The antecedents and outcomes of persistent and remitting adolescent depressive symptom trajectories: a longitudinal, population-based English study

Sex-specific association of peripheral blood cell indices and inflammatory markers with depressive symptoms in early adolescence

BACKGROUND

Previous studies have reported the correlation of dysregulated blood cell indices and peripheral inflammatory markers with depression in adults but limited studies have examined this correlation in early adolescents.

METHODS

This study used data from the Chinese Early Adolescents Cohort Study, which was conducted in Anhui, China. Students' depression symptoms were repeatedly measured using the Chinese version of the Center for Epidemiological Studies Depression Scale for Children. Students' blood samples were collected in September 2019 and September 2021. The peripheral blood cell counts and inflammatory marker levels were determined using routine blood tests. Multivariable regression models were used to explore the associations between blood cell indices and adolescent depressive symptoms in both the whole sample and the sex-stratified samples.

RESULTS

The white blood cell (WBC) count, neutrophil count (NC), platelet (PLT) count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune inflammation index (SII) were positively correlated with the severity of depressive symptoms during follow-up. The mean corpuscular volume (MCV), mean hemoglobin (HGB) volume (MCH), and mean corpuscular HGB concentration (MCHC) exhibited negative temporal correlations with depressive symptoms. Additionally, several sex-specific blood cell markers were correlated with depression. Male adolescents with increased red blood cell (RBC) and female adolescents with decreased HGB levels and upregulated WBC, NC, NLR, and SII levels exhibited severe depressive symptoms at follow-up.

CONCLUSIONS

These findings suggested the potential usefulness of peripheral blood cell indices in the assessment of depression in early adolescents.

Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes

Importance

Depression is a leading cause of disability. The timing and persistence of depression may be differentially associated with long-term mental health and psychosocial outcomes.

Objective

To examine if depression symptoms during early and middle childhood and adolescence and persistent depression symptoms are associated with impaired young adult outcomes independent of early risk factors.

Design, Setting, and Participants

Data for this prospective, longitudinal cohort study were from the Québec Longitudinal Study of Child Development, a representative population-based Canadian birth cohort. The cohort consists of infants born from October 1, 1997, to July 31, 1998. This is an ongoing study; data are collected annually or every 2 years and include those ages 5 months to 21 years. The end date for the data in this study was June 30, 2019, and data analyses were performed from October 4, 2022, to January 3, 2024.

Exposures

Depression symptoms were assessed using maternal reports in early childhood (ages 1.5 to 6 years) from 1999 to 2004, teacher reports in middle childhood (ages 7 to 12 years) from 2005 to 2010, and self-reports in adolescence (ages 13 to 17 years) from 2011 to 2015.

Main Outcomes and Measures

The primary outcome was depression symptoms at age 20 years, and secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived stress; not being in education, employment, or training; social support; and experiencing online harrasment) at age 21 years. All outcomes were self-reported. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019. Risk factors assessed when children were aged 5 months old were considered as covariates to assess the independent associations of childhood and adolescent depression symptoms with adult outcomes.

Results

The cohort consisted of 2120 infants. The analytic sample size varied from 1118 to 1254 participants across outcomes (56.85% to 57.96% female). Concerning the primary outcome, adjusting for early risk factors and multiple testing, depression symptoms during adolescence were associated with higher levels of depression symptoms (β, 1.08 [95% CI, 0.84-1.32]; P < .001 unadjusted and Bonferroni adjusted) in young adulthood. Concerning the secondary outcomes, depression symptoms in adolescence were only associated with perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P < .001 unadjusted and Bonferroni adjusted), while both middle-childhood (β, -1.58 [95% CI, -2.65 to -0.51]; P = .003 unadjusted and P < .001 Bonferroni adjusted) and adolescent (β, -1.97 [95% CI, -2.53 to -1.41]; P < .001 unadjusted and Bonferroni adjusted) depression symptoms were associated with lower levels of social support. There were no associations for binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Conclusions and Relevance

In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

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.

Major challenges in youth psychopathology: treatment-resistant depression. A narrative review

Major depressive disorder (MDD) represents a major health issue in adolescents and young adults, leading to high levels of disability and profoundly impacting overall functioning. The clinical presentation of MDD in this vulnerable age group may slightly differ from what can be observed in adult populations, and psychopharmacological strategies do not always lead to optimal response. Resistance to antidepressant treatment has a prevalence estimated around 40% in youths suffering from MDD and is associated with higher comorbidity rates and suicidality. Several factors, encompassing biological, environmental, and clinical features, may contribute to the emergence of treatment-resistant depression (TRD) in adolescents and young adults. Furthermore, TRD may underpin the presence of an unrecognized bipolar diathesis, increasing the overall complexity of the clinical picture and posing major differential diagnosis challenges in the clinical practice. After summarizing current evidence on epidemiological and clinical correlates of TRD in adolescents and young adults, the present review also provides an overview of possible treatment strategies, including novel fast-acting antidepressants. Despite these pharmacological agents are promising in this population, their usage is expected to rely on risk-benefit ratio and to be considered in the context of integrated models of care.

Association between green space and multiple ambient air pollutants with depressive and anxiety symptoms among Chinese adolescents: The role of physical activity

OBJECTIVE

To explore the association between green space, multiple ambient air pollutants and depressive/anxiety symptoms and the mediating role of physical activity (PA) in Chinese adolescents.

