research in related fields.

Associations between trajectories of adolescent conduct problems and psychological well-being in young women

INTRODUCTION

Despite the clinical relevance, little is known about variability in positive adult outcomes (i.e., flourishing, life satisfaction) of female adolescent conduct problems (CP), or interpersonal factors that promote these types of well-being. We hypothesized differential associations between adolescent CP trajectories and indicators of adult well-being due to level of positive relationships with caregivers during ages 12-17.

METHOD

Data were drawn from participants (N = 1965) of the Pittsburgh Girls Study, a longitudinal study of girls' development. Caregiver reported CP, adolescent reports of parental trust and positive parenting, and adolescent-reported peer delinquency were assessed annually between ages 12-17. Well-being in young adulthood was measured using self-reported flourishing and life satisfaction between ages 18-22.

RESULTS

Latent class growth analysis of adolescent CP revealed four trajectories characterized as low stable (20.0%), moderate stable (63.9%), adolescent-onset (8.1%), and high quadratic (8.0%). Main effects of trust and positive relationships with caregivers during adolescence on well-being in early adulthood were found. Positive parenting was found to moderate the association between CP trajectory and flourishing. The magnitude of the negative association between the high quadratic trajectory group and life satisfaction decreased as positive parenting increased.

CONCLUSION

These results support the importance of intervention in adolescence to focus on increasing trusting and positive relationships with caregivers for all females, as this may increase well-being in adulthood regardless of adolescent CP history.

Attachment and brooding rumination during children's transition to adolescence: the moderating role of effortful control

Brooding rumination is a maladaptive form of emotion regulation and confers a risk for psychopathology. Insecure attachment and low cognitive self-regulation are important antecedents of brooding. Yet, little is known about the developmental interplay between these two systems. Thus, we tested how children's attachment and cognitive self-regulation, conceptualized as effortful control (EC), interact to predict brooding. The participants in the three-wave longitudinal study were n = 157 children (10 to 14 years) and their mothers. Children reported their attachment and brooding, and mothers reported children's EC. Results showed that children with low avoidance received benefit from high EC to decrease brooding, whereas children with high anxiety brooded irrespective of EC. Thus, high EC may foster constructive emotion regulation among securely attached children, whereas the beneficial effects of high EC on emotional functioning seem to be overridden by insecurity. The functional role of cognitive self-regulation on different attachment strategies is discussed.

Parental Psychological Flexibility and Children's Behavior Problems in Rural Areas in Northeast China: The Mediation of Children's Emotion Regulation

Children's behavior problems are not conducive to their sustainable development. Therefore, it is of great value to explore the mechanism of relevant influencing factors on the behavior problems of rural preschoolers. This study aimed to reveal the direct effect of parental psychological flexibility on children's behavior problems and the mediating effect of children's emotion regulation. Based on simple random sampling, 355 caregivers (male = 31.25 years, SD = 9.78; 74.08% females; 9.01% bachelor degree) were recruited from eight rural kindergartens in three provinces in northeast China. With questionnaires, caregivers reported their parental psychological flexibility and assessed their children's emotion regulation and behavior problems. SPSS 25.0 software was used for statistical data analysis. The results support our hypotheses, suggesting that parental psychological flexibility, emotional stability, and emotional regulation negatively predicted children's externalizing and internalizing behavior problems. Meanwhile, emotional stability and regulation partially mediated the relationship between parental psychological flexibility and children's externalizing and internalizing behavior problems. These findings provide a new perspective for preventing and intervening in preschoolers' behavior problems.

The neuroanatomy of social trust predicts depression vulnerability

Trust attitude is a social personality trait linked with the estimation of others’ trustworthiness. Trusting others, however, can have substantial negative effects on mental health, such as the development of depression. Despite significant progress in understanding the neurobiology of trust, whether the neuroanatomy of trust is linked with depression vulnerability remains unknown. To investigate a link between the neuroanatomy of trust and depression vulnerability, we assessed trust and depressive symptoms and employed neuroimaging to acquire brain structure data of healthy participants. A high depressive symptom score was used as an indicator of depression vulnerability. The neuroanatomical results observed with the healthy sample were validated in a sample of clinically diagnosed depressive patients. We found significantly higher depressive symptoms among low trusters than among high trusters. Neuroanatomically, low trusters and depressive patients showed similar volume reduction in brain regions implicated in social cognition, including the dorsolateral prefrontal cortex (DLPFC), dorsomedial PFC, posterior cingulate, precuneus, and angular gyrus. Furthermore, the reduced volume of the DLPFC and precuneus mediated the relationship between trust and depressive symptoms. These findings contribute to understanding social- and neural-markers of depression vulnerability and may inform the development of social interventions to prevent pathological depression.

