Heterogeneous trajectories of depressive symptoms: adolescent predictors and adult outcomes

Psychosocial profiles and blood pressure control: results from the multi-ethnic study of atherosclerosis (MESA)

Growing research shows psychosocial factors are associated with blood pressure (BP) control among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BP control remains unknown. To characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BP control over 14 years. We included 2,665 MESA participants with prevalent hypertension in 2002-2004. Nine psychosocial variables representing individual, interpersonal, and neighborhood factors were included. BP control was achieved if systolic blood pressure (SBP)  < 140 mmHg and diastolic blood pressure (DBP) < 9090 mmHg. Latent profile analysis (LPA) revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) "Healthy", "Psychosocially Distressed" and "Discriminated Against". Overall, there were no significant differences in systolic and diastolic BP control combined, across the profiles. Participants in the "Discriminated Against" profile group were significantly less likely [OR= 0.60; 95% CI: 0.43, 0.84] to have their DBP < 9090 mmHg as compared to the "Healthy" profile, but this was attenuated with full covariate adjustment. Discrete psychosocial profiles exist among individuals with hypertension but were not associated with BP control after full covariate adjustment.

Trajectories of depressive symptoms in early to mid-adolescence: associations with school pedagogical and social climate

AIMS

Adolescence is a critical period for mental health development, yet research exploring how contextual factors influence the development of depressive symptoms remains limited. This study explored trajectories of depressive symptoms during early to mid-adolescence and their association with various aspects of school climate.

METHODS

The study sample comprised 3671, 7th-grade students (aged 12-13 years) from 101 schools across Sweden, followed longitudinally across three time points spanning grades 7, 8 and 9. Depressive symptom trajectories were identified using latent class growth modelling. The Pedagogical and Social Climate questionnaire assessed school climate, and multinomial logistic regression was employed to predict trajectory membership based on sociodemographic and school climate factors.

RESULTS

Four distinct developmental patterns of depressive symptoms emerged: 'Sustained low symptoms' (76.7%), 'Low-increasing' (10.9%), 'Sustained high symptoms' (7.9%), and 'High-decreasing' (4.5%). Gender, parental education and six specific school climate factors, out of the total 19 examined, significantly distinguished these trajectory classes. Positive teacher expectations and strong principal involvement were associated with more favourable trajectories, whereas teaching activities, teacher support and communication between school and home were associated with less favourable trajectories, suggesting a nuanced understanding of their relationship with depressive symptom trajectories.

CONCLUSIONS

Few school factors were found to be relevant to depressive symptoms, highlighting the importance of considering external factors beyond the school environment in supporting adolescents during this developmental stage. Although the findings are multifaceted, it is primarily positive interpersonal relationships, especially through teacher expectations, that stand out as significant factors in promoting youth mental health.

Immunometabolic Blood Biomarkers of Developmental Trajectories of Depressive Symptoms: Findings From the ALSPAC Birth Cohort

Studies of longitudinal trends of depressive symptoms in young people could provide insight into aetiologic mechanism, heterogeneity and origin of common cardiometabolic comorbidities for depression. Depression is associated with immunological and metabolic alterations, but immunometabolic characteristics of developmental trajectories of depressive symptoms remain unclear. Using depressive symptoms scores measured on 10 occasions between ages 10 and 25 years in the Avon Longitudinal Study of Parents and Children (n=7302), we identified four distinct trajectories: low-stable (70% of the sample), adolescent-limited (13%), adulthood-onset (10%) and adolescent-persistent (7%). We examined associations of these trajectories with: i) anthropometric, cardiometabolic and psychiatric phenotypes using multivariable regression (n=1709-3410); ii) 67 blood immunological proteins and 57 metabolomic features using empirical Bayes moderated linear models (n=2059 and n=2240 respectively); and iii) 28 blood cell counts and biochemical measures using multivariable regression (n=2256). Relative to the low-stable group, risk of depression and anxiety in adulthood was higher for all other groups, especially in the adolescent-persistent (ORdepression=22.80, 95% CI 15.25-34.37; ORGAD=19.32, 95% CI 12.86-29.22) and adulthood-onset (ORdepression=7.68, 95% CI 5.31-11.17; ORGAD=5.39, 95% CI 3.65-7.94) groups. The three depression-related trajectories vary in their immunometabolic profile, with evidence of little or no alterations in the adolescent-limited group. The adulthood-onset group shows widespread classical immunometabolic changes (e.g., increased immune cell counts and insulin resistance), while the adolescent-persistent group is characterised by higher BMI both in childhood and adulthood with few other immunometabolic changes. These findings point to distinct mechanisms and intervention opportunities for adverse cardiometabolic profile in different groups of young people with depression.

Parenting practices and trajectories of proactive coping assets among emerging adult Black men

Positive youth development (PYD) frameworks suggest that a critical response to investigating the challenges young Black men living in resource poor communities experience involves identifying contextual resources in young men's lives and personal assets that promote success. The following study examines heterogeneity in proactive coping assets trajectories, parental practices as predictors of developmental trajectories, and associated outcomes of each trajectory. The study sample consisted of Black emerging adult men living in rural Georgia (N = 504). At baseline, men were between the ages of 19 and 22 (Mage = 20.29; SD = 1.10). At wave four, the participants' mean age was 27.67 (SD = 1.39). Results of growth mixture modeling from waves 1 to 3 discerned three developmental trajectory classes of emerging adults' proactive coping assets: a high and increasing class (n = 247, 49%), a low and stable class (n = 212, 42%), and a moderate and decreasing class (n = 45, 9%). Trajectory classes were linked to baseline levels of parental support, coaching, and expectations. Analysis revealed that parental support and parental coaching predicted proactive coping asset trajectory class identification. Links were then investigated between emerging adults' proactive coping asset trajectory classes and wave four physical health, depression, and alcohol use. Results revealed significant associations between class identification, alcohol use, and physical health. Study findings provide evidence supporting the impact of parenting on emerging adult Black men, underscoring the need to expand resources that support parenting and emerging adult relationships.

A prospective longitudinal study of multidomain resilience among youths with and without maltreatment histories

The majority of children with maltreatment histories do not go on to develop depression in their adolescent and adult years. These individuals are often identified as being "resilient", but this characterization may conceal difficulties that individuals with maltreatment histories might face in their interpersonal relationships, substance use, physical health, and/or socioeconomic outcomes in their later lives. This study examined how adolescents with maltreatment histories who exhibit low levels of depression function in other domains during their adult years. Longitudinal trajectories of depression (across ages 13-32) in individuals with (n = 3,809) and without (n = 8,249) maltreatment histories were modeled in the National Longitudinal Study of Adolescent to Adult Health. The same "Low," "increasing," and "declining" depression trajectories in both individuals with and without maltreatment histories were identified. Youths with maltreatment histories in the "low" depression trajectory reported lower romantic relationship satisfaction, more exposure to intimate partner and sexual violence, more alcohol abuse/dependency, and poorer general physical health compared to individuals without maltreatment histories in the same "low" depression trajectory in adulthood. Findings add further caution against labeling individuals as "resilient" based on a just single domain of functioning (low depression), as childhood maltreatment has harmful effects on a broad spectrum of functional domains.