METHOD

A school-based health survey was conducted in eight provinces in China in 2021. 22,868 students aged 14.64 (±1.77) years completed standard questionnaires to record details of depressive, anxiety symptoms and PA. We calculated the average normalized difference vegetation index (NDVI) in circular buffers of 200 m, 500 m and 1000 m and estimated the concentrations of PM10, PM2.5, CO, NO2, O3, SO2 around the adolescents' school addresses.

RESULTS

The exposure-response curves showed that the lower the NDVI value, the higher the risk of depressive and anxiety symptoms. CO, PM2.5 and SO2 and air pollution score were associated with increased risk of depressive and anxiety symptoms. NDVI in all circular buffers decreased the risk of depressive and anxiety symptoms at low levels of PA, but the associations were not significant at high levels of PA. In the subgroup analysis, PM10, PM2.5, CO, NO2, SO2, AQI and air pollution score increased the risk of depressive and anxiety symptoms at low PA levels, but the associations were not significant at high levels of PA. Mediation analysis indicated that the mediating effect of PA on the association between NDVI, NDVI-200 m NDVI-500 m, CO, PM10, PM2.5, SO2, AQI and depressive/anxiety symptoms was statistically significant（p < 0.05）.

CONCLUSION

Middle-high level PA could reduce the strength of association between air pollution and depressive and anxiety symptoms. Meanwhile, the association between green space/air pollution and depressive/anxiety symptoms was partly mediated by PA.

Factors associated with chronic depressive symptoms across adolescence and young adulthood: a UK birth cohort study

AIMS

Identifying children and/or adolescents who are at highest risk for developing chronic depression is of utmost importance, so that we can develop more effective and targeted interventions to attenuate the risk trajectory of depression. To address this, the objective of this study was to identify young people with persistent depressive symptoms across adolescence and young adulthood and examine the prospective associations between factors and persistent depressive symptoms in young people.

METHODS

We used data from 6711 participants in the Avon Longitudinal Study of Parents and Children. Depressive symptoms were assessed at 12.5, 13.5, 16, 17.5, 21 and 22 years with the Short Mood and Feelings Questionnaire, and we further examined the influence of multiple biological, psychological and social factors in explaining chronic depressive symptoms.

RESULTS

Using latent class growth analysis, we identified four trajectories of depressive symptoms: persistent high, persistent low, persistent moderate and increasing high. After applying several logistic regression models, we found that loneliness and feeling less connected at school were the most relevant factors for chronic course of depressive symptoms.

CONCLUSIONS

Our findings contribute with the identification of those children who are at highest risk for developing chronic depressive symptoms.

Association of Problematic Internet Use With Psychotic Experiences and Depression in Adolescents: A Cohort Study

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.

A Narrative Review of Depression and Suicide in Adolescent Females to Guide Assessment and Treatment Recommendations

STUDY OBJECTIVE

Suicide is a leading cause of death for adolescents. Medical professionals are increasingly being asked to screen for depressive symptoms and suicidal ideation with little training. The purpose of this paper is to review factors related to suicidal thoughts and actions, assessment of symptoms, and initial suggestions for treatment for medical providers.

METHODS

A literature review of risk and resilience factors, assessment measures, and treatment options for depression and suicidal ideation and behavior in adolescent females was conducted.

RESULTS

Given the higher risk of suicidal thoughts and depressive symptoms in adolescent females, accurate and thorough assessment of symptoms is recommended.

CONCLUSION

Medical providers should be aware of symptoms related to depression and suicidal ideation in order to provide more effective assessments. Recommendations for brief assessment measures that can be used in the clinic and possible first line treatments are provided.

5-year mental health outcomes for children and adolescents presenting with psychiatric symptoms to general practitioners in England: a retrospective cohort study

BACKGROUND

Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses.

METHODS

In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3-18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress.

FINDINGS

We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4-16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000-2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio vs low-contact group 2·19 [95% CI 2·03-2·36]) and suicide (2·67 [1·72-4·14]).

INTERPRETATION

Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents.

FUNDING

National Institute for Health and Care Research and the Wellcome Trust.

Childhood correlates and young adult outcomes of trajectories of emotional problems from childhood to adolescence

BACKGROUND

Emotional problems, especially anxiety, have become increasingly common in recent generations. Few population-based studies have examined trajectories of emotional problems from early childhood to late adolescence or investigated differences in psychiatric and functional outcomes.

METHODS

Using the Avon Longitudinal Study of Parents and Children (ALSPAC, n = 8286, 50.4% male), we modeled latent class growth trajectories of emotional problems, using the parent-reported Strength and Difficulties Questionnaire emotional scale (SDQ-E) on seven occasions (4-17 years). Psychiatric outcomes in young adulthood (21-25 years) were major depressive disorder (MDD), generalized anxiety disorder (GAD), and self-harm. Functional outcomes were exam attainment, educational/occupational status, and social relationship quality.

RESULTS

We identified four classes of emotional problems: low (67.0%), decreasing (18.4%), increasing (8.9%), and persistent (5.7%) problems. Compared to those in the low class, individuals with decreasing emotional problems were not at elevated risk of any poor adult outcome. Individuals in the increasing and persistent classes had a greater risk of adult MDD (RR: 1.59 95% CI 1.13-2.26 and RR: 2.25 95% CI 1.49-3.41) and self-harm (RR: 2.37 95% CI 1.91-2.94 and RR: 1.87 95% CI 1.41-2.48), and of impairment in functional domains. Childhood sleep difficulties, irritability, conduct and neurodevelopmental problems, and family adversity were associated with a persistent course of emotional problems.