Pathways from Maternal Harsh Discipline Through Rumination to Anxiety and Depression Symptoms: Gender and Normativeness of Harsh Discipline as Moderators

This study examined gender-specific longitudinal pathways from harsh parenting through rumination to anxiety and depression symptoms among early adolescents from three countries and six subgroups. Participants were 567 mothers, 428 fathers, and 566 children (T1: Mage = 10.89; 50% girls) from Medellín, Colombia (n = 100); Naples, Italy (n = 95); Rome, Italy (n = 99); Durham, North Carolina, United States (Black n = 92, Latinx n = 80, and White n = 100). Parent reported maternal and paternal harsh parenting were measured at T1. Adolescent reported rumination was measured at T2 (Mage = 12.58) and anxiety and depression symptoms were measured at T1 and T3 (Mage = 13.71). Rumination mediated the pathway from maternal harsh discipline to girls' anxiety and depression symptoms, controlling for baseline anxiety and depression symptoms. The more harsh discipline mothers used, the more their daughters ruminated, which in turn was associated with increased anxiety and depression symptoms. Exploratory moderated mediation analyses indicated that the strength of the mediational pathway from maternal harsh discipline through girls' rumination to anxiety and depression symptoms decreased as the normativeness of harsh parenting increased. Mediational pathways for boys and for paternal harsh discipline were not significant. Our findings expand knowledge on specific contexts in which rumination is a mechanism for understanding pathways to anxiety and depression symptoms.

Interpersonal trust in adolescents with psychiatric disorders and borderline pathology

Background:

Adolescents with features of borderline personality disorder (BPD) may experience deficits in interpersonal trust; however, a simultaneous comparison of interpersonal trust among adolescents with BPD, other psychiatric disorders, and no psychiatric conditions (healthy controls) has never been conducted.

Objective:

The aims of this study were to 1) explore differences in interpersonal trust (emotional trust, honesty beliefs, and reliability beliefs) between these three groups, and 2) examine the incremental value of BPD features in association with interpersonal trust over and above internalizing and externalizing.

Method:

Adolescents (N = 445, 67.9% female, M_age = 15.13) recruited from two psychiatric hospitals (psychiatric sample, n = 280) and community organizations (healthy sample, n = 165) completed measures of BPD features, interpersonal trust, and internalizing and externalizing psychopathology. Psychiatric adolescents also completed an interview assessing BPD (n = 83 BPD). ANCOVA and hierarchical linear regression were used for analyses.

Results:

Emotional trust differed significantly across all three groups, with the lowest level of emotional trust in adolescents with BPD. Reliability was also lower in the two psychiatric groups relative to healthy controls. BPD features were significantly, inversely associated with emotional trust and reliability beliefs when controlling for internalizing and externalizing pathology. Post-hoc analyses testing specificity of the three forms of trust found that lower emotional trust predicted BPD diagnosis over and above the other two forms of trust.

Conclusions:

Findings highlight emotional trust as a correlate and important target of intervention for adolescents with BPD, and add to knowledge on interpersonal trust deficits for adolescents with psychiatric disorders more broadly.

Insecure Attachment to Parents and PTSD among Adolescents: The Roles of Parent-Child Communication, Perceived Parental Depression, and Intrusive Rumination

Based on attachment theory and a social-cognitive model of posttraumatic stress disorder (PTSD), this study examined the roles of parent-child communication, perceived parental depression, and intrusive rumination in the association between insecure attachment to parents and PTSD among adolescents following the Jiuzhaigou earthquake. In this study, 620 adolescents were recruited to complete self-report questionnaires. The results showed that the direct association between anxious attachment and PTSD was significant, but that between avoidant attachment and PTSD was non-significant. In addition, both anxious and avoidant attachment had indirect associations with PTSD via the mediating effects of parent-child communication openness and problems, perceived parental depression, and intrusive rumination. However, the specific paths between anxious and avoidant attachment and PTSD were different. The findings indicated that insecure attachment among adolescents following the earthquake was predictive for their PTSD, and the mechanisms underlying the association between anxious attachment and PTSD and the association between avoidant attachment and PTSD were distinct. To alleviate PTSD, more attention should be paid to improving the quality of parent-child communication for adolescents with avoidant attachment to parents, and to reducing negative cognition in adolescents with anxious attachment.

