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Cheng X, Chen J, Zhang X, Wang T, Sun J, Zhou Y, Yang R, Xiao Y, Chen A, Song Z, Chen P, Yang C, QiuxiaWu, Lin T, Chen Y, Cao L, Wei X. Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts. Eur Child Adolesc Psychiatry 2024; 33:1179-1191. [PMID: 37284850 PMCID: PMC11032277 DOI: 10.1007/s00787-023-02242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.
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Affiliation(s)
- Xiaofang Cheng
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ting Wang
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ruilan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yeyu Xiao
- Guangzhou Integrated Traditional Chinese and Western Medicine, Guangzhou, 510800, Guangdong, People's Republic of China
| | - Amei Chen
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Ziyi Song
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Pinrui Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - QiuxiaWu
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Taifeng Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yingmei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China.
| | - Xinhua Wei
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China.
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Haack LM, Armstrong CC, Travis K, Aguilera A, Darrow SM. HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let's Text!): Pilot Feasibility and Acceptability Study. JMIR Ment Health 2024; 11:e49317. [PMID: 38373030 PMCID: PMC10912989 DOI: 10.2196/49317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts. OBJECTIVE This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes. METHODS Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. RESULTS All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. CONCLUSIONS Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research.
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Affiliation(s)
- Lauren M Haack
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Courtney C Armstrong
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Kate Travis
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Adrian Aguilera
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
| | - Sabrina M Darrow
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
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Nguyen GH, Oh S, Schneider C, Teoh JY, Engstrom M, Santana-Gonzalez C, Porter D, Quevedo K. Neurofeedback and Affect Regulation Circuitry in Depressed and Healthy Adolescents. BIOLOGY 2023; 12:1399. [PMID: 37997998 PMCID: PMC10669603 DOI: 10.3390/biology12111399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
Neurodevelopmental psychopathology seeks to understand higher-order emotion regulation circuitry to develop new therapies for adolescents with depression. Depressed (N = 34) and healthy youth (N = 19) completed neurofeedback (NF) training and exhibited increased bilateral amygdala and hippocampus activity in the region of interest (ROI) analyses by recalling positive autobiographical memories. We tested factors supportive of the engagement of emotion regulation's neural areas during NF (i.e., parental support, medication, and gender effects upon anterior cingulate cortex (ACC) engagement). Whole-brain analyses yielded effects of NF vs. control condition and effects of diagnosis. Youth showed higher amygdala and hippocampus (AMYHIPPO) activity during the NF vs. control condition, particularly in the left hippocampus. ACC's activity was also higher during NF vs. control. Higher average ACC activity was linked to better parental support, absent depression, female gender, and absent medication. Control youth showed higher average AMYHIPPO and ACC activity throughout the task and a faster decline in activity vs. depressed youths. Whole-brain level analyses showed higher activity in the frontotemporal network during the NF vs. control conditions, suggesting targeting their connectivity in future neurofeedback trials.
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Affiliation(s)
- Giang H. Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Sewon Oh
- Department of Psychology, Institute for Mind and Brain, University of South Carolina, Columbia, SC 29208, USA;
| | - Corey Schneider
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Jia Y. Teoh
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Maggie Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Carmen Santana-Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - David Porter
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Karina Quevedo
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
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Xu F, Xie Q, Kuang W, Dong Z. Interactions Between Antidepressants and Intestinal Microbiota. Neurotherapeutics 2023; 20:359-371. [PMID: 36881351 PMCID: PMC10121977 DOI: 10.1007/s13311-023-01362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
The microbiota-gut-brain axis has been shown to influence human health and diseases, including depression. The interactions between drugs and intestinal microbiota are complex and highly relevant to treat diseases. Studies have shown an interaction between antidepressants and intestinal microbiota. Antidepressants may alter the abundance and composition of intestinal microbiota, which are closely related to the treatment outcomes of depression. Intestinal microbiota can influence the metabolism of antidepressants to change their availability (e.g., tryptophan can be metabolized to kynurenine by intestinal microbiota) and regulate their absorption by affecting intestinal permeability. In addition, the permeability of the blood-brain barrier can be altered by intestinal microbiota, influencing antidepressants to reach the central nervous system. Bioaccumulation is also a type of drug-microbiota interaction, which means bacteria accumulate drugs without biotransformation. These findings imply that it is important to consider intestinal microbiota when evaluating antidepressant therapy regimens and that intestinal microbiota can be a potential target for depression treatment.
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Affiliation(s)
- Feiyu Xu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Qinglian Xie
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weihong Kuang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Burgess A, Wahid SS, Ottman K, Kieling C, Mondelli V, Kohrt BA, Fisher HL. Detection of risk for future depression among adolescents: Stakeholder views of acceptability and feasibility in the United Kingdom. Early Interv Psychiatry 2022; 16:1319-1334. [PMID: 35106925 PMCID: PMC10078769 DOI: 10.1111/eip.13278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 01/15/2023]
Abstract
AIM Depression is one of the most common mental illnesses globally and a leading cause of disability. It is often established by late adolescence and thus identifying which adolescents are most at risk is crucial to enable early intervention to prevent depression onset. We have previously developed a risk calculator to stratify which adolescents are at high risk of developing depression and in this study explore the views of stakeholders to ascertain the acceptability and feasibility of implementing such a tool in the UK. METHODS Semi-structured interviews were conducted with 60 UK-based stakeholders (12 healthcare workers, 12 social workers, 12 school workers, 12 policymakers and 12 parents). Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed drawing on framework analysis techniques in NVivo 12. RESULTS Six overarching themes were identified: facilitators of acceptability; barriers to acceptability; role of stakeholders in implementing risk screening; feasibility of delivering the risk calculator in practice; barriers to implementation; and policy and system implications of using it in the current UK health and social care climate. The implementation of a depression risk calculator in the UK was seen as largely acceptable and feasible by most respondents. There was a strong emphasis on the utility of schools to implement this risk calculator, although it was recognized that training and support would be essential. CONCLUSIONS Stakeholders were generally positive about utilizing a tool to screen for risk of future depression among adolescents in the UK but raised important concerns which should be taken into account before implementation.
