Screening for depression prevention: identifying adolescent girls at high risk for future depression

A Short-Form Measure of Loneliness to Predict Depression Symptoms Among Adolescents

The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n = 1683; T 3, n = 1406). Items were reduced while preserving predictability. Follow-up confirmatory factor analyses and predictive models with the reduced and full PALs were then tested. A reduced six-item scale (PALs-6) preserved the two-factor structure of the PALs and showed strong prediction of very elevated depressive symptoms (Sensitivity = 0.70, Specificity = 0.78, AUC = 0.81); it was less successful in predicting future symptoms (Sensitivity = 0.67, Specificity = 0.64, AUC = 0.74). The PALs-6 provides a brief measure of adolescent loneliness for clinicians and researchers that also predicts very elevated levels of depression.

Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 208 adolescents (48.5% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Data from 153 adolescents who completed all assessments in the different phases of the study were analyzed. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6 month follow-up was carried out, together with a 1 month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE + in the short and long term. Interventions were acceptable in terms of acceptability, with good satisfaction rates. Tailored targeted selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

Examining the use of decision trees in population health surveillance research: an application to youth mental health survey data in the COMPASS study

INTRODUCTION

In population health surveillance research, survey data are commonly analyzed using regression methods; however, these methods have limited ability to examine complex relationships. In contrast, decision tree models are ideally suited for segmenting populations and examining complex interactions among factors, and their use within health research is growing. This article provides a methodological overview of decision trees and their application to youth mental health survey data.

METHODS

The performance of two popular decision tree techniques, the classification and regression tree (CART) and conditional inference tree (CTREE) techniques, is compared to traditional linear and logistic regression models through an application to youth mental health outcomes in the COMPASS study. Data were collected from 74 501 students across 136 schools in Canada. Anxiety, depression and psychosocial well-being outcomes were measured along with 23 sociodemographic and health behaviour predictors. Model performance was assessed using measures of prediction accuracy, parsimony and relative variable importance.

RESULTS

Decision tree and regression models consistently identified the same sets of most important predictors for each outcome, indicating a general level of agreement between methods. Tree models had lower prediction accuracy but were more parsimonious and placed greater relative importance on key differentiating factors.

CONCLUSION

Decision trees provide a means of identifying high-risk subgroups to whom prevention and intervention efforts can be targeted, making them a useful tool to address research questions that cannot be answered by traditional regression methods.

Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders

Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, online-delivered, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session, to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 286 adolescents (53.3% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6-month follow-up was carried out, together with a 1-month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE +. Interventions were excellent in terms of acceptability, with good satisfaction rates. Tailored selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.

Using Decision Trees to Examine Environmental and Behavioural Factors Associated with Youth Anxiety, Depression, and Flourishing

Modifiable environmental and behavioural factors influence youth mental health; however, past studies have primarily used regression models that quantify population average effects. Decision trees are an analytic technique that examine complex relationships between factors and identify high-risk subgroups to whom intervention measures can be targeted. This study used decision trees to examine associations of various risk factors with youth anxiety, depression, and flourishing. Data were collected from 74,501 students across Canadian high schools participating in the 2018-2019 COMPASS Study. Students completed a questionnaire including validated mental health scales and 23 covariates. Decision trees were grown to identify key factors and subgroups for anxiety, depression, and flourishing outcomes. Females lacking both happy home life and sense of connection to school were at greatest risk for higher anxiety and depression levels. In contrast with previous literature, behavioural factors such as diet, movement and substance use did not emerge as differentiators. This study highlights the influence of home and school environments on youth mental health using a novel decision tree analysis. While having a happy home life is most important in protecting against youth anxiety and depression, a sense of connection to school may mitigate the negative influence of a poor home environment.

Assessing Aspects of Social Relationships in Youth Across Middle Childhood and Adolescence: The NIH Toolbox Pediatric Social Relationship Scales

OBJECTIVE

Social relationships are a critical context for children's socioemotional development and their quality is closely linked with concurrent and future physical and emotional wellbeing. However, brief self-report measures of social relationship quality that translate across middle childhood, adolescence, and adulthood are lacking, limiting the ability to assess the impact of social relationships on health outcomes over time. To address this gap, this article describes the development and testing of the National Institutes of Health (NIH) Toolbox Pediatric Social Relationship Scales, which were developed in parallel with the previously-reported Adult Social Relationship Scales.

METHODS

Item sets were selected from the NIH Toolbox adult self-report item banks in the domains of social support, companionship, and social distress, and adapted for use in preadolescent (ages 8-11 years) and adolescent (ages 12-18 years) cohorts. Items were tested across a U.S. community sample of 1,038 youth ages 8-18 years. Classical test and item response theory approaches were used to identify items for inclusion in brief unidimensional scales. Concurrent validity was assessed by comparing resultant scales to established pediatric social relationship instruments.

RESULTS

Internal reliability and concurrent validity were established for five unique scales, with 5-7 items each: Emotional Support, Friendship, Loneliness, Perceived Rejection, and Perceived Hostility.

CONCLUSIONS

These brief scales represent developmentally appropriate and valid instruments for assessing the quality of youth social relationships across childhood and adolescence. In conjunction with previously published adult scales, they provide an opportunity for prospective assessment of social relationships across the developmental spectrum.

Disentangling emotional processing in dysphoria: An ERP and cardiac deceleration study

The present study aimed to investigate emotional processing in dysphoria. To this end, the amplitude of the Late Positive Potential (LPP) and cardiac deceleration were assessed during the passive viewing of affective (pleasant, neutral, and unpleasant) pictures in 26 individuals with dysphoria and in 25 non-depressed controls. The group with dysphoria revealed a smaller LPP amplitude than the group without dysphoria in response to pleasant and neutral, but not unpleasant, stimuli at centro-parieto-occipital sites. Interestingly, whereas both groups showed cardiac deceleration when viewing pleasant compared to neutral pictures (3-6 s time window), only individuals with dysphoria showed a prolonged cardiac deceleration in response to unpleasant stimuli as compared with neutral ones. This study suggests that dysphoria is characterized by reduced motivated attentional allocation to positive information and by sustained intake of unpleasant information. Overall, the present findings provide novel insights into the characterization of valence-specific attentional processes in dysphoria as potential vulnerability factors for clinically significant depression.