Associations of affective and cognitive empathy with depressive symptoms among a sample of Chinese college freshmen

BACKGROUND

College freshmen are at high risk for mental and socioemotional problems after entering a new environment. However, few investigators have evaluated the associations between empathy and depressive symptoms among college freshmen. The present study examined the presence and associations of affective and cognitive empathy with depressive symptoms among college freshmen in China.

METHODS

In total, 4297 college freshmen completed the Interpersonal Reactivity Index as an assessment of empathy and the University Personality Inventory to evaluate the prevalence of depressive symptoms.

RESULTS

The empathy scores of females were higher than that of males, and approximately 18.4% of freshmen had high-depressive symptoms (HDS). Freshmen with a higher positive component of affective empathy (empathic concern (EC)) experienced fewer HDS. In contrast, freshmen with a higher negative component of affective empathy (personal distress (PD)) and lower cognitive empathy (perspective taking (PT)) experienced more HDS. EC was negatively associated with depressive symptoms, PD was positively related to depressive symptoms, and PT was negatively associated with depressive symptoms. Males with a higher degree of PT experienced fewer HDS, while females with a higher degree of PT experienced more HDS.

CONCLUSION

Affective empathy was positively associated with depressive symptoms, while cognitive empathy was negatively related to depressive symptoms. The association between affective and cognitive empathy with depressive symptoms may add some support to the detection of clinical depressive symptoms. These findings call for the necessity of considering the characteristics of affective and cognitive empathy as a crucial concern in the prevention of depressive symptoms.

Developmental Stage-Specific Effects of Parenting on Adolescents' Emotion Regulation: A Longitudinal Study From Infancy to Late Adolescence

The quality of parenting shapes the development of children's emotion regulation. However, the relative importance of parenting in different developmental stages, indicative of sensitive periods, has rarely been studied. Therefore, we formulated four hypothetical developmental timing models to test the stage-specific effects of mothering and fathering in terms of parental autonomy and intimacy in infancy, middle childhood, and late adolescence on adolescents' emotion regulation. The emotion regulation included reappraisal, suppression, and rumination. We hypothesized that both mothering and fathering in each developmental stage contribute unique effects to adolescents' emotion regulation patterns. The participants were 885 families followed from pregnancy to late adolescence. This preregistered study used data at the children's ages of 1 year, 7 to 8 years, and 18 years. At each measurement point, maternal and paternal autonomy and intimacy were assessed with self- and partner reports using the Subjective Family Picture Test. At the age of 18 years, adolescents' reappraisal and suppression were assessed using the Emotion Regulation Questionnaire and rumination using the Cognitive Emotion Regulation Questionnaire. Stage-specific effects were tested comparing structural equation models. Against our hypotheses, the results showed no effects of mothering or fathering in infancy, middle childhood, or late adolescence on adolescents' emotion regulation patterns. The results were consistent irrespective of both the reporter (i.e., self or partner) and the parental dimension (i.e., autonomy or intimacy). In addition to our main results, there were relatively low agreement between the parents in each other's parenting and descriptive discontinuity of parenting across time (i.e., configural measurement invariance). Overall, we found no support for the stage-specific effects of parent-reported parenting in infancy, middle childhood, or late adolescence on adolescents' emotion regulation. Instead, our findings might reflect the high developmental plasticity of emotion regulation from infancy to late adolescence.

Mediational mechanisms involved in the relation between attachment insecurity and depression: A meta-analysis

BACKGROUND

Several studies have investigated the intermediate variables or mediators through which attachment insecurity influence the development of depression. However, there has not been a systematic synthesis of this literature to date. The current meta-analytic review aimed at identifying such mediators and quantifying their effect size.