Active labour market policies in emerging adulthood may act as a protective factor against future depressiveness: an analysis of the long-term trajectories of depressive symptoms in the Northern Swedish Cohort

Introduction

Drawing upon the framework of life course epidemiology, this study aligns with research on the mental health consequences of significant social transitions during early adulthood. The focus is on the variation in initial labour market attachment and the development of depressiveness, assuming that a firm attachment is associated with decreasing depressiveness.

Methods

The baseline investigation of the studied cohort (n = 1,001) took place during their final year of compulsory schooling at age 16. Follow-up surveys were conducted at ages 18, 21, 30, and 43. Depressiveness was measured with a five-item score. Multiple trajectory analysis, incorporating five labour market statuses observed over seven half-year periods from ages 18 to 21, was employed to categorize the cohort into six distinct groups. Among these, 'All-time education,' 'From education to employment,' 'Education and employment,' and 'From employment to education' were considered to demonstrate firm labour market attachment. Meanwhile, 'Active labour market policy' and 'Unemployment' represented less firm attachment.

Results

The trajectory of depressive symptoms among the total cohort from age 16 to age 43 exhibited a 'broken stick' pattern, reaching its lowest point at age 21. This pattern was evident in all groups classified as having a firm attachment. A substantial decrease in depressiveness was also observed in the relatively weakly attached 'Active labour market policy' group, whereas no 'broken stick' pattern emerged in the 'Unemployment' group. The disparities in the levels of depressiveness observed at age 21 remained relatively stable across the measurements at ages 30 and 43.

Discussion

The results were as expected, except for the observed improvement in mental health within the 'Active labour market policy' group. Supported labour market attachment during emerging adulthood can enhance mental well-being similarly to regular mainstream attachment. In terms of policy recommendations, the consistently high levels of depressiveness within the 'Unemployment' group underscore the importance of reducing long-term and repeated unemployment in young age. The findings regarding the 'Active labour market policy' provide evidence of the intervention's benefits. While the primary goal of these measures is to create jobs for the unemployed, they also include elements that contribute to participants' mental health.

Adolescent Depression Symptom Trajectories Detected Via Universal Screening in Pediatric Primary Care

Unique trajectories of adolescent depression symptoms have been identified, yet less is known about whether such patterns translate to real-world clinical settings. Because annual adolescent depression screening is becoming more prevalent in primary care, we examined whether longitudinal patterns of depression symptoms documented in the developmental psychopathology literature can also be detected via routine screening in primary care and explored how membership in the identified trajectories varied based on concurrent suicide risk and sociodemographic factors. A total of 1,359 adolescents aged 12-16 years old at the first timepoint were included in the current analyses. These adolescents completed three depression screeners during their well-visits in a large pediatric primary care network between November 15, 2017 and February 1, 2020. Retrospective electronic health record data were extracted, including sociodemographic variables and depression screening results. Dynamic functional time series clustering results indicated the optimal number of clusters was five. The five depression symptom trajectories were: (1) A-Shaped (i.e., relatively low depression symptoms at Time 1, a substantial increase in symptoms at Time 2, and a return to low symptoms at Time 3), (2) Increasing, (3) Low-Stable, (4) High-Decreasing, and (5) Low-Decreasing. Cluster differences in suicide risk largely mapped onto depression symptom levels at each assessment. We found cluster differences based on practice location, insurance type, and adolescent race. The symptom trajectories observed in this study resemble those found in the developmental psychopathology literature, though some key differences were noted. Findings can inform future research and symptom monitoring in primary care.

Longitudinal Associations Between Pet Relationship Quality and Socio-Emotional Functioning in Early Adolescence

Adolescence is a key developmental period for socio-emotional skills, and companion animal relationships may be one potential source of emotional support and resilience during this time. This study used longitudinal data from 940 pet-owning adolescents, collected over four time points, from youth in the Northeastern United States. We assessed whether pet relationship quality (indexed by relationship satisfaction, companionship, and emotional disclosure) predicted trajectories of loneliness, social anxiety, and depression. Results indicated that high satisfaction with a pet relationship was associated with more favorable trajectories, but companionship (i.e., regarding frequency of interacting with the pet) was not related significantly to socio-emotional functioning. High levels of disclosure to a pet were linked with less favorable trajectories for loneliness and depression, but not related to social anxiety. These results suggest that a pet relationship can, in some cases, be associated positively with socio-emotional development, but that there is significant complexity in these associations. Families, educators, and practitioners should take a nuanced approach to understanding individual adolescent-pet relationships as a contextual asset for specific youth.

Using a longitudinal network structure to subgroup depressive symptoms among adolescents

BACKGROUND

Network modeling has been proposed as an effective approach to examine complex associations among antecedents, mediators and symptoms. This study aimed to investigate whether the severity of depressive symptoms affects the multivariate relationships among symptoms and mediating factors over a 2-year longitudinal follow-up.

METHODS

We recruited a school-based cohort of 1480 primary and secondary school students over four semesters from January 2020 to December 2021. The participants (n = 1145) were assessed at four time points (ages 10-13 years old at baseline). Based on a cut-off score of 5 on the 9-item Patient Health Questionnaire at each time point, the participants were categorized into the non-depressive symptom (NDS) and depressive symptom (DS) groups. We conducted network analysis to investigate the symptom-to-symptom influences in these two groups over time.

RESULTS

The global network metrics did not differ statistically between the NDS and DS groups at four time points. However, network connection strength varied with symptom severity. The edge weights between learning anxiety and social anxiety were prominently in the NDS group over time. The central factors for NDS and DS were oversensitivity and impulsivity (3 out of 4 time points), respectively. Moreover, both node strength and closeness were stable over time in both groups.

CONCLUSIONS

Our study suggests that interrelationships among symptoms and contributing factors are generally stable in adolescents, but a higher severity of depressive symptoms may lead to increased stability in these relationships.

Emotion Regulation Predicts Depressive Symptoms in Adolescents: A Prospective Study

Emotion regulation as a proximal factor has been linked with depressive symptoms. However, studies have mainly focused on a limited number of strategies and have mostly been cross-sectional in design. This is particularly evident when examining the protective effects of adaptive strategies. This study aimed to investigate the prospective relationship between putatively adaptive and maladaptive emotion regulation strategies and depressive symptoms among adolescents. Additionally, a person-oriented approach was applied to identify latent classes of adolescents based on their depressive symptoms and compared these classes in terms of their adaptive and maladaptive strategies. Two waves of data from a prospective study, which included 1371 youth (mean age: 15.66 years; SD = 0.49 years; 55.1% girls), were analysed. The two points of data collection were spaced approximately half a year apart. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale, and putatively adaptive and maladaptive emotion regulation strategies were assessed with the Cognitive Emotion Regulation Questionnaire. Seven strategies (acceptance, positive refocusing, positive reappraisal, putting into perspective, self-blame, rumination, and catastrophizing) were categorised into adaptive and maladaptive factors using exploratory structural equation modeling. After controlling for gender, age, and depressive symptoms at Time 1, both maladaptive and adaptive emotion regulation strategies at Time 1 predicted depressive symptoms at Time 2. Three subgroups emerged based on the intensity of depressive symptoms across the waves: the stable low, stable moderate, and stable high depressive symptom groups. The use of maladaptive emotion regulation strategies (such as rumination, self-blame, and catastrophizing) at Time 1 was more pronounced in the stable moderate and high symptom groups compared to the stable low depressive symptom group. The comparable prospective associations between putatively adaptive and maladaptive strategies with symptoms suggest the need to identify factors that may mitigate the negative impact of maladaptive emotion regulation and/or promote adaptive emotion regulation to buffer the effects of everyday stressors.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents

INTRODUCTION

Early adolescence represents a time of heightened vulnerability for depression. Negative interpretation biases have been associated with increases in depressive symptoms during this developmental period; however, the mechanisms underlying the association between interpretation biases and depression remain poorly understood. Cognitive theories posit that interpretation biases give rise to depression by modulating daily affect, particularly in the context of stress. However, this has not yet been directly examined. The present study tested affect intensity and instability as mechanisms linking negative interpretation biases with change in adolescent depressive symptoms.