CONCLUSIONS

Childhood emotional problems were common, but those whose symptoms improved over time were not at increased risk for adverse adult outcomes. In contrast, individuals with persistent or adolescent-increasing emotional problems had a higher risk of mental ill-health and social impairment in young adulthood which was especially pronounced for those with persistent emotional problems.

A collaborative realist review of remote measurement technologies for depression in young people

Digital mental health is becoming increasingly common. This includes use of smartphones and wearables to collect data in real time during day-to-day life (remote measurement technologies, RMT). Such data could capture changes relevant to depression for use in objective screening, symptom management and relapse prevention. This approach may be particularly accessible to young people of today as the smartphone generation. However, there is limited research on how such a complex intervention would work in the real world. We conducted a collaborative realist review of RMT for depression in young people. Here we describe how, why, for whom and in what contexts RMT appear to work or not work for depression in young people and make recommendations for future research and practice. Ethical, data protection and methodological issues need to be resolved and standardized; without this, RMT may be currently best used for self-monitoring and feedback to the healthcare professional where possible, to increase emotional self-awareness, enhance the therapeutic relationship and monitor the effectiveness of other interventions.

HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let's Text!): Pilot Feasibility and Acceptability Study

BACKGROUND

The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts.

OBJECTIVE

This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes.

METHODS

Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system.

RESULTS

All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement.

CONCLUSIONS

Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research.

Cognitive functioning in children and adolescents with depression: A systematic review and meta-analysis

Although cognitive dysfunction is associated with depression in adults, the link in children and adolescents is unclear. This systematic review and meta-analysis quantifies the association between depression and cognitive function in children and adolescents. Systematic searches were conducted in six databases: Child Development and Adolescent Studies, Ovid MEDLINE, Ovid Embase, Ovid APA PsycINFO, EBSCO CINAHL Plus, Scopus (last search: April 2023). Studies including measures of cognitive outcomes (memory, attention, executive function, processing speed, language) among children (≤18 years) with depression were included. The Joanna Briggs Institute Critical Appraisal Tools were used to determine study risk of bias. Random-effects meta-analyses of study outcomes were performed. Seventeen studies were included (15 were cross-sectional, 1 prospective, 1 randomized control trial). Participants (N = 13,567) were 10 to 17 years old (mean 13.8 ± 2.2 years; 60 % female). Compared with healthy controls, depressed participants had lower performance on tests of working memory (g = -0.40; 95 % CI: -0.67, -0.13), long-term memory (g = -0.48; 95 % CI: -0.72, -0.25), attention (g = -0.15; 95 % CI: -0.26, -0.04), executive function (g = -0.16; 95 % CI: -0.24, -0.08), and language (g = -0.23; 95 % CI: -0.36, -0.09). No performance differences were observed on tests of short-term memory or processing speed. Children and adolescents with depression demonstrated lower performance on tests of working and long-term memory, attention, executive function and language. These findings emphasize the importance of considering cognitive functioning among children with depression, and greater understanding of the effect of treatment on these outcomes. PROSPERO (CRD42022332064).

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.

Physical activity, recreational screen time, and depressive symptoms among Chinese children and adolescents: a three-wave cross-lagged study during the COVID-19 pandemic

BACKGROUND

Longitudinal evidence is lacking on the interplay between lifestyle behaviors and depressive symptoms, especially in the context of the COVID-19 pandemic. This study investigated the changes in physical activity and recreational screen time during the pandemic, along with their reciprocal associations with depressive symptoms among children and adolescents.

METHODS

The public health emergency due to the pandemic started in January 2023 and lasted for two months in Shanghai, China. A three-wave longitudinal study was conducted among 1,666 children and adolescents (6-18 years) in January, March, and July 2023. Moderate-to-vigorous intensity physical activity (MVPA), recreational screen time, and depressive symptoms were measured using self-reported questionnaires. Random-intercept cross-lagged panel models were constructed to examine the bidirectional associations between physical activity and recreational screen time with depressive symptoms.

RESULTS

Children and adolescents experienced a significant decrease in MVPA and a substantial increase in recreational screen time during the pandemic, which failed to return to pre-pandemic levels post-pandemic. Pre-pandemic MVPA was negatively associated with subsequent depressive symptoms (β = -0.147). Conversely, pre-pandemic depressive symptoms were positively associated with subsequent recreational screen time (β = 0.085), which in turn predicted heightened post-pandemic depressive symptoms (β = 0.076). When stratified by age, significant associations were found in adolescents but not children.

CONCLUSIONS

Sustained unhealthy changes in physical activity and recreational screen time were observed during the COVID-19 pandemic among children and adolescents. This study elucidates a potential reciprocal relationship between lifestyle behaviors and mental well-being. Effective interventions are emphasized to counter the negative impacts of insufficient physical activity and excessive screen use on the mental health of children and adolescents.

Immature defense mechanisms mediate the relationship between negative life events and depressive symptoms

Objective

This study aimed to analyze the patterns of life events (LEs) and defense mechanisms in outpatients with depression and investigate the mediating role of defense mechanisms in the association between LEs and depressive symptoms in a psychosomatic outpatient sample in China.

Materials and methods

All of 2,747 outpatients (aged 18-65) from psychosomatic department were investigated in this study. LEs, depressive symptoms, and defense mechanisms were assessed by the Life Events Scale (LES), Patient-Health-Questionnaire-9 (PHQ-9), and the Defense Style Questionnaire (DSQ), respectively.