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Affiliation(s)
- Abigail Burgess
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Department of Psychology and Human Development, UCL Institute of Education, University College London, London, UK
| | - Syed Shabab Wahid
- Division of Global Mental Health, George Washington University, Washington, District of Columbia, USA
| | - Katherine Ottman
- Division of Global Mental Health, George Washington University, Washington, District of Columbia, USA
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington, District of Columbia, USA
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
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Dong Z, Shen X, Hao Y, Li J, Xu H, Yin L, Kuang W. Gut microbiome: A potential indicator for predicting treatment outcomes in major depressive disorder. Front Neurosci 2022; 16:813075. [PMID: 35937875 PMCID: PMC9354493 DOI: 10.3389/fnins.2022.813075] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/27/2022] [Indexed: 12/12/2022] Open
Abstract
The therapeutic outcomes in major depressive disorder (MDD), one of the most common and heterogeneous mental illnesses, are affected by factors that remain unclear and often yield unsatisfactory results. Herein, we characterized the composition and metabolic function of the gut microbiota of patients with MDD during antidepressant treatment, based on 16S rRNA sequencing and metabolomics. The microbial signatures at baseline differed significantly between responder and non-responder groups. The gut microbiota of the non-responder group was mainly characterized by increased relative abundances of the phylum Actinobacteria, families Christensenellaceae and Eggerthellaceae, and genera Adlercreutzia and Christensenellaceae R7 group compared to that of the responder group. Additionally, the gut microbiota composition of the responder and non-responder groups differed significantly before and after treatment, especially at the genus level. Moreover, 20 differential metabolites between the responder and non-responder groups were identified that were mainly involved in lipid metabolism (cholestane steroids and steroid esters). Eggerthellaceae and Adlercreutzia displayed strong co-occurrence relationships with certain metabolites, suggesting alternations in the gut microbiome, and associated metabolites may be potential mediators of successful antidepressant treatment. Overall, our study demonstrates that alterations in gut microbiota composition and metabolic function might be relevant to the response to antidepressants, thereby providing insight into mechanisms responsible for their efficacy.
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Affiliation(s)
- Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
- Department of Psychiatry, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoling Shen
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Yanni Hao
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Jin Li
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Haizhen Xu
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Li Yin
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Weihong Kuang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
- Department of Psychiatry, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weihong Kuang,
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Atoum MH, Al-Rawashdeh S, Al-Hawamdih S, Atoum H, Atoum D, Al Atoum S, Almwajeh A. The psychological distress mediates the relationship between electronic devices use and insomnia in adolescents. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chartier MJ, Bolton JM, Ekuma O, Mota N, Hensel JM, Nie Y, McDougall C. Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:512-523. [PMID: 34796744 PMCID: PMC9234896 DOI: 10.1177/07067437211055417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. METHODS De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. RESULTS Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0-7.6), social housing use (aHR: 1.7; CI 1.4-2.1), income assistance (aHR: 1.8; CI 1.6-2.1), criminal accusation (aHR: 2.2; CI 2.0-2.5), criminal victimization (aHR:2.5; CI 2.2-2.7), and not completing high school (aOR: 3.1; CI: 2.5-3.9). CONCLUSION Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.
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Affiliation(s)
- Mariette J. Chartier
- Department of Community Health
Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Mariette J. Chartier PhD, Manitoba Centre
for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg,
Manitoba, R3E 3P5, Canada.
| | - James M. Bolton
- Department of Psychiatry and Community Health Sciences, Rady Faculty
of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer M. Hensel
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yao Nie
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Chelsey McDougall
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
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9
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Dong Z, Kuang W, Shen X, Tian L. Plasma levels of interleukin-6 and antidepressant response to Paroxetine in Chinese depressive patients. Psychiatry Res 2021; 297:113723. [PMID: 33545432 DOI: 10.1016/j.psychres.2021.113723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
This study aimed to investigate the correlation between interleukin-6 (IL-6) plasma levels and treatment outcomes of selective serotonin reuptake inhibitors in patients with major depressive disorder (MDD). A total of 104 patients (33 males and 71 females), aged 18 to 72 years, were enrolled. Peripheral blood samples were collected before treatment initiation (baseline) and eight weeks after oral paroxetine treatment. The Hamilton Depression Rating Scale (HAMD)-17 was used to evaluate the efficacy of paroxetine. Baseline plasma IL-6 levels were found to be significantly lower in patients who responded to treatment than in non-responders. A negative correlation was found between the HAMD-17 reduction rate and baseline IL-6 levels. Furthermore, associations were examined between HAMD-17 reduction rate in patients and other factors, such as IL-6 levels, sex, age, and body mass index. Baseline IL-6 was the only factor showing a significant impact on the reduction rate of HAMD-17 at week 8. These results suggest that plasma IL-6 level may be a promising biological marker for predicting the likely treatment response to paroxetine in individual patients with MDD.