METHODS

We systematically searched Medline, Pubmed, Psycinfo, Embase, Proceedings Web of Science and ProQuest Dissertations & Theses Global up until May 2019. 108 studies met inclusion criteria (i.e., investigated intermediate variables that explain the effect of attachment insecurity [exposure] on depressive symptoms [outcome]). Standardized regression coefficients of the indirect and total paths of mediation models of 80 studies were pooled using the inverse of their variance as a weight. Studies were coded and ranked for quality.

RESULTS

Dysfunctional attitudes (β = 0.10, 95% CI = 0.01 to 0.20), self-criticism (β = 0.17, 95% CI = 0.04 to 0.28), low self-compassion (β = 0.16, 95% CI = 0.02 to 0.29), and cognitive hyperactivating regulation strategies (β = 0.13, 95% CI = 0.05 to 0.20), such as repetitive thinking (β = 0.17, 95% CI = 0.07 to 0.28), and particularly, brooding rumination β = 0.20, 95% CI = 0.07 to 0.32), mediated the association between insecure attachment and depressive symptoms. Indirect effects were only significant among adult populations.

LIMITATIONS

The methodological quality of studies was mostly moderate to low and analyses revealed considerable heterogeneity.

CONCLUSION

Our findings support the direct targeting of cognitive-emotional psychological mechanisms in prevention programs and treatment of depression. More longitudinal studies are needed to clarify the interplay of such mediators along with other interpersonal factors between insecure attachment and depression.

Parental attachment, coping, and psychological adjustment among adolescents following an earthquake: a longitudinal study

Background and objective: The study aim was to examine the predictive effect of parental attachment on positive psychological outcomes (posttraumatic growth, PTG) and negative psychological outcomes (posttraumatic stress disorder (PTSD) and depression symptoms), and to test the mediating role of positive and negative coping in the relationship among adolescents following an earthquake in China. Design: The study used a longitudinal design with a 6-month time interval. Method: Data was collected from middle schools in the most severely affected areas at 18 and 24 months following an earthquake. Data were analyzed from 398 adolescents who completed self-report measures of parental attachment, coping, PTSD, depression, and PTG. Path analysis was conducted to examine the relationships among the main study variables. Results: Secure parental attachment predicted lower PTSD and depression symptoms at 24-months follow-up, and negative coping partly mediated the effects of parental attachment on PTSD and depression. No significant association was observed between parental attachment and PTG. Conclusions: The findings indicate that secure parental attachment had a protective effect for adolescents after the disaster. Such attachment may reduce the use of negative coping and in turn decrease psychological distress over time.

The developmental origins of ruminative response style: An integrative review

Rumination has been conceptualized as a stable, trait-level response style involving repetitive and passive focus on the symptoms of distress and the possible causes and consequences of those symptoms. This theoretical review examines developmental risk factors of ruminative response style, incorporating a developmental psychopathology perspective. A model integrating these developmental factors within a conceptual framework is proposed, wherein risk factors for distress (i.e., temperamental negative affectivity, stressful environments, parenting, and genetic vulnerability) lead to engagement in rumination. We propose that when rumination is well-practiced, it will consolidate into a trait-like response style, especially among adolescents who experience cognitive control deficits. Reciprocal relationships and moderators that may contribute to the formation of a ruminative response style are also included. To understand how these factors converge and influence the formation of ruminative response styles, we review patterns of stability and change in physical and cognitive development to demonstrate that individual differences in rumination may emerge and consolidate into enduring, trait-level response styles during early adolescence.

Self-criticism, interpersonal conditions, and biosystemic inflammation in suicidal thoughts and behaviors within mood disorders: A bio-cognitive-interpersonal hypothesis

We review the theoretical and empirical literature on the role of self-concept in suicidal behavior in the context of mood disorders (i.e., unipolar depression and bipolar spectrum disorders). The main themes emanating from this review are then juxtaposed against (a) the Interpersonal-Psychological Theory of Suicide and (b) biological research on the role of inflammatory processes in suicidality. Such a juxtaposition paves the way for a bio-cognitive-interpersonal hypothesis. Pathologies of the self-concept-primarily self-criticism-propel mood disorder sufferers to generate interpersonal stress that culminates in two proximal causes of suicidality: thwarted belongingness and perceived burdensomeness. In turn, these two interpersonal conditions set in motion systemic biosystemic inflammation, serving as a proximal cause for suicidality in mood disorders. We conclude by describing a research project aimed at testing this hypothesis, and by outlining pertinent implications for assessment, treatment, and prevention.

