1
|
Narita Z, Ando S, Yamasaki S, Miyashita M, DeVylder J, Yamaguchi S, Hosozawa M, Nakanishi M, Hiraiwa-Hasegawa M, Furukawa TA, Kasai K, Nishida A. Association of Problematic Internet Use With Psychotic Experiences and Depression in Adolescents: A Cohort Study. Schizophr Bull 2024:sbae089. [PMID: 38825582 DOI: 10.1093/schbul/sbae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND HYPOTHESIS Problematic internet use (PIU) is prevalent among adolescents. Past research suggested cross-sectional associations between PIU and psychotic experiences, but little information is available on the longitudinal association. We hypothesized that PIU in adolescence may be longitudinally associated with psychotic experiences, adjusting for confounders. STUDY DESIGN We analyzed a random sample of adolescents in the Tokyo Teen Cohort to examine how PIU at ages 10 (2012-2015), 12 (2014-2017), and 16 (2019-2021) was associated with mental health issues at age 16. PIU was evaluated by the modified Compulsive Internet Use Scale, psychotic experiences by the Adolescent Psychotic-like Symptom Screener, and depression by the Short Mood and Feelings Questionnaire. We also examined the mediating role of social withdrawal. STUDY RESULTS We analyzed 3171 adolescents; 151 reported psychotic experiences and 327 reported depression at age 16. Compared with the lowest tertile PIU group, the highest tertile PIU group at age 12 showed an increased adjusted risk of psychotic experiences (RD 3.3%, 95% CI 2.9%-3.7%; RR 1.65, 95% CI 1.55-1.73) and depression (RD 5.9%, 95% CI 5.5%-6.3%; RR 1.61, 95% CI 1.55-1.68) at age 16. PIU at age 16 showed analogous results, while PIU at age 10 suggested a smaller impact. Social withdrawal mediated 9.4%-29.0% of the association between PIU and psychotic experiences. CONCLUSIONS PIU is longitudinally associated with psychotic experiences and depression in adolescents. Further longitudinal and intervention studies are warranted to provide robust public health implications and foster a safer digital future.
Collapse
Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shuntaro Ando
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Syudo Yamasaki
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jordan DeVylder
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Silver School of Social Work, New York University, New York, New York City, USA
| | - Satoshi Yamaguchi
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mariko Hosozawa
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Miharu Nakanishi
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN), University of Tokyo Institutes of Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| |
Collapse
|
2
|
Seiffge-Krenke I, Volz M. Effectiveness of psychodynamic treatment: Comparing trajectories of internalizing and externalizing psychopathology of adolescents in treatment, healthy and physically ill adolescents. Dev Psychopathol 2024; 36:478-493. [PMID: 36744527 DOI: 10.1017/s0954579422001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effectiveness of psychodynamic therapy for adolescents in reducing internalizing and externalizing psychopathology was determined by comparing treated adolescents (86 sessions) with the normative developmental progression in two groups without treatment: healthy and diabetic adolescents. In a three-wave longitudinal study, n = 531 adolescents (n = 303 patients, n = 119 healthy, n = 109 diabetics) and their mothers filled out psychopathology questionnaires (Youth Self-Report and Child Behavior Checklist). Latent growth curve modeling and multilevel modeling were used to analyze and compare within-person symptoms changes across groups. Analyses showed a significant reduction over the course of treatment for internalizing (Cohen's d = .90-.92) and externalizing (d = .58-.72) symptoms, also when the developmental progression of both control groups was accounted for (d = .48-.76). Mothers reported lower levels than their children in internalizing symptoms (p ≤ .01) while this discrepancy increased over time for treated adolescents (p = .02). Results established the effectiveness of psychodynamic treatment for adolescents both with externalizing and internalizing symptoms in comparison with growth and change in nonclinical samples. Cross-informant differences and age-specific trajectories require attention in psychotherapy treatment and research.