METHODS

Ninety-four adolescents (aged 11-13 years; 51% boys) from Vancouver, Canada, were recruited for this longitudinal study. At baseline (Time 1), participants self-reported depressive symptoms and completed the Scrambled Sentences Task to assess negative interpretation biases. Next, participants completed daily diaries to assess positive affect (PA) and negative affect (NA) during a naturalistic stressor-the first 2 weeks of high school (Time 2). Finally, participants self-reported depressive symptoms 3 months later (Time 3). Path models were conducted to test whether PA and NA intensity and instability mediated prospective associations between negative interpretation biases and depressive symptom changes.

RESULTS

Although NA intensity, NA instability, and PA instability predicted increases in depressive symptoms, only NA intensity mediated associations between interpretation biases and symptom changes. Neither PA intensity nor instability mediated these associations.

CONCLUSIONS

Elevated daily NA represents a specific mechanism through which stronger negative interpretation biases predict increases in depressive symptoms in adolescence.

Dynamic risk for first onset of depressive disorders in adolescence: does change matter?

BACKGROUND

Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The 'Risk Escalation hypothesis' posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the 'Chronic Risk hypothesis' posits that the average level rather than change predicts first-onset DD.

METHODS

We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5-15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset.

RESULTS

Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors.

CONCLUSIONS

Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study

INTRODUCTION

This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan.

METHODS

Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis.

RESULTS

A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support.

CONCLUSIONS

The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

Prediction of depressive symptoms onset and long-term trajectories in home-based older adults using machine learning techniques

OBJECTIVES

Our aim was to explore the possibility of using machine learning (ML) in predicting the onset and trajectories of depressive symptom in home-based older adults over a 7-year period.

METHODS

Depressive symptom data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2650) recruited in the China Health and Retirement Longitudinal Study (CHARLS) were included in the current analysis. The latent class growth modeling (LCGM) and growth mixture modeling (GMM) were used to classify different trajectory classes. Based on the identified trajectory patterns, three ML classification algorithms (i.e. gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUC).

RESULTS

Four trajectories were identified for the depressive symptoms: no symptoms (63.9%), depressive symptoms onset {incident increasing symptoms [new-onset increasing (16.8%)], chronic symptoms [slowly decreasing (12.5%), persistent high (6.8%)]}. Among the analyzed baseline variables, the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score, cognition, sleep time, self-reported memory were the top five important predictors across all trajectories. The mean AUCs of the three predictive models had a range from 0.661 to 0.892.

CONCLUSIONS

ML techniques can be robust in predicting depressive symptom onset and trajectories over a 7-year period with easily accessible sociodemographic and health information.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2031868.

A hybrid machine learning model of depression estimation in home-based older adults: a 7-year follow-up study

BACKGROUND

Our aim was to explore whether a two-step hybrid machine learning model has the potential to discover the onset of depression in home-based older adults.

METHODS

Depression data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2,548) recruited in the China Health and Retirement Longitudinal Study were included in the current analysis. The long short-term memory network (LSTM) was applied to identify the risk factors of participants in 2015 utilizing the first 2 waves of data. Based on the identified predictors, three ML classification algorithms (i.e., gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUROC) to estimate the depressive outcome.

RESULTS

Time-varying predictors of the depression were successfully identified by LSTM (mean squared error =0.8). The mean AUCs of the three predictive models had a range from 0.703 to 0.749. Among the prediction variables, self-reported health status, cognition, sleep time, self-reported memory and ADL (activities of daily living) disorder were the top five important variables.

CONCLUSIONS

A two-step hybrid model based on "LSTM+ML" framework can be robust in predicting depression over a 5-year period with easily accessible sociodemographic and health information.

Factors associated with symptom severity in Canadian youth with mental health and/or addictions concerns accessing service navigation

This study investigated the factors associated with clinical symptoms and level of functioning at baseline and after 4 months of navigation, in youth with mental health and/or addiction concerns involved with a family navigation service. Participants in this pre-post study were caregivers who accessed a mental health and addictions navigation service between March 2018 and July 2019 on behalf of their youth aged 13-26 who had mental health and/or addiction concerns. Evaluations were conducted at baseline and at 4 months after entering navigation. The dependent variable, youth mental health symptoms and functioning, was assessed by caregivers using the Symptoms and Functioning Severity Scale. The sample included 345 caregivers of youth (youth: mean age 18 years, 57% male). At intake, using multiple linear regression, caregiver strain (β = 0.481, p < 0.001), youth completion of ADLs (β = -0.156, p = 0.002) and youth motivation (β = -0.110, p = 0.021) contributed significantly to variance in symptoms and functioning (R²  = 0.373, p < 0.001). Using ANOVA to compare complete pre/post data (n = 115), there was a significant main effect of time on the youth symptoms and functioning score (F[1, 107] = 9.278, p = 0.003). Furthermore, the interaction of time, youth completion of ADLs (low vs. high at baseline) and youth motivation (low vs. high at baseline) was significant (F[1, 107] = 4.699, p = 0.032). Youth with low motivation and low completion of ADLs at baseline experienced the largest improvements in symptoms and functioning after 4 months of navigation. These findings suggest that this group of youth should be a primary target in mental health and addiction navigation.

Current Evidence and Theories in Understanding the Relationship between Cognition and Depression in Childhood and Adolescence: A Narrative Review

The present narrative review has covered the current evidence regarding the role of cognitive impairments during the early phase of major depressive disorder (MDD), attempting to describe the cognitive features in childhood, adolescence and in at-risk individuals. These issues were analyzed considering the trait, scar and state hypotheses of MDD by examining the cold and hot dimensions, the latter explained in relation to the current psychological theoretical models of MDD. This search was performed on several electronic databases up to August 2022. Although the present review is the first to have analyzed both cold and hot cognitive impairments considering the trait, scar and state hypotheses, we found that current evidence did not allow to exclusively confirm the validity of one specific hypothesis since several equivocal and discordant results have been proposed in childhood and adolescence samples. Further studies are needed to better characterize possible cognitive dysfunctions assessing more systematically the impairments of cold, hot and social cognition domains and their possible interaction in a developmental perspective. An increased knowledge on these topics will improve the definition of clinical endophenotypes of enhanced risk to progression to MDD and, to hypothesize preventive and therapeutic strategies to reduce negative influences on psychosocial functioning and well-being.