Long Term Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders: Analyses at 12 Months Post-Treatment

Depression is a major problem in youth mental health and identified as the leading cause of disability worldwide. There is ample research on the acute effects of treatment, with estimated small-to-moderate effect sizes. However, there is a lack of research on long-term outcomes. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03), received blended CBT, face-to-face CBT or treatment as usual. Data were collected at 12 months after the intervention and compared between treatment conditions. Clinical diagnosis, depressive symptoms, suicide risk, internalizing symptoms and externalizing symptoms decreased significantly over time, from baseline to the 12-month follow-up, and also from post-treatment to the 12-month follow-up in all three conditions. Changes were not significantly different between conditions. At the long-term, improvements following the treatment continued. Due to the large amount of missing data and use of history control condition, our findings need to be interpreted with caution. However, we consider these findings as a clinical imperative. More evidence might contribute to convincing adolescents to start with therapy, knowing it has lasting effects. Further, especially for adolescents for whom it is not possible to receive face-to-face treatment, blended treatment might be a valuable alternative. Our findings might contribute to the implementation of blended CBT.

Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents

Major depressive disorder (MDD) and other affective disorders may surreptitiously arise in children and adolescents during their school period and impair their social and educational functioning. Besides the social and personal burden, which are increased during the SARS-CoV-2 pandemic, the onset of depression may compromise the future of the growing person with chronicity and recurrence. In this context, educators’ training is essential to detect early the onset of a depressive disorder, to spare later consequences through the timely establishment of adequate treatment. The educational staff should receive adequate training to be able to work closely with healthcare providers and parents, thus directing the young person with an affective disorder to the right psychological and pharmacological treatment provider, i.e., a specialized psychologist or psychiatrist. The first approach should be to establish a trustful relationship with the adolescent and his/her classmates, to reduce social and self-stigma and inform about mental illness. If symptoms do not subside and the suffering child or adolescent fails to reintegrate within his/her school environment, cognitive–behavioral interventions are recommended that are individual, group, or computer-based. When needed, these should be implemented with individualized pharmacotherapy.

Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.

School-Based Approaches to Prevent Depression in Adolescents

Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.

Increased functional connectivity within alpha and theta frequency bands in dysphoria: A resting-state EEG study

BACKGROUND

The understanding of neurophysiological correlates underlying the risk of developing depression may have a significant impact on its early and objective identification. Research has identified abnormal resting-state electroencephalography (EEG) power and functional connectivity patterns in major depression. However, the entity of dysfunctional EEG dynamics in dysphoria is yet unknown.

METHODS

32-channel EEG was recorded in 26 female individuals with dysphoria and in 38 age-matched, female healthy controls. EEG power spectra and alpha asymmetry in frontal and posterior channels were calculated in a 4-minute resting condition. An EEG functional connectivity analysis was conducted through phase locking values, particularly mean phase coherence.

RESULTS

While individuals with dysphoria did not differ from controls in EEG spectra and asymmetry, they exhibited dysfunctional brain connectivity. Particularly, in the theta band (4-8 Hz), participants with dysphoria showed increased connectivity between right frontal and central areas and right temporal and left occipital areas. Moreover, in the alpha band (8-12 Hz), dysphoria was associated with increased connectivity between right and left prefrontal cortex and between frontal and central-occipital areas bilaterally.

LIMITATIONS

All participants belonged to the female gender and were relatively young. Mean phase coherence did not allow to compute the causal and directional relation between brain areas.

CONCLUSIONS

An increased EEG functional connectivity in the theta and alpha bands characterizes dysphoria. These patterns may be associated with the excessive self-focus and ruminative thinking that typifies depressive symptoms. EEG connectivity patterns may represent a promising measure to identify individuals with a higher risk of developing depression.

Translating Cognitive Vulnerability Theory Into Improved Adolescent Depression Screening: A Receiver Operating Characteristic Approach

Traditionally, screening research tests how well a given symptom inventory can identify a concurrent depressive episode. Although developmental psychopathology could inform screening protocols for a myriad of depression outcomes (e.g., prospective depressive episodes), approaches typically used in research make it difficult to translate these findings. Using a translational analytic approach and multiwave longitudinal study design, we examined how screening for cognitive vulnerabilities (rumination, dysfunctional attitudes, and attributional style) may improve our ability to identify concurrent depressive episodes, prospective depressive episodes, first lifetime episodes of depression, and recurrent major depressive episodes. There were 473 sixth-grade (early adolescents) and ninth-grade (middle adolescents; AgeM = 13.15, AgeSD = 1.62) students who completed baseline self-report cognitive vulnerability and depressive symptom measures. At baseline and every 6 months for 3 years, pediatric depression interviews were completed by the caregiver and youth. A receiver operating characteristic (ROC) approach was utilized to test our aims. Distinct algorithms best forecasted our depression outcomes. Rumination and attributional style emerged as unique and incrementally valid predictors for prospective episodes after controlling for baseline depressive symptoms. Rumination was the only unique predictor for first lifetime depressive episodes. For recurrent major depression, rumination in early adolescence and attributional style in middle adolescence served as incremental predictors beyond baseline depressive symptoms. Proposed cutoffs and diagnostic likelihood ratios are offered for algorithms for each depression outcome. Assessing cognitive vulnerability represents a feasible method to improve depression screening initiatives. Using an ROC-informed approach can help prevention initiatives better leverage the considerable gains made within developmental psychopathology research.