Results

Based on the optimal cut-off point of PHQ-9, 1840 (67.0%) patients had a PHQ-9 score of 10 or higher (depression group), and 907 (33.0%) had a score below 10 (non-depression group). The scores of Negative Life Events (NLEs), immature and intermediate defense mechanisms in the depression group were significantly higher than those in the non-depression group, while the scores of mature defense mechanisms were the opposite (p < 0.001). NLEs was directly related to depressive symptoms (b = 0.010, p < 0.001), and significant indirect effect via immature defense mechanisms (b = 0.008, p < 0.001) was observed.

Conclusion

Immature defense mechanisms play an important mediating role in the relationship between NLEs and depressive symptoms. Helping patients improving defense mechanisms and dealing with NLEs may be of great help in the treatment of relevant patients.

Suicidal Thoughts and Trajectories of Psychopathological and Behavioral Symptoms in Adolescence

Importance

The suicidal risk of psychopathology in adolescence is suggested to differ based on its longitudinal trajectory, but the comorbidity of these symptom trajectories has not been well examined. This study comprehensively clustered trajectories of multiple psychopathological and behavioral symptoms and examined their associations with suicidal thoughts in adolescence.

Objective

To determine which categories and trajectories of psychopathological and behavioral symptoms are associated with suicidal thoughts in adolescence, accounting for comorbid symptoms.

Design, Setting, and Participants

This population-based cohort study in Japan used data from the Tokyo Teen Cohort (TTC) study, which was established in 2012 and is currently ongoing. Data from 3 waves of surveys conducted at ages 10, 12, and 16 years from October 2012 to September 2021 were used. Of the adolescents in the cohort, participants with at least 2 evaluations of psychopathological and behavioral symptoms were included. Data were analyzed from December 2022 to March 2023.

Exposure

Latent class growth analysis was used to cluster the trajectory of each psychopathological and behavioral symptom.

Main Outcomes and Measures

The associations between symptom trajectories and suicidal thoughts at age 16 were examined. Suicidal thoughts were assessed using a self-report questionnaire. Psychopathological and behavioral symptoms were assessed using the 8 subscale scores of the caregiver-report Child Behavior Checklist.

Results

This study included 2780 adolescents (1306 female participants [47.0%]). Of the 1920 adolescents with data on suicidal thoughts, 158 (8.2%) had suicidal thoughts. The median (IQR) age was 10.2 (10.0-10.3) years at the first evaluation, 11.9 (11.8-12.1) years at the second evaluation, and 16.3 (16.1-16.5) years at the last evaluation. The clustering pattern of trajectories varied depending on symptom categories. After adjusting for each symptom trajectory and confounders, adolescents with persistent high withdrawn symptoms (odds ratio [OR], 1.88; 95% CI, 1.10-3.21) and those with increasing somatic symptoms (OR, 1.97; 95% CI, 1.16-3.34) had a significantly higher risk of suicidal thoughts than adolescents without these symptoms. There was no interaction between these symptom trajectories and the risk of suicidal thoughts.

Conclusions and Relevance

This cohort study found that persistent withdrawn symptoms and increasing somatic symptoms during early to midadolescence were associated with an increased risk of suicidal thoughts in midadolescence, even after accounting for comorbid symptoms and confounders. Attention should be paid to the suicidal risk associated with these symptoms, particularly when they persist or increase in the longitudinal follow-up.

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.

Premorbid intelligence quotient and school failure as risk markers for bipolar disorder and major depressive disorder

Mood disorders significantly impact global health, with MDD ranking as the second leading cause of disability in the United States and BD ranking 18th. Despite their prevalence and impact, the relationship between premorbid intelligence and the subsequent development of BD and MDD remains inconclusive. This study investigates the potential of premorbid Intelligence Quotient (IQ) and school failure frequency as risk factors for Bipolar Disorder (BD) and Major Depressive Disorder (MDD) in a birth cohort setting. We analyze data from the Pelotas population-based birth cohort study, comprising 3580 participants aged 22, who had no prior mood disorder diagnoses. Utilizing regression models and accounting for potential confounders, we assess the impact of IQ and school failure, measured at age 18, on the emergence of BD and MDD diagnoses at age 22, using individuals without mood disorders as comparators. Results reveal that lower IQ (below 70) at 18 is associated with an increased risk of BD (Adjusted Odds Ratio [AOR] 1.75, 95%CI: 1.00-3.09, p < 0.05), while higher IQ (above 120) is linked to MDD (AOR 2.16, 95%CI: 1.24-3.75, p < 0.001). Moreover, an elevated number of school failures is associated with increased BD risk (AOR 1.23, 95%CI: 1.11-1.41, p < 0.001), particularly for BD type 1 (AOR 1.36, 95% CI: 1.17-1.58, p < 0.001). These findings offer insights into the distinct premorbid intellectual characteristics of BD and MDD and contribute to a deeper understanding of their developmental trajectories, potentially informing the development of risk assessment tools for mood disorders.

Promoting mental health among young males in sporting contexts: A systematic review

BACKGROUND

Young males experience markedly poorer mental health outcomes. Organised sport settings provide novel prospects to improve the mental health of this subpopulation.

AIM

This systematic review aimed to evaluate interventions targeted at the promotion of mental health and wellbeing among young males in organised sporting contexts.

METHODS

Six databases (SportDiscus, PsycInfo, Medline, Web of Science, Scopus, CINAHL) were searched from inception to June 2022 (and updated in September 2023). Eligible studies examined interventions targeting the mental health and wellbeing (e.g., depression, anxiety, resilience) or mental health literacy (e.g., stigmatising attitudes, help-seeking) of young males aged 10-24 years (or associated stakeholder samples; e.g., parents or coaches of male youth).