The role of family and peer factors in the development of early adolescent depressive symptoms: A latent class growth analysis

Few studies have explored the trajectories of Chinese early adolescent depressive symptoms or comprehensively considered the factors of family and peers. The present study aimed to identify the trajectories of depressive symptoms in early adolescence using a school-based sample assessed in three waves. The study also examined whether family and peer factors were significant predictors. A total of 586 Chinese primary and middle school students participated in the survey. A growth mixture model was used to find the trajectories of depressive symptoms, and multinominal logistic regression was used to identify the predictors. Three trajectories were identified, including a stable-low class, an increasing class, and a high-decreasing class. Results indicated that gender, parental psychological aggression and neglect, parental psychological control, traditional bullying/cyberbullying victimization, and friendship quality were significant predictors. However, witnessing intimate partner violence, parental behavior control, and traditional bullying/cyberbullying perpetration could not significantly predict the trajectories. The findings of this study can provide an empirical basis for teachers and clinical interveners to determine different development trajectories of depressive symptoms and carry out prevention and intervention.

Prediction of the trajectories of depressive symptoms among children in the adolescent brain cognitive development (ABCD) study using machine learning approach

BACKGROUND

Depression often first emerges during adolescence and evidence shows that the long-term patterns of depressive symptoms over time are heterogeneous. It is meaningful to predict the trajectory of depressive symptoms in adolescents to find early intervention targets.

METHODS

Based on the Adolescent Brain Cognitive Development Study, we included 4962 participants aged 9-10 who were followed-up for 2 years. Trajectories of depressive symptoms were identified by Latent Class Growth Analyses (LCGA). Four types of machine learning models were built to predict the identified trajectories and to obtain variables with predictive value based on the best performance model.

RESULTS

Of all participants, 536 (10.80%) were classified as increasing, 269 (5.42%) as persistently high, 433 (8.73%) as decreasing, and 3724 (75.05%) as persistently low by LCGA. Gradient Boosting Machine (GBM) model got the highest discriminant performance. Sleep quality, parental emotional state and family financial adversities were the most important predictors and three resting state functional magnetic resonance imaging functional connectivity data were also helpful to distinguish trajectories.

LIMITATION

We only have depressive symptom scores at three time points. Some valuable predictors are not specific to depression. External validation is an important next step. These predictors should not be interpreted as etiology and some variables were reported by parents/caregivers.

CONCLUSION

Using GBM combined with baseline characteristics, the trajectories of depressive symptoms with two years among adolescents aged 9-10 years can be well predicted, which might further facilitate the identification of adolescents at high risk of depressive symptoms and development of effective early interventions.

Trajectories of Substance Use and Well-being in Early and Middle Adolescence Shaped by Social Connectedness

Increasing substance use and decreasing well-being are typical in adolescence, yet how social contexts shape disparate development during this time is less well-understood. A latent growth class analysis was conducted that identified groups of early (N = 706; Age_m  = 12.20) and middle (N = 666; Age_m  = 14.38) adolescents distinguished by rates of substance use and well-being over three years. In both cohorts, the largest group reported low substance use and high well-being, with a smaller group exhibiting maladaptive trajectories for both substance use and well-being. Two additional groups were identified during middle adolescence characterized by either low well-being or high substance use. Family connectedness was a protective factor, while high peer connectedness was a risk factor for substance-use groups and low peer connectedness for languishing.

Pathways linking attachment and depressive symptoms for Black and White adolescents: do race and neighborhood racism matter?

Decades of evidence demonstrate that insecure attachment is associated with increased risk for depressive symptoms. Yet research has focused on predominantly White samples, with little attention to whether developmental pathways vary by social-contextual factors like racial identity and neighborhood racism. This study examines whether longitudinal links between attachment style and depressive symptoms differ for White and Black American adolescents or by exposure to neighborhood racism (N = 171, Mage at Time 1 = 14 years). Multigroup measured variable path analyses controlling for gender and household income revealed that attachment avoidance predicted relative increases in depressive symptoms for White adolescents, but not for Black adolescents. Links between attachment style and depressive symptoms did not differ based on exposure to neighborhood racism. Experiences of neighborhood racism were associated with greater attachment avoidance but not anxiety. Results highlight the importance of examining attachment in different socioecological contexts to illuminate the unique pathways characterizing Black youth development.

Developmental Trajectory of Depressive Symptoms in Chinese College Students: Latent Classes and Gender Effect

Depressive symptoms are prevalent in Chinese college students, but little is known about the heterogeneity in the developmental trajectory of depressive symptoms in China. This study examined heterogeneity in the development of depressive symptoms and examined the effect of gender on the developmental trajectories over a 14-month period among Chinese college students (N = 1163, mean age 20.18, 80.31% female). Three different trajectories, moderate-increasing, high-stable and low-stable, captured the heterogeneity in the development of depressive symptoms. Gender showed significant influence on class membership. Relative to the moderate-increasing class, males emerged as significantly more likely than females to be found in the low-stable class (odds ratio (OR) = 2.73, 95% CI = (1.21, 6.13), p = 0.015) and the high-stable class (OR = 5.10, 95% CI = (1.12, 23.18), p = 0.035). The results provide additional evidence for the conclusion that the trajectories of depressive symptoms are heterogeneous with Chinese samples. Moreover, cultural difference should be paid more attention to when examining the effect of gender and other predictors of the trajectories of depressive symptoms.

Depressive symptom trajectories and polygenic risk scores in individuals with an immune-mediated inflammatory disease

OBJECTIVE

To develop group-based trajectories of depressive symptoms in immune-mediated inflammatory disease (IMID) to understand their evolution and identify any associated factors, with the overall goal of identifying those at highest risk of higher depressive symptom burden.

METHOD

922 participants had an IMID or anxiety/depression. The PHQ-9 was administered at four visits, and polygenic risk scores (PRS) for major depressive disorder, depressive symptoms, and body mass index (BMI) were generated. Group-based trajectory modelling of PHQ-9 scores estimated distinct trajectories. Regression tested whether specific factors were associated with the trajectories. Mediation analyses assessed whether IMID mediated the association between BMI PRS and trajectories.

RESULTS

Three trajectories were identified. Regression demonstrated those in Group 3 ('high symptoms') had significantly higher PRS for the three traits, compared to Group 1 ('minimal symptoms') (OR: 1.34-1.66, P < 0.01). Stratified analyses in the IMID subgroup revealed an increased effect for BMI PRS in Group 3 (OR: 2.31, P < 0.001), in contrast, BMI PRS was no longer associated in the non-IMID sample. No significant indirect effect of BMI PRS on depressive symptoms trajectories was identified via IMID.

CONCLUSIONS

A significant association between polygenicity and PHQ-9 trajectories supports a role for genetic inheritance in the variability in depressive symptoms in IMID.

Psychopathological symptoms as precursors of depressive symptoms in adolescence: a prospective analysis of the GINIplus and LISA birth cohort studies

INTRODUCTION

Depressive symptoms are highly prevalent in adolescence, highlighting the need for early identification of precursors. Research into psychopathological symptoms predicting depressive psychopathology in adolescents is therefore of great relevance. Moreover, given that the prevalence of depressive symptomatology in adolescence shows marked differences between girls and boys, insight into potential sex-specific differences in precursors is important.

METHODS

This study examined the relationships between emotional problems, conduct problems, hyperactivity/inattention, peer problems, and difficulties in prosocial behaviour at age 10 (Strengths and Difficulties Questionnaire), and the presence of depressive symptoms at age 15 (Depression Screener for Teenagers). Using data from 2824 participants of the GINIplus and LISA birth cohorts, the association of each SDQ subscale at age 10 years with the presence of depressive symptoms at age 15 years was analyzed using sex-specific logistic regression, adjusting for potential confounders.