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Affiliation(s)
- Zaiquan Dong
- Department of Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weihong Kuang
- Department of Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoling Shen
- Department of Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liantian Tian
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
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Lynch FL, Dickerson JF, Rozenman MS, Gonzalez A, Schwartz KTG, Porta G, O’Keeffe-Rosetti M, Brent D, Weersing VR. Cost-effectiveness of Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care. JAMA Netw Open 2021; 4:e211778. [PMID: 33720373 PMCID: PMC7961309 DOI: 10.1001/jamanetworkopen.2021.1778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Youth anxiety and depression are common and undertreated. Pediatric transdiagnostic interventions for anxiety and/or depression may be associated with improved access to treatment among youths. OBJECTIVE To evaluate the cost-effectiveness of a pediatric transdiagnostic brief behavioral therapy (BBT) program for anxiety and/or depression compared with assisted referral to community outpatient mental health care (ARC). DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, an incremental cost-effectiveness analysis was performed from the societal perspective using data from a randomized clinical trial of youths with full or probable diagnoses of anxiety or depression who were recruited from pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania. The trial was conducted from October 6, 2010, through December 5, 2014, and this analysis was performed from January 1, 2019, through October 20, 2020. INTERVENTIONS In the randomized clinical trial, youths were randomized to BBT (n = 95) or ARC (n = 90). The BBT program consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level therapists. Families randomized to ARC received personalized referrals to mental health care and telephone calls to support access to care. MAIN OUTCOMES AND MEASURES Anxiety-free days, depression-free days, quality-adjusted life-years (QALYs), and costs based on incremental cost-effectiveness ratios from intake through 32-week follow-up. A cost-effectiveness acceptability curve for QALYs was used to assess the probability that BBT was cost-effective compared with ARC over a range of amounts that a decision-maker might be willing to pay for an additional outcome. RESULTS Enrolled patients included 185 youths (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] White; and 38 [20.7%] Hispanic). Youths who received BBT experienced significantly more anxiety-free days (difference, 28.63 days; 95% CI, 5.86-50.71 days; P = .01) and QALYs (difference, 0.026; 95% CI, 0.009-0.046; P = .007) compared with youths who received ARC. Youths who received BBT experienced more depression-free days than did youths who received ARC (difference, 10.52 days; 95% CI, -4.50 to 25.76 days; P = .18), but the difference was not statistically significant. The mean incremental cost-effectiveness ratio was -$41 414 per QALY (95% CI, -$220 601 to $11 468). The cost-effectiveness acceptability curve analysis indicated that, at a recommended willingness-to-pay threshold of $50 000 per QALY, the probability that BBT would be cost-effective compared with ARC at 32 weeks was 95.6%. CONCLUSIONS AND RELEVANCE In this economic evaluation, BBT in primary care was significantly associated with better outcomes and a greater probability of cost-effectiveness at 32 weeks compared with ARC. The findings suggest that transdiagnostic BBT may be associated with improved youth anxiety and functioning at a reasonable cost.
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Affiliation(s)
- Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Araceli Gonzalez
- Department of Psychology, California State University of Long Beach, Long Beach
| | | | - Giovanna Porta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego
- Department of Psychology, San Diego State University, San Diego, California
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Toth SL, Handley ED, Manly JT, Sturm R, Adams TR, Demeusy EM, Cicchetti D. The Moderating Role of Child Maltreatment in Treatment Efficacy for Adolescent Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1351-1365. [PMID: 32696103 PMCID: PMC7484366 DOI: 10.1007/s10802-020-00682-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescent girls are at heightened risk of depression, and because adolescent depression may initiate a negative developmental cascade, intervention early in adolescence has potential for altering a negative developmental trajectory. Identifying risk factors that impact response to intervention may inform decisions about the type of treatment to provide for adolescent girls with depression. Understanding moderators of outcomes in evidence-based treatment is critical to the delivery of timely and effective interventions. Matching patients effectively with optimal intervention will not only expedite the alleviation of patients' distress, but will also reduce unnecessary time and resources spent on less advantageous interventions. The current investigation examines the efficacy of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) in a racially and ethnically diverse sample of 120 low-income adolescent girls age 13-15 with and without histories of child maltreatment. Adolescent and parent report of depressive symptoms were assessed at the beginning and end of treatment and a diagnosis of subsyndromal symptoms of depression or depression were required for purposes of inclusion. Results indicated that among adolescent girls who had experienced two or more subtypes of maltreatment, IPT-A was found to be more efficacious than Enhanced Community Standard (ECS) treatment. Importantly, when the subtype of maltreatment experienced was further probed, among girls with a history of sexual abuse, we found preliminary evidence that IPT-A was significantly more effective than ECS in reducing depressive symptoms, and the effect size was large. Thus, if a history of maltreatment is present, especially including sexual abuse, specifically addressing the interpersonal context associated with depressive symptoms may be necessary.
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Affiliation(s)
- Sheree L Toth
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA.
