Caffeine consumption, sleep, and affect in the natural environments of depressed youth and healthy controls

Methodological review of caffeine assessment strategies with a focus on adolescents

Adolescent caffeine use and its implications for developmental changes in sleep and circadian rhythms is under-researched. A majority of adolescents report consuming caffeine and yet the United States has not established federal guidelines for this age group. This widely used stimulant is primarily studied using self-report methodologies; however, there is no standardized method for collecting self-report caffeine data and past studies' findings have limited generalizability and comparability, making it challenging to examine the effects of caffeine use on adolescents' sleep. This review discusses methods and measures used for assessing caffeine in the field with adolescents: questionnaires, interviews, and diaries. Based on the review, recommendations for future methodologies and approaches are discussed.

Youth Psychopathology in Daily Life: Systematically Reviewed Characteristics and Potentials of Ecological Momentary Assessment Applications

Traditionally, symptoms of youth psychopathology are assessed with questionnaires, clinical interviews, or laboratory observations. Ecological Momentary Assessment (EMA) could be a particularly valuable additional methodology, since EMA enables examining the daily lives of youths near real-time, considering fluctuations and specific contexts of symptoms. This systematic review aimed to review the characteristics of current EMA applications and to provide a synthesis of their potential in studying youth psychopathology. Following a systematic search in PsycInfo and Medline, we identified 50 studies in clinical samples. Most studies used EMA to examine fluctuations in symptoms, affect, and behavior, and the relation with contextual factors. EMA was also used to investigate interactions between parents and their children over time, and to monitor and predict treatment response. EMA appeared feasible in youth and could provide valuable insights that contribute to understanding youth psychopathology. Benefits, gaps, and suggestions for future research and clinical practice are discussed.

Do Children of Patients with Bipolar Disorder have a Worse Perception of Sleep Quality?

INTRODUCTION

The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances.

OBJECTIVE

To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP).

METHODS

A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch.

RESULTS

A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P = .04) and Disruptive Mood Dysregulation Disorder (DMDD; P = .04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P = .65), and Separation Anxiety Disorder (SAD; P = .46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P = .02), a higher frequency of nightmares (P = .01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements.

CONCLUSIONS

The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy.

Too Jittery to Sleep? Temporal Associations of Actigraphic Sleep and Caffeine in Adolescents

Caffeine consumption has been linked to poor sleep health in adolescents, but it is unknown whether poor sleep predicts caffeine consumption, and/or whether caffeine consumption predicts poor sleep, particularly when sleep is measured objectively. Data were collected from a micro-longitudinal sub-study of the age 15 wave of the Fragile Families and Child Wellbeing Study (n = 589). Adolescents wore an actigraphy device and completed daily surveys for ~1 week. Daily surveys assessed subjective sleep quality and caffeinated beverage consumption (0 = no caffeine, 1 = any caffeine). Separate mixed models assessed whether actigraphy-measured sleep duration, timing, maintenance efficiency, and subjective quality predicted next-day caffeinated beverage consumption within and between adolescents. Variability (standard deviation) of sleep duration and timing, sleep regularity index, and social jetlag were tested as additional between-person predictors. Lagged models tested whether daily caffeinated beverage consumption predicted sleep that night (n = 458). Adolescents with more variable sleep duration and midpoint had higher average odds of consuming caffeinated beverages compared to others. After adolescents consumed ≥1 caffeinated beverage, they had later sleep onset that night and wake time the next morning than usual versus when they did not consume caffeine. Curbing caffeinated beverage consumption may aid in the maintenance of regular sleep schedules and advance sleep timing in adolescents.