RESULTS

A total of 15 studies were included in this review. Overall, the findings indicate promising effects of sport-based interventions on the mental health and mental health literacy outcomes of young males.

CONCLUSIONS

This review suggests that there is scope to improve the capacity of sports-based interventions to affect positive change in the mental health of male youth. The findings from this review also have important implications for the development and evaluation of sports-based interventions targeted at young males in future.

Stratifying early-onset emotional disorders: using genetics to assess persistence in young people of European and South Asian ancestry

BACKGROUND

Depression and anxiety are the most common mental health problems in young people. Currently, clinicians are advised to wait before initiating treatment for young people with these disorders as many spontaneously remit. However, others develop recurrent disorder but this subgroup cannot be identified at the outset. We examined whether psychiatric polygenic scores (PGS) could help inform stratification efforts to predict those at higher risk of recurrence.

METHODS

Probable emotional disorder was examined in two UK population cohorts using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ). Those with emotional disorder at two or more time points between ages 5 and 25 years were classed as 'recurrent emotional disorder' (n = 1,643) and those with emotional disorder at one time point as having 'single episode emotional disorder' (n = 1,435, controls n = 8,715). We first examined the relationship between psychiatric PGS and emotional disorders in childhood and adolescence. Second, we tested whether psychiatric PGS added to predictor variables of known association with emotional disorder (neurodevelopmental comorbidity, special educational needs, family history of depression and socioeconomic status) when discriminating between single-episode and recurrent emotional disorder. Analyses were conducted separately in individuals of European and South Asian ancestry.

RESULTS

Probable emotional disorder was associated with higher PGS for major depressive disorder (MDD), anxiety, broad depression, ADHD and autism spectrum disorder (ASD) in those of European ancestry. Higher MDD and broad depression PGS were associated with emotional disorder in people of South Asian ancestry. Recurrent, compared to single-episode, emotional disorder was associated with ASD and parental psychiatric history. PGS were not associated with episode recurrence, and PGS did not improve discrimination of recurrence when combined with clinical predictors.

CONCLUSIONS

Our findings do not support the use of PGS as a tool to assess the likelihood of recurrence in young people experiencing their first episode of emotional disorder.

Following the children of depressed parents from childhood to adult life: A focus on mood and anxiety disorders

Background

Parental depression increases risk for anxiety and depression in offspring. The transition from adolescence to adulthood is a common risk period for onset of such disorders. However, relatively few studies have considered development of these disorders from childhood to adulthood including multiple assessments during this transition period.

Method

Offspring of depressed parents aged 9-17 years at baseline were followed prospectively for 13 years (n = 337). Average length of follow-up was 16 months between the first and second waves, 13 months between the second and third, and 8 years between the third and fourth. Current (3-month) psychopathology was assessed at each wave using diagnostic interviews. We derived estimates of 3-month prevalence, age at first diagnosis, course and comorbidity of disorders. Social functioning in adult life was assessed at the final wave and we assessed how prior and current disorder impacted adult functioning.

Results

A quarter of young people met criteria for a mood disorder and a third for anxiety disorder at least once. Mood and anxiety disorder prevalence increased from 4.5% and 15.8% respectively in childhood (9-11 years) to 22.3% and 20.9% respectively by age 23-28. Increased prevalence across the transition from adolescence to adulthood was particularly marked in males, while prevalence increased earlier in adolescence in females. Age at first diagnosis varied widely (mood disorder mean = 16.5 years (range 9-26); anxiety disorder mean = 14.5 years (range 9-28)). Over half (52%) reported functional impairment in early adulthood, 31% harmful alcohol use, and 10% self-harm or a suicide attempt. Both previous and current mood or anxiety disorder were associated with functional impairment in early adulthood.

Conclusions

There is a prolonged risk period for mood and anxiety disorders in this group, with prevalence peaking in early adulthood. This highlights the need for prolonged vigilance and effective targeted interventions in the offspring of depressed parents.

Commentary: Mind the blip in the curve when assessing educational attainment in youths - a reflection on Wickersham et al. (2023)

Dr. Wickersham et al.'s study linked educational and health records providing important knowledge on educational trajectories in youths with mental disorders. They found that youths diagnosed with depression prior to age 18 were more likely to have a decline in educational attainment over time than youths without depression. Furthermore, educational attainment trajectories showed some specificity with different patterns between youths with depression and youths with neurodevelopmental disorders. In this commentary, we highlight the clinical implications of these findings, showing that low or declining educational attainment in youths might serve as a marker for psychopathology, providing the opportunity to identify youths that could benefit from coordinated interventions across diagnostic boundaries.

The association between adolescent depression and dyslipidemia

BACKGROUND

Children and adolescents with major depressive disorder (MDD) are at increased risk for premature cardiovascular disease (CVD). Whether adolescents with MDD manifest evidence of dyslipidemia, a key risk factor for CVD, is unknown.

METHODS

Youth recruited through an ambulatory psychiatry clinic and the community, were categorized following diagnostic interview as MDD or as healthy controls [HC]. CVD risk factors including high density lipoprotein (HDL), low density lipoprotein (LDL), and triglyceride concentrations were collected. Depression severity was measured using the Center for Epidemiological Studies Depression Scale for Children. The associations of diagnostic group as well as depressive symptom severity with lipid concentrations were examined using multiple regression analyses. Models were adjusted for age, sex, and standardized Body Mass Index.