| | - Elizabeth D Handley
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Jody Todd Manly
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Robin Sturm
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Tangeria R Adams
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Elizabeth M Demeusy
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- University of Minnesota, Minneapolis, MN, USA
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Quevedo K, Yuan Teoh J, Engstrom M, Wedan R, Santana-Gonzalez C, Zewde B, Porter D, Cohen Kadosh K. Amygdala Circuitry During Neurofeedback Training and Symptoms' Change in Adolescents With Varying Depression. Front Behav Neurosci 2020; 14:110. [PMID: 32774244 PMCID: PMC7388863 DOI: 10.3389/fnbeh.2020.00110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
Typical adolescents have increased limbic engagement unchecked by regulatory medial prefrontal cortex (PFC) activity as well as heightened self-focus. The resulting emotion dysregulation and self-focused rumination make adolescents more susceptible to depression and suicide attempts. Heightened self-focus converges with mental illness among depressed adolescents, who deploy exaggerated attention to negative self-relevant stimuli and neglect positive ones as part of depression's phenomenology. This results in rigid negative self-representations during an identity formative period with potential lifetime repercussions. Current empirically supported treatments fail to allay recurrent depression. Evidence-based interventions for illnesses linked to suicide ideation and attempts (e.g., depression) underperform across the lifespan. This could be because current treatments are not successful in altering pervasive negative self-representations and affect dysregulation, which is known to be a risk factor of chronic depression. This study departs from the premise that increasing positive self-processing might be protective against chronic depression particularly during adolescence. The present research is a novel investigation of neurofeedback as a potential treatment alternative for adolescent depression. To enhance positive self-processing, we used the happy self-face as a cue to initiate neurofeedback from the bilateral amygdala and hippocampus and adolescents attempted to upregulate that limbic activity through the recall of positive autobiographical memories. We identified limbic functional circuitry engaged during neurofeedback and links to short-term symptoms' change in depression and rumination. We found that depressed youth showed greater right amygdala to right frontocortical connectivity and lower left amygdala to right frontocortical connectivity compared to healthy controls during neurofeedback vs. control conditions. Depressed youth also showed significant symptom reduction. Connectivity between the right amygdala and frontocortical regions was positively correlated with rumination and depression change, but connectivity between frontocortical regions and the left amygdala was negatively correlated with depression change. The results suggest that depressed youth might engage implicit emotion regulation circuitry while healthy youth recruit explicit emotion regulation circuits during neurofeedback. Our findings support a compensatory approach (i.e., target the right amygdala) during future neurofeedback interventions in depressed youth. Future work ought to include a placebo condition or group.
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Affiliation(s)
- Karina Quevedo
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Jia Yuan Teoh
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Maggie Engstrom
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Riley Wedan
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Carmen Santana-Gonzalez
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Betanya Zewde
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - David Porter
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, United States
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Amitai M, Taler M, Ben-Baruch R, Lebow M, Rotkopf R, Apter A, Fennig S, Weizman A, Chen A. Increased circulatory IL-6 during 8-week fluoxetine treatment is a risk factor for suicidal behaviors in youth. Brain Behav Immun 2020; 87:301-308. [PMID: 31887416 DOI: 10.1016/j.bbi.2019.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and/or depression in pediatric populations. However, the response rates are low (approximately 50%). Moreover, SSRI use is frequently associated with adverse events (AE). Currently there are no available biomarkers for treatment response/AE. Identification of biomarkers predicting early response and/or AE could help maximize the benefit-risk ratio for the use of SSRIs, and accelerate matching of treatments to patients. Pro-inflammatory cytokines were proposed as potential biomarkers. METHOD Ninety-two patients (35 boys and 57 girls) with major depressive disorder and/or anxiety disorders, aged 13.90 ± 2.41 years, were treated with fluoxetine (FLX) for 8 weeks. Plasma concentrations of TNFα, IL-6, and IL-1β were measured by enzyme linked immunosorbent assays before and after FLX treatment. Clinical response and AE were measured using several clinical scales, including the Clinical Global Impression - improvement, Children's Depression Rating Scale-Revised, the Beck Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Columbia suicide severity rating scale, and the Suicide Ideation Questionnaire. RESULTS IL-6 levels increased after treatment only in the group of children who developed FLX-associated suicidality. CONCLUSION An increase in IL-6 levels during treatment may be a risk factor for the emergence of FLX-associated suicidality (OR = 1.70). Further studies are necessary to clarify the role and mechanism(s) of this cytokine in the pathogenesis of this life-threatening AE.
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Affiliation(s)
- Maya Amitai
- The Ruhman Family Laboratory for Research on the Neurobiology of Stress, Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany; Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Taler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Reut Ben-Baruch
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Maya Lebow
- The Ruhman Family Laboratory for Research on the Neurobiology of Stress, Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Ron Rotkopf
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach Tikva, Israel; Research Unit, Geha Mental Health Center, Petach Tikva, Israel
| | - Alon Chen
- The Ruhman Family Laboratory for Research on the Neurobiology of Stress, Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany
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Lynch FL, Dickerson JF, Clarke GN, Beardslee WR, Weersing VR, Gladstone TRG, Porta G, Brent DA, Mark TL, DeBar LL, Hollon SD, Garber J. Cost-Effectiveness of Preventing Depression Among At-Risk Youths: Postintervention and 2-Year Follow-Up. Psychiatr Serv 2019; 70:279-286. [PMID: 30929618 PMCID: PMC6897501 DOI: 10.1176/appi.ps.201800144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. METHODS A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. RESULTS Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CONCLUSIONS CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.
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Affiliation(s)
- Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Gregory N Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - William R Beardslee
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - V Robin Weersing
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tracy R G Gladstone
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Giovanna Porta
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - David A Brent
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tami L Mark
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Lynn L DeBar
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Steven D Hollon
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Judy Garber
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
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Hurd D, Herrera M, Brant JM, Coombs NC, Arzubi E. Prospective, Open Trial of Adjunctive Triple Chronotherapy for the Acute Treatment of Depression in Adolescent Inpatients. J Child Adolesc Psychopharmacol 2019; 29:20-27. [PMID: 30388037 DOI: 10.1089/cap.2018.0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this pilot study was to explore the feasibility and proof of concept of triple chronotherapy (TCT) as a nonpharmacological adjunctive treatment in the acute management of depression in the adolescent population. METHODS Thirty-one adolescents with nonpsychotic moderate-to-severe depression were included in the study. The 4-day TCT intervention comprised one night of sleep deprivation followed by 3 days of sleep phase advancement and daily bright light therapy. Primary outcomes were feasibility and depression, as measured by the Hamilton Depression Scale-17 (HAMD-17). Secondary outcomes included severity of illness, anxiety, self-harm, insomnia, and suicidality. RESULTS Twenty-nine (94%) adolescents completed the 4-day TCT intervention. Twenty-six (84%) of the 31 enrolled patients experienced a reduction in depressive symptoms of at least 50% from baseline; 24 (77%) achieved remission, defined as a HAMD-17 score less than 8. The mean depression score was severe before the start of the intervention ( \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\overline X$$ \end{document} = 21.8 ± 3.8) and dropped below the remission threshold by day 4 ( \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\overline X$$ \end{document} = 4.4 ± 5.1; p < 0.001); the mean depression score was mild at 1 week (n = 17; \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\overline X$$ \end{document} = 9.3 ± 5.2; p < 0.001) and 1 month (n = 10, \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\overline X$$ \end{document} = 7.8 ± 5.2; p < 0.001). Severity of illness scores according to the Clinical Global Impressions severity subscale improved from a mean of 5.3 at baseline to 3.1 following the TCT intervention (p < 0.0001); the effect was sustained through the 1-week postdischarge and the 1-month follow-up. Secondary outcomes showed significant improvement following the 4-day TCT intervention; improvement was sustained through the 1-week and 1-month follow-up periods. CONCLUSIONS This pilot study determined TCT to be a feasible, safe, rapid, and potentially effective adjunctive treatment for depression in the adolescent population.