Caffeine Intake and Mental Health in College Students

Background The effect of caffeine on the human body, both short-term and long-term, has been studied in great depth, particularly its association with psychiatric disorders. This study aims to investigate whether there is a correlation between caffeine intake and anxiety and depression among college students. Methodology A survey was administered to college students at Florida State University. Data regarding participant characteristics and caffeine intake were collected. Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores were used to assess symptoms of anxiety and depression, respectively. Results A total of 114 participants were included in the survey, consisting mainly of women (94 [82.5%]) and junior-level students (37 [32.5%]). The main source of caffeine was coffee (64.0%), and the main reasons for caffeine intake were pleasure (43.9%) and to study outside of class (29.8%); however, no association was found between sex or grade point average and number of cups of caffeine consumed. Upper levels of education (super senior or fifth-year students), depressive symptoms (poor appetite, overeating, sleep disorders, depressed mood), and anxiety were statistically associated with greater caffeine intake (P < 0.05). Conclusions As caffeine is commonly consumed and our study showed that its intake was associated with depressive symptoms and higher levels of anxiety in college students, further studies are needed to determine a possible causality, so that measures may be taken to educate these students about alternative methods for increasing energy and alertness.

Purinergic transmission in depressive disorders

Purinergic signaling involves the actions of purine nucleotides and nucleosides (such as adenosine) at P1 (adenosine), P2X, and P2Y receptors. Here, we present recent data contributing to a comprehensive overview of the association between purinergic signaling and depression. We start with background information on adenosine production and metabolism, followed by a detailed characterization of P1 and P2 receptors, with an emphasis on their expression and function in the brain as well as on their ligands. We provide data suggestive of altered metabolism of adenosine in depressed patients, which might be regarded as a disease biomarker. We then turn to considerable amount of preclinical/behavioral data obtained with the aid of the forced swim test, tail suspension test, learned helplessness model, or unpredictable chronic mild stress model and genetic activation/inactivation of P1 or P2 receptors as well as nonselective or selective ligands of P1 or P2 receptors. We also aimed to discuss the reason underlying discrepancies observed in such studies.

Do Children of Patients with Bipolar Disorder have a Worse Perception of Sleep Quality?

INTRODUCTION

The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances.

OBJECTIVE

To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP).

METHODS

A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch.

RESULTS

A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P=.04) and Disruptive Mood Dysregulation Disorder (DMDD; P=.04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P=.65), and Separation Anxiety Disorder (SAD; P=.46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P=.02), a higher frequency of nightmares (P=.01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements.

CONCLUSIONS

The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy.

Caffeine Consumption in Children: Innocuous or Deleterious? A Systematic Review

Caffeine is the most consumed psychostimulant worldwide. Its use among children is controversial. Although it produces an increase in brain activity, it could hamper growth and development in young consumers. Therefore, the aim of this review was to recognize changes produced by caffeine in children under 12 years of age and to identify the relevant alterations and the conditions of their occurrence. A systematic review of the literature was carried out using PRISMA. Initially, 5468 articles were found from the EBSCO, ScienceDirect, PubMed, and Clarivate Analytics databases. In this review, were retained 24 published articles that met the inclusion criteria. The results obtained showed that caffeine consumption hampers children's growth and development. In contrast, it supports the activation of the central nervous system and brain energy management.

Review: Trends, Safety, and Recommendations for Caffeine Use in Children and Adolescents

OBJECTIVE

Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents.

METHOD

A search of the National Library of Medicine database was conducted using the terms caffeine, children, adolescents, and safety, in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep, and regulations.

RESULTS

The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but that higher doses of caffeine consumption (>400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use, and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered.

CONCLUSION

More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.

Inverse association between caffeine intake and depressive symptoms in US adults: data from National Health and Nutrition Examination Survey (NHANES) 2005-2006

The objective of this study was to examine the association between caffeine consumption and depressive symptoms. We used data from the 2005-06 National Health and Nutritional Examination Surveys (NHANES). A total of 4737 individuals aged ≥ 18 years who answered the caffeine intake and PHQ-9 questionnaires were selected for this study. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) with total scores between 0 and 27. Those with PHQ-9 total scores ≥ 10 were considered as having clinically relevant depression. To investigate the association of caffeine intake and PHQ-9 scores, a multiple logistic regression was used in different models. The overall weighted prevalence of depression was 5.5% (4.3% in men and 6.6% in women). After controlling for potential confounders (age, sex, family PIR, education, marital status, disease history, sleep disorders, thyroid problems, physical activity, social support, smoking, total energy, and cholesterol, retinol, vitamin A, beta-carotene, beta-criptoxanthin, vitamin B1, iron, and phosphorus levels), a significant nonlinear inverse association between caffeine consumption and PHQ-9 scores was observed. In conclusion, caffeine's psychostimulant properties appear to protect against depressive symptoms; however, additional prospective studies are required to ascertain whether or not caffeine consumption can lead to a decrease in depressive symptoms.