RESULTS

Emotional problems [odds ratio (OR) 1.99, p = 0.002 for boys and OR 1.77, p < 0.001 for girls] and peer problems (OR 2.62, p < 0.001 for boys, OR 1.91, p = 0.001 for girls) at age 10 showed an increased risk for the presence of depressive symptoms at age 15. Additionally, boys with conduct problems at age 10 were at greater risk of showing depressive symptoms in adolescence (OR 2.50, p < 0.001).

DISCUSSION

Based on the identified prospective relationships in our study, it might be of particular importance to tailor prevention approaches during childhood to peer and emotional problems to reduce the risk of depressive psychopathology in adolescence. Moreover, particularly in boys, it seems important to also target conduct problems in childhood as a precursor of depressive symptoms in the adolescent period.

Perceived causal symptom network of adolescent mental health issues

Adolescent mental health is difficult to capture in categories such as depression or specific anxiety disorders. An alternative is to approach psychiatric symptoms as causal networks, potentially revealing feedback loops that maintain a pathological state. One approach to creating such networks, implemented in the PECAN methodology, is to ask adolescents about their perceptions of the causes to their symptoms. For this purpose, a transdiagnostic item list was created, and adolescents who screened positive for depression (N = 55) completed twice in two weeks a survey quantifying perceptions of causality between their mental health problems. A network that was averaged across all participants was reliable and revealed three strong feedback loops: a first loop running through stress, insomnia, fatigue, procrastination, and back to stress; a second loop between stress and overthinking; and a third loop between stress and procrastination. Although all adolescents in the study screened positive for depression, symptoms of depression were not particularly central to the network. Instead, the most central symptoms were procrastination and overthinking. The average test-retest reliability for individual networks was low, limiting clinical application. In conclusion, PECAN was found to be reliable and useful when creating a group-level network of adolescent mental health problems. While informative at a group level, the method should be improved before it can be used to inform treatment at the individual level.

Adolescent Context and Depressive Symptom Trajectories in a National Sample: Ages 13 to 34

Background

Group-based trajectory analyses of depressive symptoms are often conducted with convenience samples, over limited developmental periods, or with a limited set of predictors in the adolescent context. Examinations of protective and risk factors in robust national samples are needed.

Aim

Using an ecological approach, this study's purpose is to identify key relational and contextual factors associated with trajectory groups of depressive symptoms that span ages 13 to 34.

Method

12,248 respondents in the National Study of Adolescent to Adult Health (Waves 1, 3, and 4) were analyzed with a group-based, cohort sequential design to identify trajectory classes, shapes, and adolescent (i.e., Wave 1) risk and protective factors for depressive symptom trajectories.

Results

A four-class quadratic solution was identified. Close attachment to parents was strongly associated with decreased odds of membership on elevated trajectories. No relationship with a mother or father was associated with better mental health than a poor relationship with that parent. Peer support, teacher support, and educational achievement were highly protective. Romantic relationships, increased number of sexual partners, and prayer were modestly associated with higher depressive symptom burden. Pregnancy was associated with increased burden later in life relative to the teenage years.

Conclusions

Assessing adolescent family, school, peer, and religious contexts indicates several protective and risk factors for depressive symptoms that are persistent over time.

Maternal and paternal depression and child mental health trajectories: evidence from the Avon Longitudinal Study of Parents and Children

BACKGROUND

The relationships between offspring depression profiles across adolescence and different timings of parental depression during the perinatal period remain unknown.

AIMS

To explore different timings of maternal and paternal perinatal depression in relation to patterns of change in offspring depressive mood over a 14 year period.

METHOD

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Parental antenatal depression (ANTD) was assessed at 18 weeks gestation, and postnatal depression (PNTD) at 8 weeks postpartum. Population-averaged trajectories of offspring depressive symptoms were estimated using the Short Mood and Feelings Questionnaire (SMFQ) on nine occasions between 10 and 24 years of age.

RESULTS

Full data were available for 5029 individuals. Offspring exposed to both timings of maternal depression had higher depressive symptoms across adolescence compared with offspring not exposed to ANTD or PNTD, characterised by higher depressive symptoms at age 16 (7.07 SMFQ points (95% CI = 6.19, 7.95; P < 0.001)) and a greater rate of linear change (0.698 SMFQ points (95% CI = 0.47, 0.93; P = 0.002)). Isolated maternal ANTD and to a lesser extent PNTD were also both associated with higher depressive symptoms at age 16, yet isolated maternal PNTD showed greater evidence for an increased rate of linear change across adolescence. A similar pattern was observed for paternal ANTD and PNTD, although effect sizes were attenuated.

CONCLUSIONS

This study adds to the literature demonstrating that exposure to two timings of maternal depression (ANTD and PNTD) is strongly associated with greater offspring trajectories of depressive symptoms.

Profile of the Change in Depression during Proton-Pump Inhibitor Therapy in Patients with Gastroesophageal Reflux Disease: Influence of the Mucosal Break

Given the frequent concomitance between depression and gastroesophageal reflux disease (GERD), it is important to evaluate the change of depression in patients with GERD, especially considering the presence of esophageal mucosal breaks (MB). This study aimed to examine the change in the levels of depression in patients with GERD during proton-pump inhibitors (PPI) therapy. We designed a prospective cohort study to explore the profile of the alteration in depression with respect to the impact of esophageal MB. This study recruited 172 eligible patients with GERD between February 2016 and May 2018. The change in depression was defined as the difference between the respective Taiwanese Depression Questionnaire (TDQ) scores obtained at baseline and after PPI therapy. Multivariate linear regression models were used to estimate the factors associated with the change in depression. The results revealed statistically significant improvements in the TDQ score (mean score: baseline = 13.2, after PPI therapy = 10.9, p < 0.01, Cohen’s d = 0.30) during PPI therapy for GERD. Moreover, the MB was an independent variable associated with changes in the TDQ score [B = 3.31, 95% confidence interval (CI): (1.12, 5.51), p < 0.01] and the improvement in depression [odds ratio = 0.38, 95% CI: (0.17, 0.86), p = 0.02]. Our findings revealed that depressive symptoms improved slightly following PPI therapy. Moreover, MB was an unfavorable prognostic factor for the improvement in depression.

A meta-analysis of the relationship between early maladaptive schemas and depression in adolescence and young adulthood

Early maladaptive schemas (EMS) are broad, pervasive themes and patterns of emotions, memories, cognition and physical sensations that impede the goal of individuals. Maladaptive behaviours can occur as a response to maladaptive or negative schemas, often culminating in depression or anxiety. The current meta-analysis integrates the existing literature to estimate the magnitude of effect of association between EMS and depression among adolescents and young adults. A systematic search of seven different databases including Embase, CINAHL, Medline, ASSIA, Psych INFO, Scopus and Web of Science was carried out identifying 24 relevant studies of adolescents (10-18 years) and young adults (19-29 years). The random-effect model estimate for association between overall EMS and depression was r = 0.56 (95% CI 0.49-0.63, Z = 12.88, p ≤ 0.0001), suggesting higher predominant EMS significantly linked to higher levels of depressive symptoms, with a large effect size. Separate meta-analytical results with schema domains indicated moderately stronger associations between schemas of disconnection/rejection, impaired autonomy/performance and other-directedness with depression. Age and gender were not found to have any significant moderating effect on the associations. The findings suggest that it is vital for clinicians to identify specific maladaptive schemas contributing towards depression, to have a better understanding of underlying cognitive processes and in turn promote psychological health, well-being and resilience in adolescents and young adults. Furthermore, findings will also assist clinicians to focus more on the content of three significant schema domains, which emerged as particularly salient factors underlying adolescent depression.