Effect of Parenting and Peer Stressors on Cognitive Vulnerability and Risk for Depression among Youth

Parenting behaviors influence clinical depression among youth, but little is known about the developmental processes that may account for this association. This study investigated whether parenting is associated with the onset of clinical depression and depressive symptoms through negative cognitive style, particularly under conditions of high exposure to stressors, in a community sample of children and adolescents (N = 275; 59% girls). Observational methods were used to assess positive and negative parenting during a laboratory social-evaluative stressor task. Depressive symptoms and clinical depressive episodes were repeatedly assessed over an 18-month prospective follow-up period. Results supported a conditional indirect effect in which low levels of observed positive parenting during a youth stressor task were indirectly associated with an increased likelihood of experiencing an episode of depression and worsening depressive symptoms over the course of the study through youth negative cognitive style, but only for youth who also experienced a high number of peer stressors. These findings elucidate mechanisms through which problematic parenting may contribute to risk for the development of clinical depression during the transition into and across adolescence. Implications for depression interventions are discussed.

At-risk studies and clinical antecedents of psychosis, bipolar disorder and depression: a scoping review in the context of clinical staging

Identifying young people at risk of developing serious mental illness and identifying predictors of onset of illness has been a focus of psychiatric prediction research, particularly in the field of psychosis. Work in this area has facilitated the adoption of the clinical staging model of early clinical phenotypes, ranging from at-risk mental states to chronic and severe mental illness. It has been a topic of debate if these staging models should be conceptualised as disorder-specific or transdiagnostic. In order to inform this debate and facilitate cross-diagnostic discourse, the present scoping review provides a broad overview of the body of literature of (a) longitudinal at-risk approaches and (b) identified antecedents of (homotypic) illness progression across three major mental disorders [psychosis, bipolar disorder (BD) and depression], and places these in the context of clinical staging. Stage 0 at-risk conceptualisations (i.e. familial high-risk approaches) were identified in all three disorders. However, formalised stage 1b conceptualisations (i.e. ultra-high-risk approaches) were only present in psychosis and marginally in BD. The presence of non-specific and overlapping antecedents in the three disorders may support a general staging model, at least in the early stages of severe psychotic or mood disorders.

A multimethod screening approach for pediatric depression onset: An incremental validity study

OBJECTIVE

Screening protocols that rely on a single informant are inadequate in predicting pediatric depression. Multi-informant and risk factor screening approaches are potentially more sensitive methods for identifying depression risk, but the incremental validity of these protocols has not been adequately tested. Using a translational analytic approach and multimethod, longitudinal study design, we simultaneously tested several multi-indicator approaches to depression screening to identify an optimal algorithm for predicting depression onset in youth.

METHOD

Participants were 222 never-depressed children and adolescents (M_age = 10.75 years old, SD_age = 1.85; female = 50.45%; 82.88% White), who completed baseline questionnaires for depressive symptoms and cognitive vulnerabilities, in addition to a morphed face task to assess pupil dilation. Mothers, meanwhile, completed baseline questionnaires and a semistructured interview to assess maternal and pediatric depression. Follow-up depression diagnostic assessments with both the mother and youth occurred every 6 months for 2 years. Receiver operating characteristics and reclassification analyses were used to test our aims.

RESULTS

Overall, we found moderate support for a multi-informant approach, and convincing evidence that individual differences in pupil dilation uniquely predicted depression onset. Youth with subthreshold depressive symptoms and elevated pupil dilation were over twice as likely to develop a first lifetime episode of depression compared to one's risk rate based on sex and age.

CONCLUSIONS

Our study provides one of the first screening batteries for detecting first lifetime episodes of depression in youth. The unique and incremental validity provided by pupil dilation suggests feasible biological indicators of depression risk can improve primary prevention efforts that target depression, such as universal pediatric depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Subsyndromal Manifestations of Depression in Children Predict the Development of Major Depression

OBJECTIVE

To evaluate the utility of assessing subsyndromal symptoms of major depressive disorder in childhood, indexed through the Child Behavior Checklist (CBCL) anxiety/depression scale, in predicting risk of developing major depressive disorder in adolescent and young adult years.

STUDY DESIGN

The sample consisted of 537 children, 6-17 years of age, originally ascertained for a longitudinal family genetic study of youth with and without attention-deficit hyperactivity disorder and their first-degree relatives who were followed prospectively and blindly for 10 years from childhood into young adult years. Children with full diagnosis major depressive disorder at baseline were excluded. For analysis, the sample was stratified into 4 groups based on the presence or absence of parental mood disorders and by the presence or absence of subsyndromal scores on the CBCL anxiety/depression scale at baseline assessment in childhood.

RESULTS

Children of parents with mood disorders plus subsyndromal scores on the CBCL anxiety/depression scale at baseline (n = 22) had the highest risk for developing major depressive disorder and anxiety disorders at the 10-year follow-up when compared with the other groups. Children with either subsyndromal scores on the CBCL anxiety/depression scale at baseline alone (n = 22) or parental mood disorders alone (n = 172) had intermediate outcomes.

CONCLUSION

The CBCL anxiety/depression scale was useful in identifying children at high risk for the development of major depressive disorder and anxiety disorders at the 10-year prospective follow-up. Furthermore, our results emphasized the importance of familial psychiatric history in youth with subthreshold symptoms of depression. Parental mood disorder and subthreshold anxiety/depressive symptoms were predictive of developing depression.

Outcomes of a Randomized Controlled Trial on the Effectiveness of Depression and Anxiety Prevention for Adolescents with a High Familial Risk

A randomized controlled trail was conducted to examine the effectiveness of a depression and anxiety prevention program ‘Een Sprong Vooruit’ (A Leap Forward) among adolescent girls with a high familial risk (N = 142). The results showed neither effects of the prevention program directly after the intervention, nor at 6 or 12 months follow-up on depression and anxiety symptoms. Further, latent growth curve modeling (LGCM) was used to examine whether the growth functions for the intervention and the control condition were different. The slope representing the change in depression symptoms was not significantly different between the intervention and the control condition. For anxiety symptoms, the difference between slopes was also not significant. Based on these results, we suggested that these high-risk adolescent girls might benefit more from a more intensive prevention program.