Ecological Momentary Assessment and Mood Disorders in Children and Adolescents: a Systematic Review

PURPOSE OF REVIEW

The aim of the present review is to systematically examine published data regarding ecological momentary assessment (EMA) in children and adolescents with mood disorders.

RECENT FINDINGS

EMA is increasingly used to collect participant's information in their real environment and in real time. There are multiple studies focused on the evaluation of mood disorders in children and adolescents, but only a few of them used EMA protocols. Results found in this review showed a wide variability of works with different fields of study, methodological approaches, and EMA protocols. More than 60% of EMA studies in children and adolescents with mood disorders were conducted via phone call, showing high completion rates with data missing in 5 to 11.5% of the calls. Length of studies varied from a 4-day EMA protocol to a maximum of 8 weeks. Positive and negative affect, daily activities, and social context were the main EMA measures. Despite the limited number of studies using EMA in children and adolescents with mood disorders, EMA was useful in assessing mood symptoms in the moment and in patients' real-life environment. Studies also showed high completion and satisfaction rates. Although web pages and apps use have been increasing over the past years, the evidence base is still scarce. Future studies can facilitate understanding of EMA methodology among youth with mood disorders.

Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research

Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.

Caffeine and Selective Adenosine Receptor Antagonists as New Therapeutic Tools for the Motivational Symptoms of Depression

Major depressive disorder is one of the most common and debilitating psychiatric disorders. Some of the motivational symptoms of depression, such anergia (lack of self-reported energy) and fatigue are relatively resistant to traditional treatments such as serotonin uptake inhibitors. Thus, new pharmacological targets are being investigated. Epidemiological data suggest that caffeine consumption can have an impact on aspects of depressive symptomatology. Caffeine is a non-selective adenosine antagonist for A1/A2A receptors, and has been demonstrated to modulate behavior in classical animal models of depression. Moreover, selective adenosine receptor antagonists are being assessed for their antidepressant effects in animal studies. This review focuses on how caffeine and selective adenosine antagonists can improve different aspects of depression in humans, as well as in animal models. The effects on motivational symptoms of depression such as anergia, fatigue, and psychomotor slowing receive particular attention. Thus, the ability of adenosine receptor antagonists to reverse the anergia induced by dopamine antagonism or depletion is of special interest. In conclusion, although further studies are needed, it appears that caffeine and selective adenosine receptor antagonists could be therapeutic agents for the treatment of motivational dysfunction in depression.

Energy Drink and Coffee Consumption and Psychopathology Symptoms Among Early Adolescents: Cross-Sectional and Longitudinal Associations

Background: Little is known about possible links between energy drink use and psychopathology among youth. This study examined cross-sectional and longitudinal associations between energy drink consumption and psychopathology among early adolescents. In addition, associations between psychopathology and coffee consumption were examined to assess whether findings were specific to energy drinks or also applied to another commonly used caffeinated beverage. Methods: One hundred forty-four youth who participated in the Camden Youth Development Study (72 males; mean age 11.9 at wave 1; 65% Hispanic, 30% African American) were assessed using self-report measures of frequency of energy drink and coffee consumption and depression, anxiety, conduct disorder (CD) symptoms, and teacher reports of attention-deficit hyperactivity disorder (ADHD). Youth (92%) were reassessed 16 months later. Results: Concurrently, energy drink and coffee consumption were associated with similar psychopathology symptoms; when the other beverage was adjusted for, energy drinks remained associated with CD and coffee remained associated with panic anxiety. Initial energy drink consumption predicted increasing ADHD and CD over time, though the association with CD dropped to a trend level of significance when coffee was adjusted for. Initial levels of hyperactive ADHD predicted increasing coffee consumption over time; this association remained when energy drinks were controlled. Social anxiety was associated with less increase in energy drink consumption over time, controlling for coffee. Conclusion: Energy drink and coffee consumption among early adolescents are concurrently associated with similar psychopathology symptoms. Longitudinally, the associations between these beverages and psychopathology differ, indicating that these substances have differing implications for development over time.