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Affiliation(s)
- Diane Hurd
- 1 Department of Psychiatry, Billings Clinic , Billings, Montana
| | - Mariela Herrera
- 1 Department of Psychiatry, Billings Clinic , Billings, Montana
| | - Jeannine M Brant
- 2 Collaborative Science & Innovation, Billings Clinic , Billings, Montana
| | - Nicholas C Coombs
- 2 Collaborative Science & Innovation, Billings Clinic , Billings, Montana
| | - Eric Arzubi
- 1 Department of Psychiatry, Billings Clinic , Billings, Montana
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Radovic S, Gordon MS, Melvin GA. Should we recommend exercise to adolescents with depressive symptoms? A meta-analysis. J Paediatr Child Health 2017; 53:214-220. [PMID: 28070942 DOI: 10.1111/jpc.13426] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/14/2016] [Accepted: 10/10/2016] [Indexed: 12/11/2022]
Abstract
There is growing interest in the potential role of exercise in the reduction of depressive symptoms. The aim of this meta-analysis was to examine whether exercise reduces depressive symptoms amongst depressed adolescents. The following databases were searched on 30 January 2015: MEDLINE, PsychINFO, SPORTDiscuss and PUBMED. Studies were included if they examined exercise interventions amongst adolescents with clinical levels of depressive symptoms, were published in peer-reviewed journals in the English language and contained a control/comparison group. Of 6631 retrieved studies, eight studies were included in the meta-analysis. Meta-analysis was conducted using a random effects model due to the high level of heterogeneity identified amongst studies ( I 2 = 65.1, P < .005). The analysis revealed a moderate reduction in depressive symptoms post-intervention (Hedge's g = -0.61, P = .007). This analysis provides preliminary evidence that exercise is effective in reducing symptoms of depression among adolescents with clinical levels of depressive symptoms. The present meta-analysis, however, is limited by the generally low quality of included studies, high level of between-study heterogeneity and restriction of inclusion criteria to published studies. Further high-quality trials with depressed adolescents are needed to determine the efficacy of exercise in the reduction of depressive symptoms and the exercise parameters associated with the antidepressant effects of exercise.
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Affiliation(s)
- Sara Radovic
- Centre of Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Melbourne, Victoria, Australia
| | - Michael S Gordon
- Centre of Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Melbourne, Victoria, Australia.,Early in Life Mental Health Services, Monash Health, Melbourne, Victoria, Australia
| | - Glenn A Melvin
- Centre of Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Melbourne, Victoria, Australia
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Lovato N, Short MA, Micic G, Hiller RM, Gradisar M. An investigation of the longitudinal relationship between sleep and depressed mood in developing teens. Nat Sci Sleep 2017; 9:3-10. [PMID: 28243156 PMCID: PMC5315345 DOI: 10.2147/nss.s111521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The prospective, bidirectional relationship between sleep disturbance and depressed mood was assessed in a school-based sample of adolescents. METHOD One hundred and thirty-eight Australian adolescents (mean age time 1 =15.69, standard deviation =0.92; 64% male) completed questionnaires to assess sleep parameters and depressed mood, on two occasions over 1 year. RESULTS Cross-sectional associations were observed between depressed mood and sleep duration, as well as wakefulness in bed. Prospective analyses revealed depressed mood predicted less total sleep time on school nights and a longer latency to sleep onset on weekends 1 year later. There was no prospective support for sleep predicting later depressed mood. CONCLUSION Contrary to prediction, our results suggest in this case that depressed mood may act as a precursor to poor sleep rather than the converse.
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Affiliation(s)
- Nicole Lovato
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Repatriation General Hospital, Flinders University
| | | | - Gorica Micic
- School of Psychology, Flinders University, Adelaide, SA, Australia
| | - Rachel M Hiller
- Department of Psychology, University of Bath, North East Somerset, UK
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, SA, Australia
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19
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20
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Infant sleep interventions – Methodological and conceptual issues. Sleep Med Rev 2016; 29:123-5. [DOI: 10.1016/j.smrv.2015.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 11/24/2022]
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21
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Amitai M, Taler M, Carmel M, Michaelovsky E, Eilat T, Yablonski M, Orpaz N, Chen A, Apter A, Weizman A, Fennig S. The Relationship Between Plasma Cytokine Levels and Response to Selective Serotonin Reuptake Inhibitor Treatment in Children and Adolescents with Depression and/or Anxiety Disorders. J Child Adolesc Psychopharmacol 2016; 26:727-732. [PMID: 26771135 DOI: 10.1089/cap.2015.0147] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In adults there is growing evidence that antidepressant (AD) treatment results in a decline in inflammatory cytokines. This is the first report, to our knowledge, of the relationship between response to selective serotonin reuptake inhibitor (SSRI) treatment for anxiety and/or depression and cytokine levels in children and adolescents. METHODS Forty-one patients who met Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder (MDD) or anxiety disorders participated in study. Their ages ranged from 9 to 18 (14.12 ± 2.30) years. The patients were treated with fluoxetine for 8 weeks. Plasma concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β were measured by enzyme linked immunosorbent assays (ELISA) before and after fluoxetine treatment. Clinical response was measured with several scales, including the Children's Depression Rating Scale-Revised (CDRS-R), the Beck Depression Inventory (BDI), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) Results: The overall response rate was 56%. Antidepressant treatment significantly reduced TNF-α levels (p = 0.037), with no significant changes in the levels of IL-6 and IL-1β. All three proinflammatory cytokines were significantly (p < 0.05) higher in SSRI-refractory than in SSRI-responsive patients. CONCLUSIONS Higher levels of TNF-α, IL-6, and IL-1β might predict nonresponse to fluoxetine treatment in children.