Cross-sectional relationship of perceived familial protective factors with depressive symptoms in vulnerable youth

BACKGROUND

There are multiple negative consequences associated with heavy episodic drinking and close associations between substance abuse and depression, alcohol-intoxicated adolescents (AIA) represent a vulnerable group. We aim to add to the current literature by investigating the cross-sectional relationship of perceived familial protective factors with depressive symptoms in AIA in hospitals, with respect to sex. Depression is among the 10 leading causes of disabilities during childhood and adolescence, with girls being more vulnerable than boys. Considerable evidence reveals a strong association between depression and alcohol abuse. The family provides the possibility to positively influence depressive symptoms.

METHODS

We present cross-sectional data of a German multisite, epidemiological cohort study on AIA. By using youth's self-reports, we assessed sociodemographic data, as well as data on perceived familial protective factors and depressive symptoms using items of the Communities that Care Youth Survey instrument. We performed descriptive and multigroup analyses to evaluate the measurement invariance of the used instruments. Moreover, to investigate the relationships between the constructs, we used structural equation modelling.

RESULTS

The study sample comprised 342 AIA, with a mean age of 15.5 years (SD = 1.2; 48.1% girls). The final structural equation model achieved an acceptable model fit of χ2 (69, 342) = 110.056; p = .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.046; SRMR = 0.042, and the rewards for prosocial involvement in the family context correlated significantly negatively with present depressive symptoms, (ß = - 0.540, p <  0.001). The effects were stronger in boys (ß = - 0.576, p <  0.001) than in girls (ß = - 0.519, p <  0.001).

CONCLUSION

In vulnerable youth in Germany, depressive symptoms are correlated to good experiences within the family. Future research should assess whether interventions that enhance parental support reduce the risk of depressive symptoms in AIA. Our findings highlight the need for family-based prevention programmes, particularly for AIA with an increased risk of depression.

Exploring Psychosocial Mechanisms and Interactions: Links Between Adolescent Emotional Distress, School Connectedness, and Educational Achievement

Internalizing mental health issues are a significant developmental and clinical concern during adolescence, but rarely identified as a problem among school staff. Using data from the National Longitudinal Study of Adolescent Health, this study examined the associations between adolescent emotional distress, school connectedness, and educational achievement by exploring potential mechanistic and interactive roles of perceived school connectedness on the emotion-education association. Emotional distress was negatively associated with adolescents' perceptions of belonging to school, which, in turn, may negatively influence educational achievement. School connectedness also had both additive and multiplicative interaction effects on the emotion-education relationship. Results support previous evidence of school connectedness as a protective factor for adolescents with internalizing mental health concerns, although much of the work to date has focused on externalizing problems. This study informs our understanding of how, why, and for whom emotional problems influence educational outcomes in light of social support in the school context.

How prevalent and morbid are subthreshold manifestations of major depression in adolescents? A literature review

INTRODUCTION

Major Depressive Disorder (MDD) among youth is a public health concern. Our aim was to examine the current body of knowledge to better characterize the prevalence and morbidity associated with subthreshold forms of MDD among youth. Given that MDD tends to develop gradually over time, we hypothesized a high prevalence and considerable impairment associated with youth suffering from depressive symptoms that fall short of full, syndromic status.

METHODS

A literature search was conducted using PubMed exclusively to identify studies assessing the prevalence and clinical characteristics of subthreshold MDD in adolescents.

RESULTS

Six scientific papers that met our priori inclusion and exclusion criteria were identified. All papers sampled adolescents. The prevalence of subthreshold MDD ranged from 5% over the past year, to 29% over the two weeks prior to screening. These papers reported clinically significant morbidity associated with subthreshold MDD among adolescents, with evidence for elevated rates of psychiatric comorbidities, impaired functioning in social and familial domains, increased suicidality, and frequent mental health service utilization.

LIMITATIONS

Though we examined a sizeable and diverse sample, we only identified six cross-sectional informative studies for this review. Variability of subthreshold MDD and major outcome definitions across studies, likely limits the specificity of findings.

CONCLUSIONS

Subthreshold MDD is prevalent among youth, and is associated with emotional and social impairments that reach the level of obtaining clinical care. These findings could lead to early intervention efforts aimed at mitigating the adverse outcomes associated with subthreshold MDD as well as the progression to full syndrome MDD. Our review documents that regardless of whether progression to full diagnostic status occurs, this condition is morbid.

Can subsyndromal manifestations of major depression be identified in children at risk?

OBJECTIVE

Children of parents with major depression are at significantly increased risk for developing major depression themselves; however, not all children at genetic risk will develop major depressive disorder (MDD). We investigated the utility of subsyndromal scores on the Child Behavior Checklist (CBCL) Anxiety/Depression scale in identifying children at the highest risk for pediatric MDD from among the pool of children of parents with MDD or bipolar disorder.

METHOD

The sample was derived from two previously conducted longitudinal case-control family studies of psychiatrically and pediatrically referred youth and their families. For this study, probands were stratified based on the presence or absence of a parental mood disorder.

RESULTS

Subsyndromal scores on the CBCL Anxiety/Depression scale significantly separated the children at high risk for pediatric MDD from those at low risk in a variety of functional areas, including social and academic functioning. Additionally, children at genetic risk without elevated CBCL Anxiety/Depression scale scores were largely indistinguishable from controls.

CONCLUSION

These results suggest that the CBCL Anxiety/Depression scale can help identify children at highest risk for pediatric MDD. If implemented clinically, this scale would cost-effectively screen children and identify those most in need of early intervention resources to impede the progression of depression.