The Impact of Academic Achievement and Parental Practices on Depressive Symptom Trajectories Among Chinese Adolescents

Though depressive symptoms tend to increase in early adolescence, the trajectories of these symptoms may vary strongly. This longitudinal study investigated the extent to which the distinct developmental trajectories of depressive symptoms were predicted by adolescents' academic achievement and perceived parental practices in a sample of Chinese young adolescents (N = 2,576). The results showed four trajectory profiles of depressive symptoms: low-stable (75%), low-increasing (11%), high-stable (9%), and high-decreasing (5%). Adolescents with high academic achievement were more likely to be classified into the low-stable, low-increasing, and high-decreasing profiles than into the high-stable depressive symptom profile. Moreover, students who perceived greater parental autonomy support were more likely to be in the low-stable and low-increasing profiles than the high-stable profile, whereas adolescents perceiving more parental psychological control had higher odds of being in the low-increasing rather than the low-stable profile. Parental educational involvement was unrelated to students' depressive symptom trajectories. In sum, Chinese adolescents with higher academic achievement and who perceived more parental autonomy support, and less psychological control, were at lower risk of experiencing depressive symptoms.

Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment

Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.

Longitudinal course of depressive symptom severity among youths with bipolar disorders: Moderating influences of sustained attention and history of child maltreatment

BACKGROUND

Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms.

METHODS

This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years).

RESULTS

A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths.

LIMITATIONS

Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths.

CONCLUSIONS

Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.

Can a Commercial Video Game Prevent Depression? Null Results and Whole Sample Action Mechanisms in a Randomized Controlled Trial

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy — on which depression prevention programs are based — may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, M_age = 17.11, SD_age = 1.76, 66.4% female) were given 4 weeks to play Journey (M_duration = 3 h 20 min) or the control game, Flower (M_duration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth’s change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

Trajectories of depressive symptoms through adolescence and young adulthood: social and health outcomes

Depressive symptoms display heterogeneous trajectories across adolescence, which can lead to different consequences. This study aimed to identify trajectories of depressive symptoms from adolescence to young adulthood, assessing the association with social and health outcomes at young adulthood. Adolescents born in 1990, enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) completed the Beck Depression Inventory II (BDI-II) at 13, 17 and 21 years. Mixed models and model-based clustering were used to describe the trajectories in the BDI-II score (n = 2010). Outcomes were assessed at age 21 years with self-administered questionnaires and face-to-face interviews (n = 1594). Odds ratios or regression coefficients, with 95% confidence intervals, were estimated using logistic and linear regression. Three trajectory classes of depressive symptoms were identified, similar in shape in both sexes: High (8.4%), Moderate (31.3%) and Low (60.2%). Participants in High or Moderate classes were more likely to describe lower scores of community involvement, more medical appointments during the last year, higher levels of pain and had higher probability of self-rating health as "good" or "fair or poor". Females in the High and Moderate classes were more likely to be current smokers, to describe ever using drugs and to report more sexual partners, emergency room visits and the use of antidepressants. The risk of depressive symptoms in adulthood is likely to be early determined in adolescence. The trajectory classes with higher levels of symptoms were associated with worse social and health outcomes.

Research Review: Brain network connectivity and the heterogeneity of depression in adolescence - a precision mental health perspective

BACKGROUND

Adolescence is a period of high risk for the onset of depression, characterized by variability in symptoms, severity, and course. During adolescence, the neurocircuitry implicated in depression continues to mature, suggesting that it is an important period for intervention. Reflecting the recent emergence of 'precision mental health' - a person-centered approach to identifying, preventing, and treating psychopathology - researchers have begun to document associations between heterogeneity in features of depression and individual differences in brain circuitry, most frequently in resting-state functional connectivity (RSFC).

METHODS

In this review, we present emerging work examining pre- and post-treatment measures of network connectivity in depressed adolescents; these studies reveal potential intervention-specific neural markers of treatment efficacy. We also review findings from studies examining associations between network connectivity and both types of depressive symptoms and response to treatment in adults, and indicate how this work can be extended to depressed adolescents. Finally, we offer recommendations for research that we believe will advance the science of precision mental health of adolescence.

RESULTS

Nascent studies suggest that linking RSFC-based pathophysiological variation with effects of different types of treatment and changes in mood following specific interventions will strengthen predictions of prognosis and treatment response. Studies with larger sample sizes and direct comparisons of treatments are required to determine whether RSFC patterns are reliable neuromarkers of treatment response for depressed adolescents. Although we are not yet at the point of using RSFC to guide clinical decision-making, findings from research examining the stability and reliability of RSFC point to a favorable future for network-based clinical phenotyping.

CONCLUSIONS

Delineating the correspondence between specific clinical characteristics of depression (e.g., symptoms, severity, and treatment response) and patterns of network-based connectivity will facilitate the development of more tailored and effective approaches to the assessment, prevention, and treatment of depression in adolescents.

Girls' brain structural connectivity in late adolescence relates to history of depression symptoms

BACKGROUND

Girls' depressive symptoms typically increase in adolescence, with individual differences in course and severity being key risk factors for impaired emotional functioning in young adulthood. Given the continued brain white matter (WM) maturation that occurs in adolescence, the present study tested whether structural connectivity patterns in late adolescence are associated with variation in the course of depression symptom severity throughout adolescence.

METHOD

Participants were girls (N = 115) enrolled in a multiyear prospective cohort study of risk for depression. Initial depression severity (intercept) at age 10 and change in severity (linear slope) across ages 10-19 were examined in relation to WM tractography collected at age 19. Network-based statistic analyses were used to identify clusters showing variation in structural connectivity in association with depressive symptom intercept, slope, and their interaction.

RESULTS

Higher initial depressive severity and steeper positive slope (separately) were associated with greater structural connectivity between temporal, subcortical socioaffective, and occipital regions. Intercept showed more connectivity associations than slope. The interaction effect indicated that higher initial symptom severity and a steeper negative slope (i.e., alleviating symptoms) were related to greater connectivity between cognitive control regions. Moderately severe symptoms that worsened over time were followed by greater connectivity between self-referential and cognitive regions (e.g., posterior cingulate and frontal gyrus).

CONCLUSIONS

Higher depressive symptom severity in early adolescence and increasing symptom severity over time may forecast structural connectivity differences in late adolescence, particularly in pathways involving cognitive and emotion-processing regions. Understanding how clinical course relates to neurobiological correlates may inform new treatment approaches to adolescent depression.