When rumination counts: Perceived social support and heart rate variability in daily life

Rumination and social support could modulate cardiac activity. Although both variables are somehow interrelated, they are often studied independently, and their interplay is seldom considered. We aimed to analyze the interaction of rumination and perceived social support on vagally mediated heart rate variability (HRV) in daily life. The sample consisted of 117 healthy participants (57% female, mean age = 27.9, SD = 5.5 years). Ambulatory HRV (root mean squared successive differences), respiration, body position, and body movements were recorded continuously on three consecutive weekdays. Momentary social, situational, and cognitive-affective variables (affect, ruminative thoughts, perceived social support) were assessed using a computerized diary. There was a significant interaction between momentary rumination and perceived social support on ambulatory HRV: When participants were involved in social interactions with low social support, concurrent rumination was associated with attenuated HRV. However, when rumination was accompanied by a strong sense of support, HRV significantly increased. The quality of social interactions and rumination seem to interact in daily life to predict cardiac autonomic control. The results stress the necessity to consider the interplay of psychological and social factors in order to evaluate beneficial or adverse effects on cardiac health.

Self-evaluative and emotion processes linked with brooding rumination among adolescents

Rumination has been linked with a number of deleterious outcomes, though relatively little is known about self-evaluative and emotion processes by which it develops. The current investigation uses a prospective, longitudinal design and self-report measures to examine the role of contingent self-worth, perfectionism, negative emotion beliefs, and suppression of negative emotion in predicting the development of brooding and reflective forms of rumination among 168 adolescents (98 girls, 79.6% European-American) undergoing the transition to high school (Mage = 13.58). Results of structural equation modeling indicate that self-evaluative vulnerability (i.e., self-worth contingencies, perfectionism) and negative emotion beliefs, but not the suppression of negative emotion, predict brooding (but not reflective) rumination. The current study demonstrates how brooding is intertwined with views of self and core assumptions about emotion.

Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review

BACKGROUND

Attachment theory has been conceptualised as an emotion regulation theory. Research attributes the occurrence of depressive symptoms to a dysfunction of emotion regulation. Anxious attachment and avoidant attachment, which are two dimensions of insecure attachment, are hypothesised to lead to the development of hyperactivating and deactivating emotion regulation strategies.

METHODS

This systematic review examines the literature on the role of emotion regulation and its relationship with attachment and depressive symptomatology. Furthermore, we examined evidence for hyperactivating and deactivating strategies.

RESULTS

Nineteen papers were identified. Adolescent studies demonstrated associations of varying strength and found unreliable and contradictory results for emotion regulation as a mediator. Conversely, adult studies provided strong evidence for emotion regulation as a mediator. The hypothesis that hyperactivating strategies mediate anxious attachment and depressive symptoms was consistently supported. Mixed evidence was provided for deactivating strategies as mediators to avoidant attachment and depressive symptomatology.

LIMITATIONS

Limitations of methodology and quality of studies are identified with particular attention drawn to problems with conceptual singularity and multicollinearity.

CONCLUSIONS

Despite mixed variable findings, this review indicates that emotion regulation is a mediator between attachment and depression. Hyperactivating strategies, in particular, have been consistently noted as mediators for anxious attachment and depressive symptomatology, whereas evidence for deactivating strategies as mediators between avoidant attachment and depressive symptoms has been mixed. Future research should test the mediators of attachment and symptoms and examine theoretically grounded models of psychopathology, such as metacognitive and cognitive models using clinical samples.

Disparities in depressive distress by sexual orientation in emerging adults: the roles of attachment and stress paradigms