Cortisol response patterns in depressed women and their healthy daughters at risk: Comparison with healthy women and their daughters

A dysfunctional hypothalamic pituitary adrenal (HPA) axis is widely accepted as a significant pathophysiological aspect of Major Depressive Disorder (MDD). Despite studies suggesting that a dysfunctional HPA axis might be present before the clinical syndrome becomes apparent, the functioning of the HPA axis in high-risk populations has not been well defined. The aim of the present study was to investigate the HPA axis functioning of mothers suffering from MDD and their healthy daughters compared to age- and sex-matched healthy controls. This design allowed a comparison of HPA axis functional differences among daughter and mother groups. HPA axis function was evaluated with a modified dexamethasone/corticotropin-releasing hormone (Dex/CRH) test, which was performed after obtaining the diurnal adrenocorticotropic hormone (ACTH) and cortisol values at 8:00, 16:00, and 23:00 h. We found that MDD mothers and their daughters had low morning cortisol and the MDD mothers additionally had low-morning ACTH compared with controls. Dexamethasone suppressed both cortisol and ACTH in all groups and subsequent HPA axis stimulation by CRH-evoked a lower cortisol response but a higher ACTH response among subjects with MDD mothers. Although high-risk daughters had comparable cortisol levels after CRH infusion, the AUC for ACTH was greater than those of controls. These patterns of results suggest that multiple level HPA dysfunctions are present in both MDD patients and their high-risk carrying daughters. However, insufficient cortisol secretion was only present in MDD mothers, while the daughters could compensate cortisol levels during CRH challenge.

Universal School-Based Depression Prevention 'Op Volle Kracht': a Longitudinal Cluster Randomized Controlled Trial

The longitudinal effectiveness of a universal, adolescent school-based depression prevention program Op Volle Kracht (OVK) was evaluated by means of a cluster randomized controlled trial with intervention and control condition (school as usual). OVK was based on the Penn Resiliency Program (PRP) (Gillham et al. Psychological Science, 6, 343-351, 1995). Depressive symptoms were assessed with the Child Depression Inventory (Kovacs 2001). In total, 1341 adolescents participated, Mage = 13.91, SD = 0.55, 47.3 % girls, 83.1 % Dutch ethnicity; intervention group n = 655, four schools; control group n = 735, five schools. Intent-to-treat analyses revealed that OVK did not prevent depressive symptoms, β = -0.01, SE = 0.05, p = .829, Cohen's d = 0.02, and the prevalence of an elevated level of depressive symptoms was not different between groups at 1 year follow-up, OR = 1.00, 95 % CI = 0.60-1.65, p = .992, NNT = 188. Latent Growth Curve Modeling over the 2 year follow-up period showed that OVK did not predict differences in depressive symptoms immediately following intervention, intercept: β = 0.02, p = .642, or changes in depressive symptoms, slope: β = -0.01, p = .919. No moderation by gender or baseline depressive symptoms was found. To conclude, OVK was not effective in preventing depressive symptoms across the 2 year follow-up. The implications of these findings are discussed.

A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression

OBJECTIVE

Undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that assessed the direction of effects between eating pathology and depression. A second aim was to use meta-regression to account for heterogeneity in terms of study-level effect modifiers.

METHOD

A systematic review was conducted on 42 studies that assessed the longitudinal relationship between eating pathology and depression. Of these 42 studies, multilevel random-effects meta-analyses were conducted on 30 eligible studies.

RESULTS

Meta-analysis results showed that eating pathology was a risk factor for depression (rm  = 0.13) and that depression was a risk factor for eating pathology (rm  = 0.16). Meta-regression analyses showed that these effects were significantly stronger for studies that operationalized eating pathology as an eating disorder diagnosis versus eating pathology symptoms, and for studies that operationalized the respective outcome measure as a categorical variable (e.g., a diagnosis of a disorder or where symptoms were "present"/"absent") versus a continuous measure. Results also showed that in relation to eating pathology type, the effect of an eating disorder diagnosis and bulimic symptoms on depression was significantly stronger for younger participants.

DISCUSSION

Eating pathology and depression are concurrent risk factors for each other, suggesting that future research would benefit from identifying factors that are etiological to the development of both constructs.

RESUMEN OBJETIVO

Llevar a cabo un meta-análisis para proporcionar una síntesis cuantitativa de los estudios longitudinales que evaluaron la dirección de los efectos entre la alimentación patológica y la depresión. Un segundo objetivo fue utilizar la meta-regresión para dar cuenta de la heterogeneidad en términos de modificadores del efecto a nivel de estudio. MÉTODO: Una revisión sistemática se llevó a cabo en 42 estudios que evaluaron la relación longitudinal entre la alimentación patológica y la depresión. De estos 42 estudios, se realizaron meta-análisis de multinivel de efectos aleatorios en 30 estudios elegibles.

RESULTADOS

Los resultados del meta-análisis mostraron que la alimentación patológica era un factor de riesgo para depresión (rm=0.13) y que la depresión era un factor de riesgo para la alimentación patológica (rm=0.16). Los análisis de meta-regresión mostraron que estos efectos eran significativamente más fuertes para estudios que operacionalizaban la alimentación patológica como un diagnóstico de trastorno de la conducta alimentaria versus síntomas de alimentación patológica, y para los estudios que operacionalizaban la medida respectiva de resultado como una variable categórica (e.g., un diagnóstico de trastorno o cuando los síntomas estaban "presentes"/"ausentes") versus una medida continua. Los resultados mostraron que en relación al tipo de alimentación patológica, el efecto de un diagnóstico de trastorno de la conducta alimentaria y síntomas bulímicos en la depresión era significativamente más fuerte para participantes más jóvenes. DISCUSIÓN: La alimentación patológica y la depresión son factores de riesgo concurrentes uno para el otro, lo que sugiere que la investigación futura se beneficiaría de identificar factores que son etiológicos al desarrollo de ambos constructos. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016;49:439-454).