Effect of energy drink and caffeinated beverage consumption on sleep, mood, and performance in children and adolescents

The increasing availability of highly caffeinated beverages, including energy drinks, in the United States has resulted in a rise in consumption by children and adolescents. In addition, there is mounting evidence that these products are often consumed by youth for their perceived fatigue-mitigating and mood- or performance-enhancing effects. Although such perceptions by children and adolescents about the potential consequences of caffeine consumption are highly likely to influence decision making regarding the use of such products, there is still a relative paucity of studies that focus on the effect of caffeinated beverages on sleep, mood, and performance in the pediatric population. This review summarizes the following aspects of this topic, as derived from the information currently available: 1) the perception, among youth, of caffeine's risks and benefits and the sources of information about caffeine, particularly with regard to sleep, mood, and performance; 2) the bidirectional effect of caffeine on sleep in children and adolescents and the association of caffeine with other sleep-related practices, and 3) the evidence that supports caffeine as a performance and mood enhancer as well as a countermeasure to sleepiness in the pediatric population. Finally, gaps in knowledge are identified, and a direction for future research is outlined.

Insufficient sleep in adolescents and young adults: an update on causes and consequences

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.

Sweetened beverages, coffee, and tea and depression risk among older US adults

Sweetened beverages, coffee, and tea are the most consumed non-alcoholic beverages and may have important health consequences. We prospectively evaluated the consumption of various types of beverages assessed in 1995-1996 in relation to self-reported depression diagnosis after 2000 among 263,923 participants of the NIH-AARP Diet and Health Study. Odds ratios (OR) and 95% confidence intervals (CI) were derived from multivariate logistic regressions. The OR (95% CI) comparing ≥4 cans/cups per day with none were 1.30 (95%CI: 1.17-1.44) for soft drinks, 1.38 (1.15-1.65) for fruit drinks, and 0.91 (0.84-0.98) for coffee (all P for trend<0.0001). Null associations were observed for iced-tea and hot tea. In stratified analyses by drinkers of primarily diet versus regular beverages, the ORs were 1.31 (1.16-1.47) for diet versus 1.22 (1.03-1.45) for regular soft drinks, 1.51 (1.18-1.92) for diet versus 1.08 (0.79-1.46) for regular fruit drinks, and 1.25 (1.10-1.41) for diet versus 0.94 (0.83-1.08) for regular sweetened iced-tea. Finally, compared to nondrinkers, drinking coffee or tea without any sweetener was associated with a lower risk for depression, adding artificial sweeteners, but not sugar or honey, was associated with higher risks. Frequent consumption of sweetened beverages, especially diet drinks, may increase depression risk among older adults, whereas coffee consumption may lower the risk.

Sleep disorders in children with developmental delay

Developmental disorders in children are common. Associated demanding co-morbidities that include sleep problems are prevalent in this group. In turn, these are linked to daytime performance issues, reduced developmental and academic growth, and considerable familial psychopathology. Behavioral modification measures are and should be the first line approach to management. Medications for sleep disorders have an important role in addition to behavioral modification therapy. This literature review looks into the occurrence and severity of sleep problems in children with developmental disorders. The probable advantages of using medications, mainly focusing on the neurohormone melatonin (a sleep inducer), are also explored.

A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression

STUDY OBJECTIVES

To investigate whether sleep disturbances are bidirectionally related to anxiety and depression, and thus identify potential risk factors for each problem.