RESULTS

Participants (n = 243) were 68 % female with a mean age of 15.04 ± 1.81 years. MDD and HC participants had comparable levels of dyslipidemia (MDD: 48 %, HC: 46 %, p > .7) and hypertriglyceridemia (MDD: 34 %, HC: 30 %, p > .7). Among depressed adolescents, greater depressive symptoms were associated with higher total cholesterol concentrations in unadjusted models only. Greater depressive symptoms were associated with higher HDL concentrations and a lower triglyceride-to-HDL ratio, after adjusting for covariates.

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Adolescents with clinically significant depressive symptoms manifested similar levels of dyslipidemia as healthy youth. Future studies examining the prospective trajectories of depressive symptoms and lipid concentrations are needed to determine the point at which dyslipidemia emerges in the course of MDD, and the mechanism of the association that imparts increased CVD risk for depressed youth.

Characterising depression trajectories in young people at high familial risk of depression

BACKGROUND

Parental depression is a common and potent risk factor for depression in offspring. However, the developmental course of depression from childhood to early-adulthood has not been characterized in this high-risk group.

METHODS

Using longitudinal data from 337 young people who had a parent with a history of recurrent major depressive disorder (MDD), we characterized trajectories of broadly defined depressive disorder using latent class growth analysis. We used clinical descriptions to further characterise trajectory classes.

RESULTS

Two trajectory classes were identified: childhood-emerging (25 %) and adulthood-emerging (75 %). The childhood-emerging class showed high rates of depressive disorder from age 12.5, which persisted through the study period. The adulthood-emerging class showed low rates of depressive disorder until age 26. Individual factors (IQ and ADHD symptoms) and parent depression severity (comorbidity, persistence and impairment) differentiated the classes but there were no differences in family history score or polygenic scores associated with psychiatric disorder. Clinical descriptions indicated functional impairment in both classes, but more severe symptomatology and impairment in the childhood-emerging class.

LIMITATIONS

Attrition particularly affected participation in young adulthood. Factors associated with attrition were low family income, single parent household status and low parental education.

CONCLUSIONS

The developmental course of depressive disorder in children of depressed parents is variable. When followed up to adult life, most individuals exhibited some functional impairment. An earlier age-of-onset was associated with a more persistent and impairing course of depression. Access to effective prevention strategies is particularly warranted for at-risk young people showing early-onsetting and persistent depressive symptoms.

Vitamin D and depressive symptoms in an early adolescent cohort

BACKGROUND

To explore the cross-sectional and longitudinal association between vitamin D and depressive symptoms across early adolescence.

METHODS

This longitudinal study included 1607 early adolescents [mean (s.d.) age, 12.49 years; 972 (60.5%) males] from the Chinese Early Adolescents Cohort, recruited from a middle school in Anhui Province and followed up annually (2019-2021). Serum 25(OH)D levels were measured in both 2019 and 2021. Self-reports on depression were assessed at each of three time points from 2019 to 2021.

RESULTS

In the whole sample, higher baseline serum 25(OH)D levels were linked with a lower risk of cumulative incident depression within two-year follow-ups (adjusted RR = 0.97, 95% CI 0.94-0.99) and the increasing trajectory of depression symptoms across the three waves (adjusted RR = 0.97, 95% CI 0.95-0.99). Baseline vitamin D deficiency (VDD) (adjusted RR = 1.50, 95% CI 1.10-2.05) were associated with an increased risk for the increasing trajectory of depression symptoms across the three waves. Remitted VDD was positively related to one dichotomous depression symptoms across three waves (adjusted OR 2.15, 95% CI 1.15-4.01). The above-mentioned significant association was also found in males. Additionally, baseline VDD (adjusted OR 1.59, 95% CI 1.04-2.44) and persistent VDD (adjusted OR 1.58, 95% CI 1.02-2.60) were linked to an increased risk of having two dichotomous depression symptoms only in males.

CONCLUSIONS

Our results highlight a prospective association between baseline vitamin D and depression risk in early adolescents. Additionally, a male-specific association between vitamin D and depression risk was observed. Our findings support a potential beneficial effect of vitamin D supplementation in reducing depression risk in early adolescents.

Cross-cohort change in parent-reported emotional problem trajectories across childhood and adolescence in the UK

BACKGROUND

Over the past three decades, the prevalence of adolescent emotional problems (ie, anxiety and depression) has risen. Although the onset and developmental course of emotional symptoms shows high variability, no study has directly tested secular differences across development. Our aim was to investigate whether and how developmental trajectories of emotional problems have changed across generations.

METHODS

We used data from two UK prospective cohorts assessed 10 years apart: the Avon Longitudinal Study of Parents and Children (ALSPAC) including individuals born in 1991-92, and the Millennium Cohort Study (MCS) with individuals born in 2000-02. Our outcome was emotional problems, assessed using the parent-rated emotional subscale of the Strengths and Difficulties Questionnaire (SDQ-E) at approximate ages 4, 7, 8, 10, 11, 13, and 17 years in ALSPAC and ages 3, 5, 7, 11, 14, and 17 years in MCS. Participants were included if the SDQ-E was completed at least once in childhood and at least once in adolescence. Trajectories were generated using multilevel growth curve models using the repeated assessments of the SDQ-E in children aged 3-17 years.

FINDINGS

Data were available for 19 418 participants (7012 from ALSPAC and 12 406 from the MCS), of whom 9678 (49·8%) were female and 9740 (50·2%) were male, and 17 572 (90·5%) had White mothers. Individuals born between 2000 and 2002 had higher emotional problem scores from around 9 years (intercept statistic β 1·75, 95% CI 1·71-1·79) than did individuals born in 1991-92 (1·55, 1·51-1·59). The later cohort had an earlier onset of problems than the earlier cohort, and sustained higher average trajectories from around 11 years, with female adolescents showing the steepest trajectories of emotional problems. Differences between cohorts peaked overall at age 14 years.