Collapse
Affiliation(s)
| | - Matthias Volz
- Department of Psychology, University of Kassel, Kassel, Germany
| |
Collapse
|
3
|
Beck A, Dryburgh N, Bennett A, Shaver N, Esmaeilisaraji L, Skidmore B, Patten S, Bragg H, Colman I, Goldfield GS, Nicholls SG, Pajer K, Meeder R, Vasa P, Shea BJ, Brouwers M, Little J, Moher D. Screening for depression in children and adolescents in primary care or non-mental health settings: a systematic review update. Syst Rev 2024; 13:48. [PMID: 38291528 PMCID: PMC10829174 DOI: 10.1186/s13643-023-02447-3] [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: 05/19/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The transition from childhood to adolescence is associated with an increase in rates of some psychiatric disorders, including major depressive disorder, a debilitating mood disorder. The aim of this systematic review is to update the evidence on the benefits and harms of screening for depression in primary care and non-mental health clinic settings among children and adolescents. METHODS This review is an update of a previous systematic review, for which the last search was conducted in 2017. We searched Ovid MEDLINE® ALL, Embase Classic+Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL on November 4, 2019, and updated on February 19, 2021. If no randomized controlled trials were found, we planned to conduct an additional search for non-randomized trials with a comparator group. For non-randomized trials, we applied a non-randomized controlled trial filter and searched the same databases except for Cochrane Central Register of Controlled Trials from January 2015 to February 2021. We also conducted a targeted search of the gray literature for unpublished documents. Title and abstract, and full-text screening were completed independently by pairs of reviewers. RESULTS In this review update, we were unable to find any randomized controlled studies that satisfied our eligibility criteria and evaluated the potential benefits and harms of screening for depression in children and adolescents. Additionally, a search for non-randomized trials yielded no studies that met the inclusion criteria. CONCLUSIONS The findings of this review indicate a lack of available evidence regarding the potential benefits and harms of screening for depression in children and adolescents. This absence of evidence emphasizes the necessity for well-conducted clinical trials to evaluate the effectiveness of depression screening among children and adolescents in primary care and non-mental health clinic settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020150373 .
Collapse
Affiliation(s)
- Andrew Beck
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nicole Dryburgh
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychology, Faculty of Science, McGill University, Montreal, Canada
| | - Alexandria Bennett
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nicole Shaver
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Scott Patten
- Department of Community Health Services and Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Heather Bragg
- Children's Hospital of Eastern Ontario, Out-Patient Mental Health, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary S Goldfield
- Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kathleen Pajer
- Department of Psychiatry, uOttawa Faculty of Medicine Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert Meeder
- Department of Pediatrics, Orillia Soldiers Memorial Hospital, Orillia, Ontario, Canada
| | - Priya Vasa
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Beverley J Shea
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Moher
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Fu YJ, Liu X, Wang XY, Li X, Dai LQ, Ren WY, Zeng YM, Li ZL, Yu RQ. Abnormal volumetric brain morphometry and cerebral blood flow in adolescents with depression. World J Psychiatry 2023; 13:386-396. [PMID: 37383288 PMCID: PMC10294138 DOI: 10.5498/wjp.v13.i6.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Prior research has demonstrated that the brains of adolescents with depression exhibit distinct structural alterations. However, preliminary studies have documented the pathophysiological changes in certain brain regions, such as the cerebellum, highlighting a need for further research to support the current understanding of this disease.
AIM To study brain changes in depressed adolescents.
METHODS This study enrolled 34 adolescents with depression and 34 age-, sex-, and education-level-matched healthy control (HC) individuals. Structural and functional alterations were identified when comparing the brains of these two participant groups through voxel-based morphometry and cerebral blood flow (CBF) analysis, respectively. Associations between identified brain alterations and the severity of depressive symptoms were explored through Pearson correlation analyses.
RESULTS The cerebellum, superior frontal gyrus, cingulate gyrus, pallidum, middle frontal gyrus, angular gyrus, thalamus, precentral gyrus, inferior temporal gyrus, superior temporal gyrus, inferior frontal gyrus, and supplementary motor areas of adolescents with depression showed an increase in brain volume compared to HC individuals. These patients with depression further presented with a pronounced drop in CBF in the left pallidum (group = 98, and peak t = - 4.4324), together with increased CBF in the right percental gyrus (PerCG) (group = 90, and peak t = 4.5382). In addition, 17-item Hamilton Depression Rating Scale scores were significantly correlated with the increased volume in the opercular portion of the left inferior frontal gyrus (r = - 0.5231, P < 0.01).