Unpacking Associations between Mood Symptoms and Screen Time in Preadolescents: a Network Analysis

Mounting evidence highlights the link between screen time and adolescent mood problems. However, there are several shortcomings to the extant literature: (1) this link is underexplored in preadolescents, (2) most existing studies look at mood problems using categorical diagnoses rather than from a symptom-level perspective, despite the heterogeneity within mood disorders, (3) few studies have simultaneously examined the links of mood symptoms with different types of screen time, and (4) family/child-level factors that have shown links to youth psychopathology are not typically considered. This study, for the first time, examined the relationships of mood symptoms with different types of screen time, while accounting for theoretically important factors-parental monitoring and the behavioral inhibition/activation systems (BIS/BAS)-in preadolescents aged 9 to 10 from 9986 families participating in the Adolescent Brain and Cognitive Development Study. Using mixed graphical models, we found that screen time involving age-inappropriate content was stably and significantly associated with various elevated mood symptoms, independent from other types of screen time, BIS/BAS, and parental monitoring. Additionally, age-inappropriate screen time was associated with increased overall symptom connectivity. Further, preadolescents engaged in high levels of age-inappropriate screen time reported different symptom profiles (i.e., differences in symptom centralities) from common pediatric mood problems. Our findings underline the multifaceted role (i.e., direct associations with symptoms, a moderator for symptom relationships, associations with distinct symptom profiles) of age-inappropriate screen time in preadolescent mood problems. These findings serve as foundations for future research that may facilitate early detection of preadolescents at risk of mood problems.

Persistence and remission of depressive symptoms and psycho-social correlates in Chinese early adolescents

BACKGROUND

This study aimed to investigate a one-year course of persistent/remitted depressive symptoms and associated demographic and psychosocial factors that predict persistent/remitted depressive symptoms in Chinese high school students.

METHODS

One thousand five hundred forty-four Grade 7 students provided data for the first wave. Of the initially recruited students, 483 who were classified as depressed (CESD score ≥ 16) at baseline were then tracked and invited to fill in the questionnaire for a second time (Grade 8) after 1 year. Finally, 435 of them were successfully matched.

RESULTS

Two hundred two (46.4%) of the subset categorized as depressed in the first survey (N = 435) remained with depressive symptoms, while 233 (53.6%) recovered from depression 1 year later. Having siblings, a lower level of positive youth development, non-intact family status, and poor family functioning at baseline significantly predicted a higher likelihood of persistent depression, while those with fathers having higher educational qualifications (bachelor's degree or higher) at baseline showed a significantly higher probability of remitting from depression.

CONCLUSIONS

The findings indicated that the prevalence of persistent depressive symptoms was generally high, and promoting aspects of positive youth development and family functioning for adolescents could be promising in preventing or reducing these symptoms.

Youth unemployment and mental health: prevalence and associated factors of depression among unemployed young adults in Gedeo zone, Southern Ethiopia

Background

The high rate of unemployment among young adults in Ethiopia, which was 25.3% in 2018, is a major social, and public health concern. The risk of mental health problems like depression is higher among the unemployed than among the employed. However, there was no study conducted on the prevalence and associated factors of depression among unemployed young adults in Ethiopia. Hence, this study was aimed to assess the prevalence and associated factors of depression among unemployed young adults in Gedeo zone, Southern Ethiopia.

Methods

Community based cross sectional study design was employed among 1452 unemployed young adults in Gedeo zone, Southern Ethiopia from May to July, 2019. In order to select the study participants, systematic random sampling technique was used. The presence of depression was assessed by using Patient Health Questionnaire-9 (PHQ-9), and data about socio-demographic characteristics of study participants were collected by using structured questionnaire. Data were coded and entered into Epi-Data version 3.1, and analyzed by SPSS version 20. A multivariable logistic regression analysis was carried out to identify factors associated with depression, and variables with p values < 0.05 were considered as statistically significant. The strength of the association was presented by adjusted odds ratio with 95% confidence interval.

Result

The overall prevalence of depression among unemployed young adults in the present study was 30.9% (95% CI: 28.4%, 33.1%). Of the total study participants with depression, 56.7% had mild depression, 36% had moderate depression, and 7.3% had severe depression. Being male (AOR = 1.40, 95% CI: 1.10, 1.80), long duration of unemployment (≥ 1 years) (AOR = 1.56, 95% CI: 1.21, 1.99), low self-esteem (AOR = 1.32, 95% CI: 1.03, 1.68), poor social support (AOR = 1.98, 95% CI: 1.34, 2.93), and current alcohol use (AOR = 1.86, 95% CI: 1.33, 2.59) were significantly associated with depression.

Conclusion

The results of our study indicated that depression is an important public health problem among unemployed young adults in Ethiopia. Therefore, our study suggested that policy makers and program planners should establish appropriate strategy for prevention, early detection and management of depression among this population. Besides, addressing the need of unemployed young people, improving access to care for depression is an important next step. Furthermore, we recommend further studies to understand the nature of depression among unemployed young people, and to strengthen the current results.

Patterns, predictors, and outcome of the trajectories of depressive symptoms from adolescence to adulthood

BACKGROUND

The long-term trajectory of depressive symptoms has a heterogeneous pattern. Identifying factors associated with different trajectories and outcomes may have important theoretical and clinical implications. This study explored patterns of depressive symptom trajectory from adolescence to adulthood, and their relationship with subsequent psychiatric disorders.

METHOD

A sample of 816 participants (58.8% girls; M = 16.58 years old at baseline, SD = 1.21) from a large community sample were interviewed four times during adolescence and adulthood. Depressive symptoms were also assessed. Symptom trajectory identification was based on latent class mixed modeling. Logistic regression was used for predicting emotional and drug use disorder over age 30.

RESULTS

Three trajectories of depressive symptoms were identified: "decreasing symptom" (decreasing trajectory of symptoms; 15.1% of participants), "increasing symptom" (initially decreasing pattern of symptoms and then increasing; 6.1% of participants), and "normative symptom" (consistently low symptom levels; 78.8% of participants). Predictors of the increasing symptom trajectory were high level of loneliness and state anxiety, presence of an emotional disorder, and low involvement in physical exercise at baseline. This trajectory membership predicted the development of anxiety disorders over age 30. Predictors of the decreasing symptom class were being female and high level of worry at baseline.

CONCLUSIONS

Long-term trajectories of depressive symptoms are heterogeneous, with each trajectory having different predictors and are associated with different outcomes during adulthood.

Trajectories of Depressive Symptoms Among North American Indigenous Adolescents: Considering Predictors and Outcomes

We identified developmental trajectories of depressive symptoms among 674 Indigenous adolescents (Mage  = 11.10, SD = 0.83 years) progressing from early to late adolescence. Four depressive symptoms trajectories were identified: (a) sustained low, (b) initially low but increasing, (c) initially high but decreasing, and (d) sustained high levels of depressive symptoms. Trajectory group membership varied as a function of gender, pubertal development, caregiver major depression, and perceived discrimination. Moreover, participants in the different trajectory groups were at differential risk for the development of an alcohol use disorder. These results highlight the benefit of examining the development of depressive symptoms and the unique ways that depressive symptoms develop among North American Indigenous youth as they progress through adolescence.

Transition Cliffs for Young Adults with Anxiety and Depression: Is Integrated Mental Health Care a Solution?

Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.

Identifying typical trajectories in longitudinal data: modelling strategies and interpretations

Individual-level longitudinal data on biological, behavioural, and social dimensions are becoming increasingly available. Typically, these data are analysed using mixed effects models, with the result summarised in terms of an average trajectory plus measures of the individual variations around this average. However, public health investigations would benefit from finer modelling of these individual variations which identify not just one average trajectory, but several typical trajectories. If evidence of heterogeneity in the development of these variables is found, the role played by temporally preceding (explanatory) variables as well as the potential impact of differential trajectories may have on later outcomes is often of interest. A wide choice of methods for uncovering typical trajectories and relating them to precursors and later outcomes exists. However, despite their increasing use, no practical overview of these methods targeted at epidemiological applications exists. Hence we provide: (a) a review of the three most commonly used methods for the identification of latent trajectories (growth mixture models, latent class growth analysis, and longitudinal latent class analysis); and (b) recommendations for the identification and interpretation of these trajectories and of their relationship with other variables. For illustration, we use longitudinal data on childhood body mass index and parental reports of fussy eating, collected in the Avon Longitudinal Study of Parents and Children.