INTERPRETATION

Our comparison of two cohorts of young people provides evidence that compared with a cohort assessed 10 years prior, emotional problems emerge earlier in development in the more recent cohort, and these are especially pronounced for females during mid-adolescence. Such findings have implications for public health planning and service provision.

FUNDING

Wolfson Centre for Young People's Mental Health, Wolfson Foundation.

Influence of on emotions and behavior of adolescents with major depressive disorder

Background

Major depressive disorder in adolescents is characterized by high prevalence rate, high recurrence rate, high suicide rate and high disability rate. However, the recognition rate and cure rate are low, and the disease has a very bad influence on the family and society. The lack of psychiatrists and psychotherapists in villages and small towns makes it difficult to get timely and professional intervention and treatment for adolescent with major depressive disorder.

Methods

A total of 84 adolescents with major depressive disorder who received treatment in the department of psychosomatic medicine of the Second Affiliated Hospital of Nanchang University participated in this survey, and they were divided into the control group and the intervention group by random number table. Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSSIAQ), Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Depression Self-Rating Scale for Childhood (DSRS) were used to investigate the negative emotions and behavior of adolescents with major depressive disorder at baseline and intervention for 12 weeks.

Results

There were no significant differences in the baseline information of adolescents (sex ratio, age, education level), including the total score of SCARED, DSRS and SQAPMPU, the total mean score of ANSSIAQ between the two groups (P > 0.05). After 12-week intervention, the score of SCARED, DSRS and SQAPMPU, the total mean score of ANSSIAQ in both groups were lower than that of the baseline, and the score of the intervention group showed a more obvious downward trend (P < 0.05).

Conclusions

In-person and remote Satir family therapy not only effectively reduced the anxiety and depression level among participants, but also validly reduced their non-suicidal self-injury behavior and mobile phone use behavior. The results verified that the model we adopted can be well applied for the out-patient management of adolescents with major depressive disorder, especially in villages and small towns.

More than the aggregation of its components: Unveiling the associations between anxiety, depression, and suicidal behavior in adolescents from a network perspective

BACKGROUND

Facing multiple changes, adolescents are prone to have anxiety and depression concurrently, which would accompany a particularly high risk for suicide. However, most previous studies have ignored the heterogeneity of the components and used latent variable methods to explore the associations between these core variables, resulting in a lack of component-level discussions.

METHOD

Using a large sample of 9300 adolescents (Mean_age = 13.51; SD_age = 1.33; 49.82 % females), two network pathways of anxiety and depression and the associations between these variables and suicidal behavior were constructed. The central components and the stability of both networks were also identified.

RESULTS

Considering the network of anxiety and depression, there were two strong bridging symptoms of sleep problems and palpitation or tachycardia. The symptoms of depression showed a more vital centrality than anxiety, and the central symptoms were tachycardia, worthlessness, fatigue, and feeling of choking. For the network of suicidal behavior and symptoms of anxiety and depression, besides sleep problems, the edge linking lifetime suicide ideation and attempt and the frequency of suicide ideation in the past year was also a strong edge. Worthlessness connected symptoms of anxiety and depression with suicidal behavior. The central components were tachycardia, worthlessness, the frequency of suicidal ideation over the past year, and fatigue. Additionally, both networks had higher stability in terms of edge and centrality.

CONCLUSION

Based on the identified relevant strong bridging and central components, effective therapies would target these components first, which would lead to the alleviating effects on other components.

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.

Association between healthy sleep patterns and depressive trajectories among college students: a prospective cohort study

BACKGROUND

The purpose of this study was to identify different develpment trajectories of depression symptoms during college period, and prospectively investigate the associations healthy sleep patterns with trajectories of depression symptoms among college students from freshman through junior year.

METHODS

A total of 999 participants from the College Student Behavior and Health Cohort Study were included between April 2019 and June 2021. Healthy sleep patterns were defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. Latent growth curve model was used to identify trajectories of depression symptoms. Then binary logistic regression was used to examine association of the healthy sleep patterns with these trajectories.

RESULTS

In baseline survey, we found that a total of 100 (10.0%) participants had healthy sleep patterns' score equal to 5. Then, we used 5 surveys' data to identify 2 distinct trajectories of depression symptoms during college (decreasing: 82.5%; increasing: 17.5%). The healthy sleep patterns were associated with these trajectories, the better healthy sleep patterns significantly decrease the risk of increasing trajectories of depression symptoms in males (OR: 0.72, 95%CI: 0.54 ~ 0.97, P = 0.031). Moreover, we found out that the healthy sleep patterns of college students can predict the future depressive symptoms in this study (all P < 0.001).

CONCLUSION

Our findings indicate that the better healthy sleep patterns may significantly decrease the risk of increasing trajectory of depression symptoms only in male college students. The results speak to a need for college student with depression symptoms to identify and address sleep problems when present, which could prevent or reduce depression detriments in later life.

Developing and validating a prediction model of adolescent major depressive disorder in the offspring of depressed parents

BACKGROUND

Parental depression is common and is a major risk factor for depression in adolescents. Early identification of adolescents at elevated risk of developing major depressive disorder (MDD) in this group could improve early access to preventive interventions.