CONCLUSION The right PerCG showed structural and CBF changes, indicating that research on this part of the brain could offer insight into the pathophysiological causes of impaired cognition.
Collapse
Affiliation(s)
- Yu-Jia Fu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xing-Yu Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Li
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lin-Qi Dai
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wen-yu Ren
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yong-Ming Zeng
- Department of Radiology, Chongqing HongRen Yi Hospital, Chongqing 408400, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Ren-Qiang Yu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
5
|
Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry 2023; 62:479-502. [PMID: 36273673 DOI: 10.1016/j.jaac.2022.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To enhance the quality of care and clinical outcomes for children and adolescents with major depressive disorder (MDD) and persistent depressive disorder (PDD). The aims are as follows: (1) to summarize empirically based guidance about the psychosocial and psychopharmacologic treatment of MDD and PDD in children and adolescents; and (2) to summarize expert-based guidance about the assessment of these disorders as an integral part of treatment, and the implementation of empirically based treatments for these disorders in clinical practice. METHOD Statements about the treatment of MDD and PDD are based upon empirical evidence derived from a critical systematic review of the scientific literature conducted by the Research Triangle Institute International-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center under contract with the Agency for Healthcare Research and Quality (AHRQ). Evidence from meta-analyses published since the AHRQ/RTI-UNC review is also presented to support or refute the AHRQ findings. Guidance about the assessment and clinical implementation of treatments for MDD and PDD is informed by expert opinion and consensus as presented in previously published clinical practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, the DSM-5-TR, and government-affiliated prescription drug information websites. RESULTS Psychotherapy (specifically, cognitive-behavioral and interpersonal therapies) and selective serotonin reuptake inhibitor (SSRI) medication have some rigorous (randomized controlled trials, meta-analyses) empirical support as treatment options. Because effective treatment outcomes are predicated in part upon accuracy of the diagnosis, depth of the clinical formulation, and breadth of the treatment plan, comprehensive, evidence-based assessment may enhance evidence-based treatment outcomes. CONCLUSION Disproportionate to the magnitude of the problem, there are significant limitations in the quality and quantity of rigorous empirical support for the etiology, assessment, and treatment of depression in children and adolescents. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, the demonstration of convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatment of MDD and PDD is a key research need. Other research priorities include the sequencing and comparative effectiveness of depression treatments, delineation of treatment mediators and moderators, effective approaches to treatment nonresponders and disorder relapse/recurrence, long-term effects and degree of suicide risk with SSRI use, and the discovery of novel pharmacologic or interventional treatments.
Collapse
|
6
|
Haley CL, Kennard BD, Morris DW, Bernstein IH, Carmody T, Emslie GJ, Mayes TL, Rush AJ. The Quick Inventory of Depressive Symptomatology, Adolescent Version (QIDS-A 17): A Psychometric Evaluation. Neuropsychiatr Dis Treat 2023; 19:1085-1102. [PMID: 37159676 PMCID: PMC10163898 DOI: 10.2147/ndt.s400591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
Objective The current study aimed to evaluate the psychometric features of the Quick Inventory of Depressive Symptomatology, Adolescent version (QIDS-A17) and the clinician-rated Children's Depression Rating Scale-Revised (CDRS-R). Methods Altogether, 103 outpatients (8 to 17 years) completed the self-report QIDS-A17-SR. Clinician interviews of adolescents (QIDS-A17-C (Adolescent)) and of parents (QIDS-A17-C (Parent)) were combined to create the QIDS-A17-C(Composite) and the CDRS-R. Results All QIDS-A17 measures and the CDRS-R evidenced high total score correlations and internal consistency. Factor analysis found all four measures to be unidimensional. Item Response Theory (IRT) analysis found results that complemented the reliability results found in CTT. All four also demonstrated discriminant diagnostic validity based on logistic regression and ANOVA analyses. Conclusion The psychometric properties of the self-report and composite versions of the QIDS-A17 suggest acceptability as a measure of depression in adolescents either as a measure of depressive symptoms or severity of illness in adolescents. The self-report version may be a helpful tool in busy clinical practices.