DESIGN

A systematic review was conducted on 9 studies (8 longitudinal, 1 retrospective) that assessed bidirectionality between a sleep disturbance, and anxiety or depression. Treatment studies were excluded, along with those solely based on clinical samples or cohorts at high risk of suffering from a sleep disturbance, anxiety and depression. Eligible studies were identified by searching PubMed, PsychINFO, Embase, and Scopus databases, and reference lists of eligible studies. Publication dates ranged from the beginning of each database to December 2011.

MEASUREMENTS AND RESULTS

Syntheses of longitudinal studies suggested insomnia and sleep quality were bidirectionally related to anxiety and depression, and depression/anxiety, respectively. Childhood sleep problems significantly predicted higher levels of depression and a combined depression/anxiety variable, but not vice-versa. A one-way relationship was found where anxiety predicted excessive daytime sleepiness, but excessive daytime sleepiness was not associated with depression.

CONCLUSIONS

Definitive conclusions regarding bidirectionality cannot be made for most sleep disturbances due to the small number and heterogeneity of cohort samples used across studies. Nevertheless, best available evidence suggests insomnia is bidirectionally related to anxiety and depression. Clinical and theoretical implications are discussed.

CITATION

Alvaro PK; Roberts RM; Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. SLEEP 2013;36(7):1059-1068.

Momentary assessment of affect, physical feeling states, and physical activity in children

OBJECTIVE

Most research on the interplay of affective and physical feelings states with physical activity in children has been conducted under laboratory conditions and fails to capture intraindividual covariation. The current study used Ecological Momentary Assessment (EMA) to bidirectionally examine how affective and physical feeling states are related to objectively measured physical activity taking place in naturalistic settings during the course of children's everyday lives.

METHODS

Children (N = 119, ages 9-13 years, 52% male, 32% Hispanic) completed 8 days of EMA monitoring, which measured positive affect (PA), negative affect (NA), feeling tired, and feeling energetic up to 7 times per day. EMA responses were time-matched to accelerometer assessed moderate-to-vigorous physical activity (MVPA) in the 30 min before and after each EMA survey.

RESULTS

Higher ratings of feeling energetic and lower ratings of feeling tired were associated with more MVPA in the 30 min after the EMA prompt. More MVPA in the 30 min before the EMA prompt was associated with higher ratings of PA and feeling energetic and lower ratings of NA. Between-subjects analyses indicated that mean hourly leisure-time MVPA was associated with less intraindividual variability in PA and NA.

CONCLUSIONS

Physical feeling states predict subsequent physical activity levels, which in turn, predict subsequent affective states in children. Active children demonstrated higher positive and negative emotional stability. Although the strength of these associations were of modest magnitude and their clinical relevance is unclear, understanding the antecedents to and consequences of physical activity may have theoretical and practical implications for the maintenance and promotion of physical activity and psychological well-being in children.

Mood disorders in everyday life: a systematic review of experience sampling and ecological momentary assessment studies

In the past two decades, the study of mood disorder patients using experience sampling methods (ESM) and ecological momentary assessment (EMA) has yielded important findings. In patients with major depressive disorder (MDD), the dynamics of their everyday mood have been associated with various aspects of their lives. To some degree similar studies have been conducted in patients with bipolar disorder (BD). In this paper we present the results of a systematic review of all ESM/EMA studies in MDD and BD to date. We focus not only on the correlates of patients' everyday mood but also on the impact on treatment, residual symptoms in remitted patients, on findings in pediatric populations, on MDD/BD specificity, and on links with neuroscience. After reviewing these six topics, we highlight the benefits of ESM/EMA for researchers, clinicians, and patients, and offer suggestions for future studies.

Experience Sampling Methodology studies of depression: the state of the art

BACKGROUND

Experience Sampling Methodology (ESM) is ideally suited to test the predictions, and inform the development of contemporary cognitive models of depression. Yet there has been no systematic examination of ESM in depression research.