An examination of participants who develop an eating disorder despite completing an eating disorder prevention program: implications for improving the yield of prevention efforts

Numerous trials provide support for the Body Project, an eating disorder prevention program wherein young women with body image concerns critique the thin ideal. Despite medium to large effects, some participants subsequently develop an eating disorder, suggesting that intervention or recruitment procedures could be improved. This study investigated baseline and acute intervention predictors of DSM-5 eating disorder development during a 3-year follow-up among Body Project participants. Combined data from two trials compare participants who experienced eating disorder onset during follow-up (n = 20) to those who did not (n = 216). Participants who did versus did not develop an eating disorder started the intervention with higher eating disorder symptoms (η (2) = 0.08), negative affect (η (2) = 0.06), thin-ideal internalization (η (2) = 0.02), and body dissatisfaction (η (2) = 0.02); the same baseline predictors of eating disorder onset emerged in controls. Attenuated pre-post reductions in eating disorder symptoms (η (2) = 0.01) predicted eating disorder onset but not after controlling for baseline levels. Given that Body Project and control participants who later developed an eating disorder started with initial elevations in risk factors and eating disorder symptoms, it might be useful to develop a more intensive variant of this program for those exhibiting greater risk at baseline and to deliver the prevention program earlier to prevent initial escalation of risk. The fact that nonresponders also showed greater negative affect and eating disorder symptoms suggests that it might be useful to add activities to improve affect and increase dissonance about disordered eating.

Family-based interpersonal psychotherapy for depressed preadolescents: examining efficacy and potential treatment mechanisms

OBJECTIVE

To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health.

METHOD

Preadolescents with depression (N = 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers.

RESULTS

Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2) = 0.35, ΔR(2) = 0.22; B = -8.15, SE = 2.61, t[37] = -3.13, p = .002, F(2) = 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms.

CONCLUSION

Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study of Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents; http://clinicaltrials.gov; NCT02054312.

Secondary outcomes of a school-based universal resiliency training for adolescents: a cluster randomized controlled trial

BACKGROUND

The study investigated the long-term effectiveness of the adolescent cognitive behavioral resiliency training Op Volle Kracht (OVK) on the secondary outcomes: anxiety symptoms, hopelessness, happiness, life satisfaction, optimism, coping, self-efficacy, and school functioning. In addition, the study analyzed whether the secondary outcomes moderated the intervention effect on depressive symptoms.

METHODS

A two-condition (intervention and control) cluster randomized controlled trial was conducted. All adolescents in the 8th grade were eligible to participate, unless they, or their parents, declined their participation. Schools were the unit of randomization. Missing data were imputed and intent to treat analyses were conducted. The results were analyzed using Latent Growth Curve Modeling across the 24-months follow-up period.

RESULTS

The total sample consisted of 1341 adolescents (Mage = 13.91, SD =0.55, 47.3% girls, 83.1% Dutch ethnicity). The intervention and control condition consisted of 634 adolescents from 4 schools and 707 adolescents from 5 schools, respectively. OVK did not have an effect on depression, anxiety, hopelessness, happiness, and life satisfaction, but promoted cognitive coping over the course of the follow-up period. OVK showed small iatrogenic effects on optimism, active coping, social self-efficacy and school grades directly post intervention, but these effects disappeared during the follow-up period. Finally, none of the outcome variables moderated the intervention effect on depressive symptoms.

CONCLUSIONS

The universal resiliency training OVK was not effective in this Dutch sample. Implications for research and practice were discussed.

TRIAL REGISTRATION NUMBER

NTR2879.

Predictors of prevention failure in college students participating in two indicated depression prevention programs

The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force.

Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk

BACKGROUND

The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD.

METHODS

Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD.

RESULTS

Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation.

LIMITATIONS

Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD.

CONCLUSIONS

Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs.

Cluster randomized controlled trial of a psycho-educational intervention for people with a family history of depression for use in general practice

BACKGROUND

The strongest risk factor for depression is having a family history of the condition. Many individuals with a family history of depression are concerned about their personal risk for depression and report unmet educational and psychological support needs. No supportive and/or educational interventions are currently available that target this group of individuals. In this study we will develop and evaluate the first online psycho-educational intervention targeted to individuals with a family history of depression. Genetic risk information and evidence-rated information on preventive strategies for depression will be provided to such individuals in a general practice setting. The intervention will also incorporate a risk assessment tool. The content and delivery of the intervention will be pilot-tested.

METHODS/DESIGN

The proposed intervention will be evaluated in the general practitioner (GPs) setting, using a cluster randomized controlled trial. GP practices will be randomized to provide either access to the online, targeted psycho-educational intervention or brief generic information about depression (control) to eligible patients. Eligibility criteria include having at least one first-degree relative with either major depressive disorder (MDD) or bipolar disorder (BD). The primary outcome measure is 'intention to adopt, or actual adoption of, risk-reducing strategies'. Secondary outcome measures include: depression symptoms, perceived stigma of depression, knowledge of risk factors for development of depression and risk-reducing strategies, and perceived risk of developing depression or having a recurrence of family history. Over the course of the study, participants will complete online questionnaires at three time points: at baseline, and two weeks and six months after receiving the intervention or control condition.

DISCUSSION

This novel psycho-educational intervention will provide individuals with a family history of depression with information on evidence-based strategies for the prevention of depression, thus, we hypothesize, enabling them to make appropriate lifestyle choices and implement behaviors designed to reduce their risk for depression. The online psycho-educational intervention will also provide a model for similar interventions aimed at individuals at increased familial risk for other psychiatric disorders.

TRIAL REGISTRATION

The study is registered with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12613000402741).

Effects of three depression prevention interventions on risk for depressive disorder onset in the context of depression risk factors

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.

Correlates of depressive symptoms among at-risk youth presenting to the emergency department

OBJECTIVE

The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED).

METHOD

A systematic sample of adolescents (ages 14-18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms.