Collapse
Affiliation(s)
- Charlotte L Haley
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Children’s Medical Center of Dallas, Dallas, TX, USA
- Correspondence: Betsy D Kennard, University of Texas Southwestern Medical Center, Child Psychiatry, 5323 Harry Hines Blvd, Dallas, TX, 75390-8589, USA, Tel +1 214.645.8680, Fax +1 214.648.3914, Email
| | - David W Morris
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ira H Bernstein
- Department of Psychology, The University of Texas at Arlington, Arlington, TX, USA
| | - Thomas Carmody
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Children’s Medical Center of Dallas, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Department of Psychiatry and Clinical Sciences, Duke-National University of Singapore, Singapore, Singapore
- Department of Psychiatry and Behavioral Sciences, Texas Tech University – Health Sciences Center, Permian Basin, TX, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
7
|
Sadeghi N, Fors PQ, Eisner L, Taigman J, Qi K, Gorham LS, Camp CC, O’Callaghan G, Rodriguez D, McGuire J, Garth EM, Engel C, Davis M, Towbin KE, Stringaris A, Nielson DM. Mood and Behaviors of Adolescents With Depression in a Longitudinal Study Before and During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2022; 61:1341-1350. [PMID: 35452785 PMCID: PMC9015953 DOI: 10.1016/j.jaac.2022.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Accepted: 04/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate whether, compared to pre-pandemic levels, depressive and anxiety symptoms in adolescents with depression increased during the pandemic. METHOD We used data from National Institute of Mental Health Characterization and Treatment of Depression (NIMH CAT-D) cohort, a longitudinal case-control study that started pre-pandemic. Most of the participants are from the states of Maryland and Virginia in the United States. We compared depressive symptoms (1,820 measurements; 519 measurements pre-pandemic and 1,302 during the pandemic) and anxiety symptoms (1,800 measurements; 508 measurements pre-pandemic and 1,292 ratings during the pandemic) of 166 adolescents (109 girls, 96 adolescents with depression) before and during the pandemic. Data were collected during yearly clinical visits, interim 4-month follow-up visits, inpatient stays, and weekly outpatient sessions, with additional data collection during the pandemic. Pre-pandemic, healthy volunteers (HVs) had a median of 1 depressive and anxiety rating (range, 1-3), and adolescents with depression had a median of 2 ratings (anxiety rating range, 1-25; depressive rating range, 1-26). During the pandemic, HVs had a median of 8 anxiety ratings and 9 depressive ratings (range, 1-13), and adolescents with depression had a median of 7 anxiety and depressive ratings (range, 1-29). We also analyzed adolescent- and parent-reported behaviors in the CoRonavIruS Health Impact Survey (CRISIS), totaling 920 self-reported measures for 164 adolescents (112 girls, 92 adolescents with depression). HVs had a median of 7 surveys (range, 1-8), and adolescents with depression had a median of 5 surveys (range, 1-8). RESULTS Pre-pandemic, adolescents with depression had a mean depressive score of 11.16 (95% CI = 10.10, 12.22) and HVs had a mean depressive score of 1.76 (95% CI = 0.40, 3.13), a difference of 9.40 points (95% CI = 7.78, 11.01). During the pandemic, this difference decreased by 22.6% (2.05 points, 95% CI = 0.71, 3.40, p = .003) due to 0.89 points decrease in severity of scores in adolescents with depression (95% CI = 0.08, 1.70, p = .032) and 1.16 points increase in HVs' depressive symptoms (95% CI = 0.10, 2.23, p = .032). Compared to their pre-pandemic levels, adolescents with depression reported overall lower anxiety symptoms during the pandemic. Parent-on-child reports also were consistent with these results. CONCLUSION Contrary to our hypothesis, we found that both depressive and anxiety symptoms were lower for adolescents with depression during the pandemic compared to before. In contrast, the depression scores for the HVs were higher during the pandemic relative to their pre-pandemic ratings; these scores remained much lower than those of adolescents with depression. CLINICAL TRIAL REGISTRATION INFORMATION Characterization and Treatment of Adolescent Depression; https://clinicaltrials.gov/; NCT03388606.