METHOD

A search of databases (PsychARTICLES, PsycINFO, AMED, Ovid Medline and CINAHL) was conducted to identify studies published within the last 25 years investigating major depressive disorder (MDD) using ESM.

RESULTS

Altogether, 19 studies using ESM, or comparable methodologies, with clinically depressed individuals were identified and critically reviewed. The identified studies examined six aspects of MDD: methodological issues; positive and negative affect; cortisol secretion; antidepressant treatment; work performance; genetic risk factors.

CONCLUSIONS

Despite some methodological limitations of existing studies, ESM has made a significant contribution to our current understanding of depression by consolidating existing theories, uncovering new and clinically relevant findings and identifying questions for future research. This review concludes by introducing the possibility of using ESM as an intervention tool in clinical practice and proposing that ESM could be useful for furthering knowledge of the causes of MDD.

Pain and sleep-wake disturbances in adolescents with depressive disorders

The aims of this study were to (a) assess and compare sleep disturbances (including daytime and nighttime sleep patterns) in adolescents with depressive disorders and healthy peers, (b) examine the prevalence of pain in adolescents with depressive disorders and healthy peers, and (c) examine pubertal development, pain intensity, and depressive symptom severity as predictors of sleep disturbance. One hundred six adolescents (46 depressed, 60 healthy), 12 to 18 years (M = 15.10 years; 67% female; 77% Caucasian) completed subjective measures of sleep, presleep arousal, fatigue, and pain. Participants also underwent 10 days of actigraphic monitoring to assess nighttime and daytime sleep duration, sleep efficiency, and wake after sleep onset. Results indicated that youth with depression exhibited greater sleep disturbances on subjective and actigraphic sleep variables than healthy controls. Depressed youth also reported more frequent and severe pain than healthy youth. Linear regression analysis indicated that pain intensity and depressive symptoms predicted worse sleep quality across groups. The interaction term was also significant, such that adolescents with high levels of depressive symptoms had poor sleep quality when pain intensity levels were high. These results indicate that sleep is important to assess in youth with depression, and that pain may be an important target for sleep intervention in this population.

"I won, but I'm not getting my hopes up": depression moderates the relationship of outcomes and reward anticipation

Major Depressive Disorder (MDD) in adolescents is characterized by alterations in positive emotions and reward processing. Recent investigations using functional magnetic resonance imaging (fMRI) find depression-related differences in reward anticipation. However, it is unknown whether feedback influences subsequent reward anticipation, which may highlight the context of reward processing. Ten youth with MDD and 16 youth with no history of MDD completed an fMRI assessment using a reward task. Reward anticipation was indexed by blood oxygen level dependent signal change in the striatum following winning, losing, non-winning, and non-losing outcomes. A significant interaction between diagnostic status and outcome condition predicted reward anticipation in the caudate. Decomposition of the interaction indicated that following winning outcomes, depressed youth demonstrated reduced reward anticipation relative to healthy youth. However, no significant differences between depressed and healthy youth were found after other outcomes. Reward anticipation is altered following winning outcomes. This finding has implications for understanding the developmental pathophysiology of MDD and suggests specific contexts where altered motivational system functioning may play a role in maintaining depression.

Potential link between caffeine consumption and pediatric depression: A case-control study

BACKGROUND

Early-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking.The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants.

METHODS

Children and adolescents (n = 51) already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI). Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL) and eating habits were assessed with the Nutrition-Behavior Inventory (NBI) 1. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city.

RESULTS

Participants with CDI scores ≥ 15 (mean = 19; S.D. = 4) also had high NBI scores (mean = 52; S.D. = 19, p < 0.001) suggestive of a relationship between depressive symptoms and environmental factors, in this case nutrition/behavior. Additional linear regression adjusted statistical analysis, considering the factors of consumption of sweets and caffeine individually, showed that caffeine, but not sweets, was associated with depressive symptoms.

CONCLUSIONS

These findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.

The bidirectional association between daytime affect and nighttime sleep in youth with anxiety and depression

OBJECTIVE

This study examines relationships between affect and sleep in youth with affective disorders using ecological momentary assessment (EMA).