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Affiliation(s)
- Maya Amitai
- 1 Department of Psychological Medicine, Schneider Children's Medical Center of Israel , Petach Tikva, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,3 The Ruhman Family Laboratory for Research on the Neurobiology of Stress, Department of Neurobiology, Weizmann Institute of Science , Rehovot, Israel
| | - Michal Taler
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Felsenstein Medical Research Center , Petach Tikva, Israel
| | - Miri Carmel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Felsenstein Medical Research Center , Petach Tikva, Israel
| | - Elena Michaelovsky
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Felsenstein Medical Research Center , Petach Tikva, Israel
| | - Tamar Eilat
- 1 Department of Psychological Medicine, Schneider Children's Medical Center of Israel , Petach Tikva, Israel
| | - Maya Yablonski
- 5 The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University , Ramat-Gan, Israel
| | - Naama Orpaz
- 6 Schneider Children's Medical Center of Israel , Petach Tikva, Israel
| | - Alon Chen
- 3 The Ruhman Family Laboratory for Research on the Neurobiology of Stress, Department of Neurobiology, Weizmann Institute of Science , Rehovot, Israel .,7 Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry , Munich, Germany
| | - Alan Apter
- 1 Department of Psychological Medicine, Schneider Children's Medical Center of Israel , Petach Tikva, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Abraham Weizman
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Felsenstein Medical Research Center , Petach Tikva, Israel .,8 Research Unit, Geha Mental Health Center , Petach Tikva, Israel
| | - Silvana Fennig
- 1 Department of Psychological Medicine, Schneider Children's Medical Center of Israel , Petach Tikva, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Cullen KR, Klimes-Dougan B, Vu DP, Westlund Schreiner M, Mueller BA, Eberly LE, Camchong J, Westervelt A, Lim KO. Neural Correlates of Antidepressant Treatment Response in Adolescents with Major Depressive Disorder. J Child Adolesc Psychopharmacol 2016; 26:705-712. [PMID: 27159204 PMCID: PMC5069704 DOI: 10.1089/cap.2015.0232] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The neural changes underlying response to antidepressant treatment in adolescents are unknown. Identification of neural change correlates of treatment response could (1) aid in understanding mechanisms of depression and its treatment and (2) serve as target biomarkers for future research. METHOD Using functional magnetic resonance imaging, we examined changes in brain activation and functional connectivity in 13 unmedicated adolescents with major depressive disorder (MDD) before and after receiving treatment with a selective serotonin reuptake inhibitor medication for 8 weeks. Specifically, we examined brain activation during a negative emotion task and resting-state functional connectivity (RSFC), focusing on the amygdala to capture networks relevant to negative emotion. We conducted whole-brain analyses to identify how symptom improvement was related to change in brain activation during a negative emotion task or amygdala RSFC. RESULTS After treatment, clinical improvement was associated with decreased task activation in rostral and subgenual anterior cingulate cortex and increased activation in bilateral insula, bilateral middle frontal cortices, right parahippocampus, and left cerebellum. Analysis of change in amygdala RSFC showed that treatment response was associated with increased amygdala RSFC with right frontal cortex, but decreased amygdala RSFC with right precuneus and right posterior cingulate cortex. CONCLUSION The findings represent a foothold for advancing understanding of pathophysiology of MDD in adolescents by revealing the critical neural circuitry changes that underlie a positive response to a standard treatment. Although preliminary, the present study provides a research platform for future work needed to confirm these biomarkers at a larger scale before using them in future target engagement studies of novel treatments.
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Affiliation(s)
- Kathryn R. Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Bryon A. Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Lynn E. Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jazmin Camchong
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Ana Westervelt
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Kelvin O. Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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Ellis S, Wakefield C, Antill G, Burns M, Patterson P. Supporting children facing a parent's cancer diagnosis: a systematic review of children's psychosocial needs and existing interventions. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12432] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S.J. Ellis
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - C.E. Wakefield
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Cancer Institute of NSW; Alexandria NSW Australia
| | | | - M. Burns
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - P. Patterson
- Research, Evaluation and Social Policy; CanTeen Australia; Sydney NSW Australia
- Faculty of Nursing; Sydney Medical School; University of Sydney; Sydney NSW Australia
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Platt B, Murphy SE, Lau JYF. The association between negative attention biases and symptoms of depression in a community sample of adolescents. PeerJ 2015; 3:e1372. [PMID: 26539335 PMCID: PMC4631462 DOI: 10.7717/peerj.1372] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/13/2015] [Indexed: 11/22/2022] Open
Abstract
Adolescence is a vulnerable time for the onset of depression. Recent evidence from adult studies suggests not only that negative attention biases are correlated with symptoms of depression, but that reducing negative attention biases through training can in turn reduce symptomology. The role and plasticity of attention biases in adolescent depression, however, remains unclear. This study examines the association between symptoms of depression and attention biases, and whether such biases are modifiable, in a community sample of adolescents. We report data from 105 adolescents aged 13–17 who completed a dot-probe measure of attention bias before and after a single session of visual search-based cognitive bias modification training. This is the first study to find a significant association between negative attention biases and increased symptoms of depression in a community sample of adolescents. Contrary to expectations, we were unable to manipulate attention biases using a previously successful cognitive bias modification task. There were no significant effects of the training on positive affect and only modest effects of the training, identified in post-hoc analyses, were observed on negative affect. Our data replicate those from the adult literature, which suggest that adolescent depression is a disorder associated with negative attention biases, although we were unable to modify attention biases in our study. We identify numerous parameters of our methodology which may explain these null training effects, and which could be addressed in future cognitive bias modification studies of adolescent depression.