Collapse
Affiliation(s)
- Neda Sadeghi
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland
| | - Payton Q. Fors
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland
| | - Lillian Eisner
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Jeremy Taigman
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Karen Qi
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Lisa S. Gorham
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Medical Scientist Training Program, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Christopher C. Camp
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut
| | - Georgia O’Callaghan
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland
| | - Diana Rodriguez
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Jerry McGuire
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Erin M. Garth
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Autoimmune Brain Disorders Program, National Institute of Mental Health, Bethesda, Maryland
| | - Chana Engel
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Mollie Davis
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Kenneth E. Towbin
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland,Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland; National and Kapodistrain University of Athens, Greece, and University College London, United Kingdom.
| | - Dylan M. Nielson
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, Bethesda, Maryland
| |
Collapse
|
8
|
Rucklidge JJ, Blampied FM, Manna L, Sherwin A, Bagshaw S, Mulder RT, Boden J. Protocol for a randomised placebo-controlled trial investigating the efficacy and safety of a vitamin-mineral formula targeting dysregulated emotions in teenagers: The balancing emotions of adolescents with micronutrients (BEAM) study. Contemp Clin Trials Commun 2022; 30:101027. [PMID: 36340698 PMCID: PMC9634271 DOI: 10.1016/j.conctc.2022.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Emotional dysregulation (ED) is a significant contributing factor to psychological distress in young people. ED is a transdiagnostic dimension characterized by an excessive reactivity to negative emotional stimuli with affective (anger) and behavioral (aggression) components, and is present across anxiety, mood and behavioral disorders. Due to early onset, high prevalence and persistence, ED in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions, with not enough children improving with conventional treatments. Clinical trials have established preliminary efficacy of micronutrients (vitamins and minerals) in the treatment of ED. This project expands the research to examine micronutrient efficacy for teenagers with ED. Methods This study is the first double-blind (participant and investigators) 8 week randomized controlled trial (with 8 week open-label extension and one year follow-up) designed to explore the efficacy and safety of micronutrients compared with placebo in 150 medication-free emotionally dysregulated youth (12–17 years), referred via self-referral, delivered remotely throughout New Zealand, using a website for monitoring symptoms, with a psychologist available online via text, email and video for assessment and monitoring. The primary outcome measures will be the Clinical Global Impression (CGI-I), the reactivity subscale of the Emotion Dysregulation Inventory (EDI) and the Clinician Rated Temper and Irritability Scale (CL-ARI). Discussion Micronutrient intervention delivered alongside online assessment and monitoring has the potential to transform delivery of mental health care to young people who may not be willing or able to access traditional therapies. We also hope that this intervention shows acceptability across different ethnicities.
Collapse
Affiliation(s)
- Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
- Corresponding author. University of Canterbury, Christchurch, New Zealand.
| | | | - Leona Manna
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - Angela Sherwin
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - Sue Bagshaw
- Psychological Medicine, University of Otago, New Zealand
| | | | - Joseph Boden
- Psychological Medicine, University of Otago, New Zealand
| |
Collapse
|
9
|
Gorham LS, Sadeghi N, Eisner L, Taigman J, Haynes K, Qi K, Camp CC, Fors P, Rodriguez D, McGuire J, Garth E, Engel C, Davis M, Towbin K, Stringaris A, Nielson DM. Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling. J Child Psychol Psychiatry 2022; 63:939-947. [PMID: 34847615 PMCID: PMC9541414 DOI: 10.1111/jcpp.13547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi-informant design to examine whether a child's FHD adds information about future depressive episodes and depression severity applying state-of-the-art predictive out-of-sample methodology. METHODS We examined data in adolescents with current or past depression (age 11-17 years) from the National Institute of Mental Health Characterization and Treatment of Adolescent Depression (CAT-D) study. We asked whether a history of depression in a first-degree relative was predictive of depressive episode duration (72 participants) and future depressive symptom severity in probands (129 participants, 1,439 total assessments). RESULTS Family history of depression, while statistically associated with time spent depressed, did not improve predictions of time spent depressed, nor did it improve models of change in depression severity measured by self- or parent-report. CONCLUSIONS Family history of depression does not improve the prediction of the course of depression in adolescents already diagnosed with depression. The difference between statistical association and predictive models highlights the importance of assessing predictive performance when evaluating questions of clinical utility.