METHODS

Participants included 94 youth, ages 8-16 (M = 11.73, 53% female) years with an anxiety disorder only (n = 23), primary major depressive disorder (with and without a secondary anxiety diagnoses; n = 42), and healthy controls (n = 29). A cell phone EMA protocol assessed affect and actigraphy measured sleep.

RESULTS

The patterns of bidirectional relationships between affect and sleep differed across diagnostic groups. Higher daytime positive affect and positive to negative affect ratios were associated with more time in bed during the subsequent night for youth with primary depression and less time in bed for youth with anxiety only. More time asleep was associated with more positive affect for both diagnostic groups the following day.

CONCLUSIONS

This relationship may be important to consider in the treatment of youth affective disorders.

Effects of caffeine on sleep and cognition

Caffeine can be used effectively to manipulate our mental state. It is beneficial in restoring low levels of wakefulness and in counteracting degraded cognitive task performance due to sleep deprivation. However, caffeine may produce detrimental effects on subsequent sleep, resulting in daytime sleepiness. This justifies a careful consideration of risks related to sleep deprivation in combination with caffeine consumption, especially in adolescents. The efficacy of caffeine to restore detrimental effects of sleep deprivation seems to be partly due to caffeine expectancy and to placebo effects. The claim that stimulant effects of caffeine are related to withdrawal or withdrawal reversal seems to be untenable.

The association between the availability of sugar-sweetened beverage in school vending machines and its consumption among adolescents in California: a propensity score matching approach

There is controversy over to what degree banning sugar-sweetened beverage (SSB) sales at schools could decrease the SSB intake. This paper uses the adolescent sample of 2005 California Health Interview Survey to estimate the association between the availability of SSB from school vending machines and the amount of SSB consumption. Propensity score stratification and kernel-based propensity score matching are used to address the selection bias issue in cross-sectional data. Propensity score stratification shows that adolescents who had access to SSB through their school vending machines consumed 0.170 more drinks of SSB than those who did not (P < .05). Kernel-based propensity score matching shows the SSB consumption difference to be 0.158 on the prior day (P < .05). This paper strengthens the evidence for the association between SSB availability via school vending machines and the actual SSB consumption, while future studies are needed to explore changes in other beverages after SSB becomes less available.

Using ecological momentary assessment to examine antecedents and correlates of physical activity bouts in adults age 50+ years: a pilot study

BACKGROUND

National recommendations supporting the promotion of multiple short (10+ minute) physical activity bouts each day to increase overall physical activity levels in middle-aged and older adults underscore the need to identify antecedents and correlates of such daily physical activity episodes.

PURPOSE

This pilot study used Ecological Momentary Assessment to examine the time-lagged and concurrent effects of empirically supported social, cognitive, affective, and physiological factors on physical activity among adults age 50+ years.

METHODS

Participants (N = 23) responded to diary prompts on a handheld computer four times per day across a 2-week period. Moderate-to-vigorous physical activity (MVPA), self-efficacy, positive and negative affect, control, demand, fatigue, energy, social interactions, and stressful events were assessed during each sequence.

RESULTS

Multivariate results showed that greater self-efficacy and control predicted greater MVPA at each subsequent assessment throughout the day (p < 0.05). Also, having a positive social interaction was concurrently related to higher levels of MVPA (p = 0.052).

CONCLUSION

Time-varying multidimensional individual processes predict within daily physical activity levels.

Understanding Adolescent Caffeine Use: Connecting Use Patterns With Expectancies, Reasons, and Sleep

Little is known about adolescents’ caffeine use, yet caffeinated soda, and more recently coffee and energy drinks, are part of youth culture. This study examines adolescents’ caffeine use and, using cluster analysis, identifies three groups of caffeine users who differed in their reasons for use, expectancies, and sleep behaviors. In this high school student sample ( N = 197), 95% of participants reported recent caffeine use—most often soda—where typical first use of the day was in the evening. Results reveal that adolescents in the mixed use and high soda use groups consumed similar amounts of soda, reporting significantly more use than the low caffeine use group. In contrast with high soda users, mixed users drank more coffee, expected more dependence symptoms and energy enhancement from caffeine, and were more likely to report getting up early, daytime sleepiness, and using caffeine to get through the day.