RESULTS

Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78-4.51], poor academic performance (OR: 1.57, 95% CI: 1.01-2.44), binge drinking (OR: 1.88, 95% CI: 1.21-2.91), community violence exposure (OR: 2.25, 95% CI: 1.59-3.18) and dating violence (OR: 2.14, 95% CI: 1.36-3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29-0.91) and older age (OR: 0.55, 95% CI 0.34-0.89). Including gender interaction terms did not significantly change findings.

CONCLUSIONS

Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.

Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women

We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.

Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology

BACKGROUND

Postpartum depression (PPD) follows 5-15% of the life births and forms a major threat to the child's mental health and psychosocial development. However, the nature, continuance, and mediators of the association of postpartum depression (PPD) with the child's mental health are not well understood. The aim of this study was to investigate whether an association between PPD and adolescent mental problems is explained by parental psychopathology and whether the association shows specificity to the internalizing or externalizing domain.

METHODS

2729 adolescents aged 10-15 years from the TRacking Adolescents' Individual Life Survey (TRAILS) were included. Both PPD and parental lifetime history of psychopathology were assessed by parent report. Adolescents' psychopathology was assessed using the Achenbach scales (parent, teacher and self report). Linear regression was used to examine the association between PPD and adolescent mental health.

RESULTS

We found a statistically significant association of adolescents' internalizing problems with maternal PPD, which remained when adjusted for parental psychopathology. We found no association for externalizing problems.

LIMITATIONS

Underreporting of both PPD and lifetime parental psychopathology may have occurred due to their retrospective assessment.

CONCLUSIONS

The association of PPD with internalizing but not externalizing problems extends into adolescence. Parental psychopathology does not explain this association suggesting a direct psychological effect on the child postpartum. If this effect appears causal, early treatment of parental psychopathology may prevent internalizing psychopathology in the offspring, ultimately in adolescence.

5-HTTLPR moderates the relation between changes in depressive and bulimic symptoms in adolescent girls: a longitudinal study

OBJECTIVE

Depression and bulimia both are associated with low serotonin levels. We examined whether the serotonin transporter gene (5-HTTLPR) moderates the relation between depressive and bulimic symptoms over time.

METHOD

Fifty adolescent girls with no current or past Axis I disorder were genotyped for the 5-HTTLPR gene. Twice, 6 months apart, participants completed self-report measures of depressive symptoms and bulimic symptoms.

RESULTS

The association between change in depressive symptoms and change in bulimic symptoms over time was significantly stronger in girls who are homozygous for the short 5-HTTLPR allele than for girls with at least one long allele.

DISCUSSION

This finding is consistent with previous studies documenting a relation between depressive and bulimic symptoms in adolescents. Few studies, however, considered the possible role of serotonin linking both disorders. Gaining a better understanding of developmental effects of low serotonin could help to identify high-risk individuals and provide effective prevention and intervention.

The CACNA1C and ANK3 risk alleles impact on affective personality traits and startle reactivity but not on cognition or gating in healthy males

OBJECTIVES

The rs10994336 ANK3 and rs1006737 CACNA1C genetic variants have recently been identified as the most consistent, genome-wide significant risk factors for bipolar disorder, while the CACNA1C variant has also been associated with schizophrenia and major depression. The aim of this study was to examine the phenotypic consequences of the risk CACNA1C and ANK3 alleles in a large homogeneous cohort of healthy young males.

METHODS

We recruited 703 randomly selected, healthy army conscripts (mean age 22.1 ± 3.0 years) from the first wave of the Learning on Genetics of Schizophrenia project in Heraklion, Crete. Of those recruited, 530 subjects entered and completed the study. Subjects were assessed for prepulse inhibition (PPI), startle reactivity, neuropsychology, and personality.

RESULTS

  UNPHASED analysis revealed that the rs1006737 A-allele was associated with lower extraversion and higher harm avoidance, trait anxiety, and paranoid ideation, while the rs10994336 T-allele was associated with lower novelty seeking and behavioral activation scores (p < 0.01). Both alleles were associated with high startle reactivity (p < 0.05). There were no significant associations with any cognitive task performance or PPI.

CONCLUSIONS

The CACNA1C genotype was associated with proneness to anxiety and negative mood, while the ANK3 genotype was associated with proneness to anhedonia. Both risk genotypes were associated with high startle reactivity, suggesting a role of these polymorphisms in threat/stress signal processing, probably in the hippocampus and/or amygdala. None of the risk genotypes affected sensorimotor gating or behavioral performance in an extensive battery of executive function tests in this cohort of healthy males.

Cognitive bias modification training in adolescents: effects on interpretation biases and mood

BACKGROUND

Negative biases in the interpretation of ambiguous material have been linked to anxiety and mood problems. Accumulating data from adults show that positive and negative interpretation styles can be induced through cognitive bias modification (CBM) paradigms with accompanying changes in mood. Despite the therapeutic potential of positive training effects, training paradigms have not yet been explored in adolescents.

METHODS

Eighty-two healthy adolescents (aged 13-17 years) were randomly allocated to either positive or negative CBM training. To assess training effects on interpretation bias, participants read ambiguous situations followed by test sentences with positive or negative interpretations of the situation. Participants rated the similarity of these sentences to the previously viewed ambiguous situations. Training effects on negative and positive affect were assessed using visual analogue scales before and after training.

RESULTS

After training, adolescents in the negative condition drew more negative and fewer positive interpretations of new ambiguous situations than adolescents in the positive condition. Within the positive condition, adolescents endorsed more positive than negative interpretations. In terms of mood changes, positive training resulted in a significant decrease in negative affect across participants, while the negative condition led to a significant decrease in positive affect among male participants only.

CONCLUSION

This is the first study to demonstrate the plasticity of interpretation bias in adolescents. The immediate training effects on mood suggest that it may be possible to train a more positive interpretation style in youth, potentially helping to protect against anxiety and depressive symptoms.

Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up

OBJECTIVE

To evaluate the effects of a brief group cognitive-behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up.

METHOD

In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB bibliotherapy, or educational brochure control condition.

RESULTS

Significantly greater reductions in depressive symptoms were shown by group CB participants relative to brochure control participants by 1-year follow-up and bibliotherapy participants by 1- and 2-year follow-up but not relative to supportive expressive participants. Supportive expressive participants showed greater symptom reduction than CB bibliotherapy participants did at 2-year follow-up. Risk for onset of major or minor depression over the 2-year follow-up was significantly lower for group CB participants (14%; odds ratio = 2.2) and CB bibliotherapy participants (3%; odds ratio = 8.1) than for brochure controls (23%).

CONCLUSIONS

Results indicate that this group CB intervention reduces initial symptoms and risk for future depressive episodes, although both supportive expressive therapy and CB bibliotherapy also produce intervention effects that persist long term. Indeed, CB bibliotherapy emerged as the least expensive method of reducing risk for future episodes of depression.

Promoting adaptive emotion regulation and coping in adolescence: a school-based programme

Particularly in adolescence, fostering adaptive emotion regulation is an important aim in health promotion. Expressive writing in combination with psycho-education on emotion regulation seems especially appropriate to serve this aim. In this study, school classes were randomly assigned either to a prevention (N = 208) or to a non-treatment control group (N = 151). The prevention group showed significant improvements regarding negative affect, grades, and days absent compared to the control-group. A combination of expressive writing with elements of psycho-education of emotion regulation might be an effective preventive tool, as it seems to improve psychosocial adjustment by establishing functional emotion regulation strategies.

Prospective reciprocal relations between physical activity and depression in female adolescents

OBJECTIVE

Although an inverse correlation between physical activity and depression among adolescents has been found in research, this relation has seldom been examined prospectively. Thus, we tested whether physical activity reduces risk for future escalations in depression and whether depression decreases likelihood of future change in physical activity.

METHOD

Data from a longitudinal study involving annual assessments of 496 adolescent girls (mean age = 13 years, SD = 0.73) followed over a 6-year period were analyzed to address these questions.

RESULTS

Using analyses that controlled for several covariates, we found that physical activity significantly reduced risk for future increases in depressive symptoms and risk for onset of major-minor depression. Further, depressive symptoms and major-minor depression significantly reduced future physical activity. However, predictive effects were modest for both.

CONCLUSIONS

Results support a bidirectional relation between exercise and depression and imply that interventions that increase physical activity may reduce risk for depression among this high-risk population.

Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders

Most mental illnesses emerge during adolescence and early adulthood, with considerable associated distress and functional decline appearing during this critical developmental phase. Our current diagnostic system lacks therapeutic validity, particularly for the early stages of mental disorders when symptoms are still emerging and intensifying and have not yet stabilized sufficiently to fit the existing syndromal criteria. While this is, in part, due to the difficulty of distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness, these factors have contributed to a growing movement for the reform of our current diagnostic system to more adequately inform the choice of therapeutic strategy, particularly in the early stages of a mental illness. The clinical staging model, which defines not only the extent of progression of a disorder at a particular point in time but also where a person lies currently along the continuum of the course of an illness, is particularly useful as it differentiates early, milder clinical phenomena from those that accompany illness progression and chronicity. This will not only enable clinicians to select treatments relevant to earlier stages of an illness, where such interventions are likely to be more effective and less harmful than treatments delivered later in the course of illness, but also allow a more efficient integration of our rapidly expanding knowledge of the biological, social, and psychological vulnerability factors involved in the development of mental illness into a useful diagnostic framework.

Detecting emotional disorder in young people in primary care

PURPOSE OF REVIEW

Screening young people for emotional disorder in primary care has seemed sensible given most attend annually and most mental disorder is undetected. Yet evidence supporting screening has been scant. This review considers recent progress around conceptual frameworks, epidemiological findings, accuracy of available instruments and evidence for effectiveness of screening in reducing the burden of emotional disorders.

RECENT FINDINGS

Despite better evidence about the accuracy of screens in identifying adolescent depression and possible benefits of early intervention with current treatments, demonstration of improved health outcomes and cost-effectiveness is still lacking. Even when screening detects mental disorder other factors such as readiness for care and availability of effective treatments may affect responses. Best results are obtained when screening is linked to collaborative models of care. Evidence around harms from screening is scant but debate exists over potential harms of false-positives such as stigma and increased strain on healthcare resources.

SUMMARY

There is growing consensus that, if screening for emotional disorder is to be effective in primary care, facilitated access of identified young people to effective treatment options is necessary. Further research is required to demonstrate that routine screening will improve mental health outcomes and be cost-effective.

Staging in neuropsychiatry: a heuristic model for understanding, prevention and treatment

The main mental disorders which develop and persist through adult life typically emerge during the critical developmental phase of adolescence and early adulthood, and are frequently associated with considerable associated distress and functional decline. Our current diagnostic system lacks validity and therapeutic utility, particularly for the early stages of these mental disorders, when symptoms are still evolving and may have not yet stabilised sufficiently to fit familiar or traditional syndromal criteria. Furthermore, there is often difficulty in distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness. These factors point to the need for reform of our current diagnostic systems. The clinical staging model seeks to define the extent of progression of a disorder at a particular point in time and aims to differentiate early, milder clinical phenomena from those that accompany illness progression and chronicity. The staging framework allows clinicians to select treatments relevant to earlier stages of an illness, and to evaluate their effectiveness in preventing progression and producing remission or return to milder or earlier stages of disorder. For staging to be a valid approach, interventions in the early stages need to shown to be not only more effective but also safer than treatments delivered later in the course of illness. Staging may also allow a more efficient integration of our rapidly expanding knowledge of the biological, social and psychological vulnerability factors involved in development of mental illness into what may ultimately resemble a clinicopathological staging model.