Collapse
Affiliation(s)
- Lisa S. Gorham
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Neda Sadeghi
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Lillian Eisner
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Jeremy Taigman
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Katherine Haynes
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Karen Qi
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Christopher C. Camp
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Payton Fors
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Diana Rodriguez
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Jerry McGuire
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Erin Garth
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Chana Engel
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Mollie Davis
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Kenneth Towbin
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Dylan M. Nielson
- Section of Clinical and Computational Psychiatry, Emotion and Development BranchNational Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| |
Collapse
|
10
|
Volz M, Ehrenthal JC, Seiffge-Krenke I. Does clinically relevant psychopathology in adolescents necessarily require treatment or does it "grow out"? Psychother Res 2021; 32:525-538. [PMID: 34132164 DOI: 10.1080/10503307.2021.1939457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To determine the treatment effect of psychodynamic therapy for adolescents in comparison to normative developmental progression in two groups without treatment: healthy adolescents and adolescents with juvenile diabetes. RESEARCH DESIGN AND METHODS In a 3-wave longitudinal study, n = 531 adolescents (n = 303 treated adolescents, n = 119 healthy, n = 109 with diabetes) and their parents filled out psychopathology questionnaires (Youth Self-Report [YSR] and Child Behaviour Checklist [CBCL]). Growth curve modeling (GCM) was used to examine within-person change in psychopathology while controlling for stable between-person differences. RESULTS GCM analyses revealed significant within-person reductions in patients' YSR and CBCL (d = 1.02-1.99) at the end of treatment. When accounted for the control groups' developmental progression (d = .14-.94), patients' within-person change remained significantly higher (d = .48-.82). In all three groups, parents rated the severity of psychopathology significantly lower, and within-person change significantly higher than the adolescents him/herself. CONCLUSIONS Psychodynamic therapy led to a significant symptom reduction in treated adolescents and was superior to development-related symptom changes occurring in the two control groups. Hence, clinically relevant symptoms in adolescents do not "grow out", but require psychotherapeutic treatment. Differences between adolescents and their parents in the evaluation of symptom severity and change require attention in psychotherapy treatment and research.
Collapse
Affiliation(s)
- Matthias Volz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | |
Collapse
|
11
|
Nordqvist SF, Boesen VB, Rasmussen ÅK, Feldt-Rasmussen U, Hegedüs L, Bonnema SJ, Cramon PK, Watt T, Groenvold M, Bjorner JB. Determining minimal important change for the thyroid-related quality of life questionnaire ThyPRO. Endocr Connect 2021; 10:316-324. [PMID: 33617467 PMCID: PMC8052573 DOI: 10.1530/ec-21-0026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE ThyPRO is the standard thyroid patient-reported outcome (PRO). The change in scores that patients perceive as important remains to be ascertained. The purpose of this study was to determine values for minimal important change (MIC) for ThyPRO. METHODS A total of 435 patients treated for benign thyroid diseases completed ThyPRO at baseline and 6 weeks following treatment initiation. At 6 weeks follow-up, patients also completed Global Rating of Change items. For each 0-100 scale, two MIC values were identified: An MIC for groups, using the receiver operating characteristic (ROC) curve method and an MIC for individual patients, using the Reliable Change Index. RESULTS ROC analyses provided group-MIC estimates of 6.3-14.3 (score range 0-100). Evaluation of area under the curve (AUC) supported the robustness for 9 of 14 scales (AUC > 0.7). Reliable Change Index estimates of individual-MIC were 8.0-21.1. For all scales but two, the individual-MIC values were larger than the group-MIC values. CONCLUSIONS Interpretability of ThyPRO was improved by the establishment of MIC values, which was 6.3-14.3 for groups and 8.0-21.1 for individuals. Thus, estimates of which changes are clinically relevant, are now available for future studies. We recommend using MIC values found by ROC analyses to evaluate changes in groups of patients, whereas MIC values identified by a dual criterion, including the reliability of changes, should be used for individual patients, for example, to identify individual responders in clinical studies or practice.