Sleep and substance use and abuse in adolescents

Substance use disorders and sleep disorders are among the most common psychiatric problems in children and adolescents. They often co-occur and have a significant negative effect upon normal development. This article provides a review of the most recent literature on the relationship between these disorders, along with recommendations on how to recognize and clinically address these disorders in children and adolescents.

Experience sampling research in psychopathology: opening the black box of daily life

A growing body of research suggests that momentary assessment technologies that sample experiences in the context of daily life constitute a useful and productive approach in the study of behavioural phenotypes and a powerful addition to mainstream cross-sectional research paradigms. Momentary assessment strategies for psychopathology are described, together with a comprehensive review of research findings illustrating the added value of daily life research for the study of (1) phenomenology, (2) aetiology, (3) psychological models, (4) biological mechanisms, (5) treatment and (6) gene-environment interactions in psychopathology. Overall, this review shows that variability over time and dynamic patterns of reactivity to the environment are essential features of psychopathological experiences that need to be captured for a better understanding of their phenomenology and underlying mechanisms. The Experience Sampling Method (ESM) allows us to capture the film rather than a snapshot of daily life reality of patients, fuelling new research into the gene-environment-experience interplay underlying psychopathology and its treatment.

Mountain Dew or mountain don't?: a pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students

BACKGROUND

Caffeine, the only licit psychoactive drug available to minors, may have a harmful impact on students' health and adjustment, yet little is known about its use or effects on students, especially from a developmental perspective. Caffeine use in 5th- and 10th-grade students was examined in a cross-sectional design, and relations and potential mediators of caffeine use to depression and anxiety symptoms were investigated.

METHODS

Children (n = 135) and adolescents (n = 79) completed a measure of naturalistic use of caffeinated and noncaffeinated beverages. Furthermore, daily availability, perceived benefits, and stimulating, psychological, and withdrawal effects of caffeinated and noncaffeinated beverages were assessed. Measures of depression and anxiety were also administered.

RESULTS

Fifth and 10th graders used caffeine frequently. Depression was positively related to caffeine use for both cohorts, though mediated by caffeine withdrawal effects. Surprisingly, anxiety was unrelated to use. Fifth graders reported less daily access to caffeine, but more psychological and stimulating effects of caffeine than 10th graders.

CONCLUSIONS

Although both children and adolescents experience negative caffeine-related outcomes, intake is seemingly not greatly limited in either cohort. In particular, youth appear vulnerable to increased depressive symptoms with increasing caffeine consumption. Implications for school policy regarding students' caffeine use are discussed.

Loss of control eating and psychological maintenance in children: an ecological momentary assessment study

OBJECTIVE

Recent research suggests that binge eating is a common experience in youth. However, it remains largely unknown how children's binge eating presents in everyday life and which psychological factors serve to maintain this binge eating.

METHODS

Children aged 8-13 years with binge eating (n=59), defined as at least one episode of loss of control (LOC) over eating within the past three months, and 59 matched children without LOC history were recruited from the community. Following a combined random- and event-sampling protocol, children were interviewed about their day-to-day eating behavior, mood, and eating disorder-specific cognitions using child-specific cell phones during a 4-day assessment period in their natural environment.

RESULTS

LOC episodes led to a significantly greater intake of energy, particularly from carbohydrates, than regular meals of children with and without LOC eating. While LOC episodes were preceded and followed by cognitions about food/eating and body image, there was minimal evidence that negative mood states were antecedents of LOC eating.

CONCLUSIONS

The results provide support for the construct validity of LOC eating in children. Maintenance theories of binge eating for adults apply to children regarding eating disorder-specific cognitions, but the association with affect regulation difficulties requires further investigation.