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Affiliation(s)
- Belinda Platt
- Department of Experimental Psychology, University of Oxford , Oxford , United Kingdom ; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilian-University of Munich , Munich , Germany
| | - Susannah E Murphy
- Oxford Centre for Human Brain Activity, University of Oxford , Oxford , United Kingdom
| | - Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford , Oxford , United Kingdom ; Department of Psychology, Institute of Psychiatry, Kings College London , London , United Kingdom
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Simon AE, Pastor PN, Reuben CA, Huang LN, Goldstrom ID. Use of Mental Health Services by Children Ages Six to 11 With Emotional or Behavioral Difficulties. Psychiatr Serv 2015; 66:930-7. [PMID: 25975889 PMCID: PMC4654459 DOI: 10.1176/appi.ps.201400342] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors reported use of mental health services among children in the United States between ages six and 11 who were described by their parents as having emotional or behavioral difficulties (EBDs). METHODS Using data from the 2010-2012 National Health Interview Survey, the authors estimated the national percentage of children ages six to 11 with serious or minor EBDs (N=2,500) who received treatment for their difficulties, including only mental health services other than medication (psychosocial services), only medication, both psychosocial services and medication, and neither type of service. They calculated the percentage of children who received school-based and non-school-based psychosocial services in 2011-2012 and who had unmet need for psychosocial services in 2010-2012. RESULTS In 2010-2012, 5.8% of U.S. children ages six to 11 had serious EBDs and 17.3% had minor EBDs. Among children with EBDs, 17.8% were receiving both medication and psychosocial services, 28.8% psychosocial services only, 6.8% medication only, and 46.6% neither medication nor psychosocial services. Among children with EBDs in 2011-2012, 18.6% received school-based psychosocial services only, 11.4% non-school-based psychosocial services only, and 17.3% both school- and non-school-based psychosocial services. In 2010-2012, 8.2% of children with EBDs had unmet need for psychosocial services. CONCLUSIONS School-age children with EBDs received a range of mental health services, but nearly half received neither medication nor psychosocial services. School-based providers played a role in delivering psychosocial services, but parents reported an unmet need for psychosocial services among some children.
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Affiliation(s)
- Alan E Simon
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Patricia N Pastor
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Cynthia A Reuben
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Larke N Huang
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Ingrid D Goldstrom
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
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Abstract
More than 36,000 people in the United States die from suicide annually, and suicide is the third leading cause of death in adolescence. Adolescence is a time of high risk for suicidal behavior, as well as a time that intervention and treatment may have the greatest impact because of structural brain changes and significant psychosocial development during this period. Functional and structural neuroimaging studies in adults who have attempted suicide suggest distinct gray matter volume abnormalities in cortical regions, as well as prefrontal cortical and dorsal anterior cingulate gyrus neural circuitry differences compared with affective and healthy adult controls. Recent functional neuroimaging studies in adolescents with a history of suicide attempt suggest differences in the attention and salience networks compared with adolescents with depression and no history of suicide attempt and healthy controls when viewing angry faces. In contrast, no abnormalities are seen in these areas in the absence of emotional stimuli. These networks may represent promising targets for future neuroimaging studies to identify markers of risk for future suicide attempt in adolescents.
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Tavitian LR, Ladouceur CD, Nahas Z, Khater B, Brent DA, Maalouf FT. Neutral face distractors differentiate performance between depressed and healthy adolescents during an emotional working memory task. Eur Child Adolesc Psychiatry 2014; 23:659-67. [PMID: 24248754 DOI: 10.1007/s00787-013-0492-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/26/2013] [Indexed: 11/24/2022]
Abstract
The aim of the present study is to examine the effect of neutral and emotional facial expressions on voluntary attentional control using a working memory (WM) task in adolescents with major depressive disorder (MDD). We administered the Emotional Face n-back (EFNBACK) task, a visual WM task with neutral, happy and angry faces as distractors to 22 adolescents with MDD (mean age 15.7 years) and 21 healthy controls (HC) (mean age 14.7 years). There was a significant group by distractor type interaction (p = 0.045) for mean percent accuracy rates. Group comparisons showed that MDD youth were less accurate on neutral trials than HC (p = 0.027). The two groups did not differ on angry, happy and blank trials (p > 0.05). Reaction time did not differ across groups. In addition, when comparing the differences between accuracies on neutral trials and each of the happy and angry trials, respectively [(HAP-NEUT) and (ANG-NEUT)], there was a group effect on (HAP-NEUT) where the difference was larger in MDD than HC (p = 0.009) but not on ANG-NEUT (p > 0.05). Findings were independent of memory load. Findings indicate that attentional control to neutral faces is impaired and negatively affected performance on a WM task in adolescents with MDD. Such an impact of neutral faces on attentional control in MDD may be at the core of the social-cognitive impairment observed in this population.