Lesbian, gay, and bisexual (BI) youth have elevated rates of depression compared to heterosexuals. We proposed and examined a theoretical model to understand whether attachment and stress paradigms explain disparities in depressive distress by sexual orientation, using the longitudinal Growing Up Today Study (GUTS) and Nurses' Health Study II (NHSII). GUTS participants eligible for this analysis reported sexual orientation, childhood gender nonconforming behaviors (GNBs), attachment to mother (all in 2005), and depressive symptoms (in 2007). Mothers of the GUTS participants who are the NHSII participants reported attitudes toward homosexuality (in 2004) and maternal affection (in 2006). The sample had 6,122 participants. Of GUTS youth (M = 20.6 years old in 2005; 64.4 % female), 1.7 % were lesbian/gay (LG), 1.7 % bisexual (BI), 10.0 % mostly heterosexual (MH), and 86.7 % completely heterosexual (CH). After adjusting for demographic characteristics and sibling clustering, LGs, BIs, and MHs reported more depressive distress than CHs. This relation was partially mediated (i.e., explained) for LGs, BIs, and MHs relative to CHs by less secure attachment. A conditional relation (i.e., interaction) indicated that BIs reported more distress than CHs as GNBs increased for BIs; no comparable relation was found for LGs versus CHs. Sibling comparisons found that sexual minorities (LGs, BIs, and MHs) reported more depressive distress, less secure attachment, and more childhood GNBs than CH siblings; the mothers reported less affection for their sexual-minority than CH offspring. The findings suggest that attachment and childhood gender nonconformity differentially pattern depressive distress by sexual orientation. Attachment and related experiences are more problematic for sexual minorities than for their CH siblings.

Attachment to parents and peers as a risk factor for adolescent depressive disorders: the mediating role of emotion regulation

This study examined emotion regulation as a mediator in the relationship of attachment and depression in adolescents. Participants (N girls = 127; M age = 14.50; N boys = 121; M age = 14.31) completed self-report questionnaires of attachment to parents and peers, emotion regulation and depression. Models with dysfunctional emotion regulation as a mediation variable were tested via hierarchical multiple regression analyses and bootstrapping procedure. Results revealed significant relations between attachment to parents and peers, dysfunctional emotion regulation and depression. For girls, internal-dysfunctional emotion regulation was a mediator in the relation of attachment to parents and depression and partly mediated the association of attachment to peers. For boys, internal- and external-dysfunctional emotion regulation acted as partly mediators in association of attachment to parents and depression. Results indicate important mechanisms that contribute to the refinement of conceptual models and provide indications for gender specific prevention and intervention for depressive disorders.

Peer attachment: a meta-analytic review of gender and age differences and associations with parent attachment

In adolescence, peers represent key actors within individual social network. Given the relevance of peer connections and the growing literature examining them, the purpose of this article was to review, through a meta-analytic approach, studies on adolescent and youth peer relationships within the theoretical framework of attachment. First, we synthesized results of 44 studies focused on relationships between parent and peer attachment. Second, we summarized findings of 54 studies reporting gender differences on peer attachment. Third, we computed an overall effect for age differences on peer attachment documented in 19 studies. Main findings highlighted that parent attachment is moderately correlated to peer attachment; that females were significantly more attached to their peers than males; and that the correlation between age and peer attachment was not significant. This set of findings was confirmed examining both overall peer attachment as well as specific dimensions of attachment, such as trust and communication. Furthermore, since a significant heterogeneity was found across studies, we tested the effects of various categorical (i.e., year and language of publication, country, attachment measure) and continuous (i.e., mean age and percentage of females of the sample, number of items of the peer attachment scale) moderators related to characteristics of the study samples and designs. Implications of these findings for future research are discussed. A focus on cultural dimensions and on peer attachment processes would be worthwhile to address relevant research questions: How do peer relationships progressively become mature attachment relationships? How is this process shaped for individuals with different parent attachment histories?

Strategies and challenges in the management of adolescent depression

PURPOSE OF REVIEW

Adolescent depression is a chronic, pervasive, and disabling problem that is often under-recognized and under-treated. The objective of this article is to review recent (over the past 12-18 months) literature on the management of depression in adolescents, with a particular focus on pharmacological and psychological treatments as well as community and internet-based prevention and treatment programmes.

RECENT FINDINGS

The tendency for depression in young people to be associated with a number of other disorders and behaviours, including anxiety, suicide, conduct disorder and substance abuse, compounds the complexity of management and can contribute to a negative long-term impact on adult mental health. Results of recent randomized controlled trials have reinforced our understanding that the management of moderate-to-severe depression in adolescents should be assertive and prompt, typically including a combination of psychological and pharmacological interventions.

SUMMARY

While the development of novel treatments is evolving, there is an urgent need to focus on defining the optimal use of available therapies and tailoring these to individual presentations, as well as upon improving identification of adolescent depressive disorders in the community.