Collapse
Affiliation(s)
- Selma Flora Nordqvist
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Herlev Gentofte Hospital, Copenhagen, Denmark
- Correspondence should be addressed to T Watt:
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
- QualityMetric Incorporated, LLC, Johnston, Rhode Island, USA
| |
Collapse
|
12
|
Liu FF, Lew A, Andes E, McNamara S, Cassidy J, Whitmore S, Plunkett R, Ong T. Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: A quality improvement project. Pediatr Pulmonol 2020; 55:3328-3336. [PMID: 32644305 DOI: 10.1002/ppul.24951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Guidelines to integrate mental health screening (MHS) into Cystic fibrosis (CF) care has increased adoption across the United States and European CF Centers, however, there has been limited discussion on specific strategies for implementation. OBJECTIVE Share key strategies that led to successful MHS implementation in one pediatric CF center and report implementation and screening outcomes. METHODS Parent partners, mental health experts from the Department of Psychiatry, and the CF clinic team codesigned interventions to support three major stakeholders: (a) patients and families (b) clinic team, and (c) hospital system. The mental health coordinator approached patients (12 and older) to introduce MHS and administered screening and reviewed results using an electronic tablet and digital measurement-feedback system. We used strategies that promoted visibility of screening progress and sharing of data with hospital administration. Descriptive statistics were used to assess prevalence of clinically significant symptoms of anxiety and depression and symptom severity within our sample. RESULTS Over the first 2 years of the project, we exceeded our goal of screening 80% of eligible patients per year (80%-95% screened) and are on a similar trajectory within the first 7 months of year 3. We identified high prevalence of clinically significant symptoms of depression (16%) and anxiety (14%) similar to those found in other chronic illness populations. These data helped us advocate hospital leadership to support the development of new mental health services to address identified needs at our center. CONCLUSION Leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
Collapse
Affiliation(s)
- Freda F Liu
- Child and Adolescent Division, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Al Lew
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth Andes
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Sharon McNamara
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Janine Cassidy
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Susan Whitmore
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Rich Plunkett
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Thida Ong
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
13
|
Zima BT. Measurement-based Data to Monitor Quality: Why Specification at the Population Level Matter? Child Adolesc Psychiatr Clin N Am 2020; 29:703-731. [PMID: 32891371 DOI: 10.1016/j.chc.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Measurement-based care is conceptualized as a driver for quality improvement. The triple aim in the National Quality Strategy purposively muddles the population levels to provide a health policy goal that is encompassing, transactional, and will stimulate change. Specification of the population level has implications for the purpose, proposed target mechanisms that drive quality improvement, methodologic challenges, and implications for program evaluation and data interpretation. To demonstrate, population levels are conceptualized at the individual (tier 1), clinical aggregate (tier 2), and national level (tier 3).
Collapse
Affiliation(s)
- Bonnie T Zima
- UCLA-Semel Institute for Neurosciences and Human Behavior, University of California at Los Angeles, UCLA Center for Health Services & Society, 10920 Wilshire Boulevard #300, Los Angeles, CA 90024, USA.
| |
Collapse
|
14
|
Novins DK, Althoff RR, Cortese S, Drury SS, Frazier JA, Henderson SW, McCauley E, White TJH. Editors' Best of 2019. J Am Acad Child Adolesc Psychiatry 2020; 59:8-12. [PMID: 31879011 DOI: 10.1016/j.jaac.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2019 articles that we think deserve your attention or at least a second read.
Collapse
|