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Affiliation(s)
- Lucy R Tavitian
- Department of Cross Cultural Psychology, Tilburg University, Tilburg, The Netherlands
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28
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Lovato N, Gradisar M. A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice. Sleep Med Rev 2014; 18:521-9. [PMID: 24857255 DOI: 10.1016/j.smrv.2014.03.006] [Citation(s) in RCA: 343] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this review was to quantify the strength of evidence for a directional relationship between sleep disturbance and depression in adolescents. A literature search was conducted to identify research investigating the relationship between sleep disturbance and depression in adolescent samples (12-20 y). Twenty-three studies were identified; 13 explored associations between depression and sleep disturbance; seven examined the prospective role of sleep disturbance in the development of depression; and three investigated the role of adolescent depression in the development of subsequent sleep disturbance. Average weighted mean differences in sleep/depression-related outcome variables were calculated between adolescents with depression, and non-clinical adolescents, or those in remission. Adolescents with depression experienced significantly more wakefulness in bed (sleep onset latency, wake after sleep onset, number of awakenings and sleep efficiency), lighter sleep (more stage 1), and reported more subjective sleep disturbance. Overall effect sizes from longitudinal and treatment studies suggest sleep disturbance acts as a precursor to the development of depression. At follow-up, depressed adolescents had significantly longer sleep onset, more wake after sleep onset, and lower sleep efficiency compared to adolescents who were non-clinical, or had undergone remission. Little support was found for a predictive role of depressive symptoms in the development of sleep disturbance. Based on these findings we propose a model to understand the development of depression from initial sleep disturbance, provide recommendations for clinicians and recommendations for future research.
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Affiliation(s)
- Nicole Lovato
- School of Psychology, Flinders University, Adelaide, SA, Australia.
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, SA, Australia
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Asarnow JR, Miranda J. Improving care for depression and suicide risk in adolescents: innovative strategies for bringing treatments to community settings. Annu Rev Clin Psychol 2014; 10:275-303. [PMID: 24437432 PMCID: PMC4295487 DOI: 10.1146/annurev-clinpsy-032813-153742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reviews the literature on interventions and services for depression and suicide prevention among adolescents, with the goals of placing this science within the context of currently changing health care environments and highlighting innovative models for improving health and mental health. We examine the challenges and opportunities offered by new initiatives and legislation designed to transform the US health and mental health care systems; summarize knowledge regarding the treatment of depression and suicidality/self-harm in adolescents; and describe innovative models for partnering with health systems and communities. This review demonstrates that treatment models and service delivery strategies are currently available for increasing evidence-based care, particularly for depression, and concludes with recommendations for future research and quality improvement initiatives aimed at inspiring additional efforts to put science to work, bridge science and community practice, and develop strategies for partnering with communities to improve care, mental health, and well-being among adolescents.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095; ,
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Parker G. Teenage depression: some navigational points for parents and professionals. World Psychiatry 2013; 12:272-4. [PMID: 24096795 PMCID: PMC3799260 DOI: 10.1002/wps.20059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales and Black Dog Institute, Prince of Wales Hospital; Randwick NSW; 2031; Sydney; Australia
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Platt B, Cohen Kadosh K, Lau JYF. The role of peer rejection in adolescent depression. Depress Anxiety 2013; 30:809-21. [PMID: 23596129 DOI: 10.1002/da.22120] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
Adolescence is a period of major risk for depression, which is associated with negative personal, social, and educational outcomes. Yet, in comparison to adult models of depression, very little is known about the specific psychosocial stressors that contribute to adolescent depression, and whether these can be targeted by interventions. In this review, we consider the role of peer rejection. First, we present a comprehensive review of studies using innovative experimental paradigms to understand the role of peer rejection in adolescent depression. We show how reciprocal relationships between peer rejection and depressive symptoms across adolescence powerfully shape and maintain maladaptive trajectories. Second, we consider how cognitive biases and their neurobiological substrates may explain why some adolescents are more vulnerable to the effects of, and perhaps exposure to, peer rejection compared to others. Finally, we draw attention to emerging cognitive and functional magnetic resonance imaging-based neurofeedback training, which by modifying aspects of information processing may promote more adaptive responses to peer rejection. A better understanding of the mechanisms underlying adolescent depression may not only alleviate symptoms during a period of substantial developmental challenges, but may also reduce the burden of the disorder across the lifespan.
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Affiliation(s)
- Belinda Platt
- Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford, United Kingdom.
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Edwards E, Mischoulon D, Rapaport M, Stussman B, Weber W. Building an evidence base in complementary and integrative healthcare for child and adolescent psychiatry. Child Adolesc Psychiatr Clin N Am 2013; 22:509-29, vii. [PMID: 23806317 PMCID: PMC3775487 DOI: 10.1016/j.chc.2013.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Complementary and integrative strategies are widely used by families with children who have mental health diagnoses. The therapies used by these children include herbs, dietary supplements, massage, acupuncture, meditation, and naturopathy. The literature on efficacy of complementary and alternative approaches is of limited value, and studies are needed to test efficacy and safety. Interpretation of complementary and integrative health care studies for symptomatic management of mental health conditions is hampered by study design and methodological limitations. Well-designed, adequately powered, and suitably controlled clinical trials on promising complementary and integrative modalities are needed for children and adolescents with psychiatric conditions.
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Affiliation(s)
- Emmeline Edwards
- Division of Extramural Research, National Center for Complementary and Alternative Medicine, National Institutes of Health, 6707 Democracy Boulevard, Suite 401, Bethesda, MD 20892, USA.
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Rocha TBM, Zeni CP, Caetano SC, Kieling C. Mood disorders in childhood and adolescence. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35 Suppl 1:S22-31. [DOI: 10.1590/1516-4446-2013-s106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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