METHODS

Using longitudinal data from 337 adolescents at high familial risk of depression, we developed a risk prediction model for adolescent MDD. The model was externally validated in an independent cohort of 1,384 adolescents at high familial risk. We assessed predictors at baseline and MDD at follow-up (a median of 2-3 years later). We compared the risk prediction model to a simple comparison model based on screening for depressive symptoms. Decision curve analysis was used to identify which model-predicted risk score thresholds were associated with the greatest clinical benefit.

RESULTS

The MDD risk prediction model discriminated between those adolescents who did and did not develop MDD in the development (C-statistic = .783, IQR (interquartile range) = .779, .778) and the validation samples (C-statistic = .722, IQR = -.694, .741). Calibration in the validation sample was good to excellent (calibration intercept = .011, C-slope = .851). The MDD risk prediction model was superior to the simple comparison model where discrimination was no better than chance (C-statistic = .544, IQR = .536, .572). Decision curve analysis found that the highest clinical utility was at the lowest risk score thresholds (0.01-0.05).

CONCLUSIONS

The developed risk prediction model successfully discriminated adolescents who developed MDD from those who did not. In practice, this model could be further developed with user involvement into a tool to target individuals for low-intensity, selective preventive intervention.

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.

Parent-Adolescent Conflict, Depressive Symptoms, and Non-Suicidal Self-Injury among Chinese Adolescents: The Moderating Effect of the COMT Gene rs4680 Polymorphism

Existing research suggests that parent-adolescent conflict is associated with increased risk for adolescent non-suicidal self-injury (NSSI). However, adolescent NSSI reactions to parent-adolescent conflicts exhibit large individual differences. This study sought to explore whether depressive symptoms mediates the relationship between parent-adolescent conflict and adolescent NSSI, and whether this mediating process is moderated by the COMT gene rs4680 polymorphism. A total of 673 adolescents (364 males, 309 females) in the age range of 12 to 15 years (Mean_age = 12.81 years, SD = 0.48) completed questionnaires regarding parent-adolescent conflict, depressive symptoms, and NSSI. Genomic DNA was extracted from saliva and buccal cells from each participant. Bootstrapping techniques displayed statistically significant moderated mediation. The results showed that the positive association between parent-adolescent conflict and adolescent NSSI was in fact mediated by depressive symptoms. Moreover, this indirect link was moderated by the COMT gene rs4680 polymorphism. Specifically, the risk effect of parent-adolescent conflict on adolescent NSSI via depressive symptoms was stronger for adolescents with Val/Val genotype than for those with Met/Met or Val/Met genotype. These findings underscore the importance of examining the interaction between genes and the environment to understand how and when parent-adolescent conflict impacts adolescent NSSI.

Depression in young people

Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.

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.

Program for education and enrichment of relational skills (PEERS) training for social skills and depressed mood intervention in young adult with depression: Study protocol for a randomized controlled trial

INTRODUCTION

Depression is a common psychiatric disorder characterized by persistent low mood, reduced interest, and slowed thinking. Young adults are the main first-onset group for depression in all categories of the population. Program for education and enrichment of relational skills (PEERS) training, a program for the Education and Enrichment of Relational Skills, has been used in Europe and America for people with various types of social disorders with good results. A Chinese adaptation of the PEERS training program may be a new approach to help youth with depression return to society as soon as possible. This study aimed to construct and optimize a social skills training program for Chinese young adults with depression and to validate the impact of the program.

MATERIALS AND METHODS AND ANALYSIS

The aim of this trial protocol is to evaluate the efficacy of the localized PEERS training program on social competence, depressed mood in a Chinese young adult population with depression. The primary outcome will be a change in self-reported depressive symptoms from baseline to week 3 post-randomization to week 6 post-randomization measured using the Liebowitz social anxiety scale (LSAS). Secondary outcomes include the rate of decline in severe social anxiety, the Social Avoidance and Distress Scale (SAD), the Social Self-Efficacy Scale (PSSE), and the Hamilton Depression Scale (HAMD-17). Data for each assessment will be collected at baseline, week 3 of the trial, and week 6 of the trial.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Hospital Ethics Committee. Findings will be disseminated through scientific journals, conferences, and university courses.

TRIAL REGISTRATION NUMBER

[http://www.chictr.org.cn/], identifier [ChiCTR2100046050].

Correlates and Predictors of Chronicity among Adolescents Living in Puerto Rico With a History of Depressive Symptoms

Chronic depression (CD) among Hispanic/Latina(o) youths has been understudied, although chronicity is the biggest risk factor for treatment-resistant depression. We examined CD correlates and predictors among 291 youths (aged 12-18 years) living in Puerto Rico with a history of depressive symptoms. They completed the Children's Depression Inventory (CDI), the Depressive Symptoms Spectrum Assessment Inventory (DSSAI), and the Brief Structured Diagnostic Measure for Depression. We explored CD correlates using Odds Ratios adjusted for CDI-Total scores. With multiple logistic regression, we identified optimal predictors of a history of chronic depressive symptoms (HCDS) or any chronic depressive disorder (HACDD). Living zone (rural), history of depressive disorder, household size (< 4), age of onset of symptoms (< 13 years), death/suicidal thoughts at the first episode, antidepressants use, and scores ≥ 84^th percentile in the DSSAI-Anhedonia subscale, accounted for 37% of HCDS variance. The latter five variables and socioeconomic status (lower-middle/low) best distinguished HACDD and episodic disorders (R ² = .331). Identifying factors that distinguish chronic and episodic depression among Hispanic/Latina(o) youths may help to improve their diagnosis, access to and quality of care, as well as treatment selection, tailoring, and outcomes.