Cross-Lagged Associations between Depressive Symptoms and Response Style in Adolescents

Depressive disorders are highly prevalent during adolescence and they are a major concern for individuals and society. The Response Style Theory and the Scar Theory both suggest a relationship between response styles and depressive symptoms, but the theories differ in the order of the development of depressive symptoms. Longitudinal reciprocal prospective relationships between depressive symptoms and response styles were examined in a community sample of 1343 adolescents. Additionally, response style was constructed with the traditional approach, which involves examining three response styles separately without considering the possible relations between them, and with the ratio approach, which accounts for all three response styles simultaneously. No reciprocal relationships between depressive symptoms and response style were found over time. Only longitudinal relationships between response style and depressive symptoms were significant. This study found that only depressive symptoms predicted response style, whereas the response style did not emerge as an important underlying mechanism responsible for developing and maintaining depressive symptoms in adolescents. These findings imply that prevention and intervention programs for adolescents with low depressive symptoms should not focus on adaptive and maladaptive response style strategies to decrease depressive symptoms, but should focus more on behavioral interventions.

Measuring the implementation strength of a perinatal mental health intervention delivered by peer volunteers in rural Pakistan

The South Asian region, including Pakistan, reports one of the highest rates of perinatal depression. Effective task-shifting perinatal mental health interventions exist and are gaining attention of policy makers, as a potential solution to bridge the existing treatment gap. However, no specific indicators are available to gauge the level of implementation for such interventions in the South Asian region. The Thinking Healthy Programme Peer-delivered (THPP) is a perinatal mental health intervention delivered, at scale, by peer volunteers (PVs). An effectiveness trial for THPP based on 570 depressed pregnant women was conducted in rural Rawalpindi, Pakistan. In addition, we also examined the implementation processes of THPP in order to develop an index to gauge implementation strength of this intervention. The key components of this index are based on four important intervention processes related to service provision which include; i) the competence of PVs, ii) supervisions attended by PVs and iii) number and iv) duration of THPP sessions. We attempt to inform an implementation strength index which best correlates with reduced perinatal depression and disability at 6 months post childbirth. Knowledge of such an implementation strength index for a task-shifted perinatal depression intervention carries implications for scale up strategies.

Trajectories of depressive symptoms and adult educational and employment outcomes

BACKGROUND

Depressive symptoms show different trajectories throughout childhood and adolescence that may have different consequences for adult outcomes.

AIMS

To examine trajectories of childhood depressive symptoms and their association with education and employment outcomes in early adulthood.

METHOD

We estimated latent trajectory classes from participants with repeated measures of self-reported depressive symptoms between 11 and 24 years of age and examined their association with two distal outcomes: university degree and those not in employment, education or training at age 24.

RESULTS

Our main analyses (n = 9399) yielded five heterogenous trajectories of depressive symptoms. The largest group found (70.5% of participants) had a stable trajectory of low depressive symptoms (stable-low). The other four groups had symptom profiles that reached full-threshold levels at different developmental stages and for different durations. We identified the following groups: childhood-limited (5.1% of participants) with full-threshold symptoms at ages 11-13; childhood-persistent (3.5%) with full-threshold symptoms at ages 13-24; adolescent onset (9.4%) with full-threshold symptoms at ages 17-19; and early-adult onset (11.6%) with full-threshold symptoms at ages 22-24. Relative to the majority 'stable-low' group, the other four groups all exhibited higher risks of one or both adult outcomes.

CONCLUSIONS

Accurate identification of depressive symptom trajectories requires data spanning the period from early adolescence to early adulthood. Consideration of changes in, as well as levels of, depressive symptoms could improve the targeting of preventative interventions in early-to-mid adolescence.

Genetic and Environmental Risk Factors Associated With Trajectories of Depression Symptoms From Adolescence to Young Adulthood

Importance

Less favorable trajectories of depressive mood from adolescence to early adulthood are associated with current and later psychopathology, impaired educational attainment, and social dysfunction, yet the genetic and environmental risk factors associated with these trajectories are not fully established. Examining what risk factors are associated with different trajectories of depressive mood could help identify the nature of depression symptoms and improve preventive interventions for those at most risk.

Objective

To examine the differential associations of genetic and environmental risk factors with trajectories of depression symptoms among individuals observed from ages 10 to 24 years.

Design, Setting, and Participants

In a longitudinal cohort study established in 1990 and currently ongoing (the Avon Longitudinal Study of Parents and Children [ALSPAC]), growth mixture modeling was used to identify trajectories of depression symptoms in 9394 individuals in the United Kingdom. Associations of different risk factors with these trajectories were then examined. Analysis was conducted between August 2018 and January 2019.

Main Outcomes and Measures

Trajectories were composed from depression symptoms measured using the Short Mood and Feelings Questionnaire at 9 occasions from ages 10 to 24 years. Risk factors included sex, a polygenic risk score taken from a recent genome-wide association study of depression symptoms, maternal postnatal depression, partner cruelty to the offspring's mother when the child was aged 2 to 4 years, childhood anxiety at age 8 years, and being bullied at age 10 years.

Results

Data on all risk factors, confounders, and the outcome were available for 3525 individuals, including 1771 (50.2%) who were female. Trajectories were assessed between the mean (SD) age of 10.7 (0.3) years and mean (SD) age of 23.8 (0.5) years. Overall, 5 distinct trajectories of depression symptoms were identified: (1) stable low (2506 individuals [71.1%]), (2) adolescent limited (325 individuals [9.2%]), (3) childhood limited (203 individuals [5.8%]), (4) early-adult onset (393 individuals [11.1%]), and (5) childhood persistent (98 individuals [2.8%]). Of all the associations of risk factors with trajectories, sex (odds ratio [OR], 6.45; 95% CI, 2.89-14.38), the polygenic risk score for depression symptoms (OR, 1.47; 95% CI, 1.10-1.96), and childhood anxiety (OR, 1.30; 95% CI, 1.16-1.45) showed the strongest association with the childhood-persistent trajectory of depression symptoms compared with the stable-low trajectory. Maternal postnatal depression (OR, 2.39; 95% CI, 1.41-4.07) had the strongest association with the early-adult-onset trajectory, while partner cruelty to mother (OR, 2.30; 95% CI, 1.36-3.90) had the strongest association with the adolescent-limited trajectory. Bullying (OR, 8.08; 95% CI, 4.92-13.26) showed the strongest association with the childhood-limited trajectory.

Conclusions and Relevance

The least favorable trajectories of depression symptoms (childhood persistent and early-adult onset) were associated with both genetic and environmental risk factors, but the 2 trajectories of limited duration that had resolved by early adulthood (childhood limited and adolescent limited) were not associated with the polygenic risk score or maternal postnatal depression. Bullying was strongly associated with both the childhood-persistent and childhood-limited trajectories, suggesting that this risk factor may have a time-specific effect. These findings suggest that examining genetic and multiple time-specific environmental antecedents could help identify trajectories of varying onset and chronicity.