Mother-child interactions in depressed children and children at high risk and low risk for future depression

Temporal Dynamics of Positive and Negative Affect in Adolescents: Associations with Depressive Disorders and Risk

Alterations in dynamic affective processes are associated with dysregulated affect and depression. Although depression is often associated with heightened inertia (i.e., greater moment-to-moment correlation) and variability (i.e., larger departures from typical levels) of affect in adults, less is known about whether altered affect dynamics are present in youth at risk for depression. This study investigated the association of clinical depression and depression risk with the inertia and variability of positive and negative affect in a sample of youth at varying risk for depression. Our sample included 147 adolescents aged 14 to 17, categorized into three groups: never-depressed lower-risk, never-depressed higher-risk (based on maternal history of depression), and currently depressed adolescents. Adolescents completed ecological momentary assessments of positive and negative affect up to seven times per day for a week. Multilevel models and ANOVAs were used to examine associations of affective inertia and variability with adolescent depression and risk based on maternal history, controlling for average affect. Depressed adolescents showed more inert and diminished positive affect, and more variable and elevated negative affect compared to lower- and higher-risk youth, though associations attenuated after controlling for average affect. No differences were identified between never-depressed higher-risk and lower-risk youth. Additional longitudinal studies are needed to evaluate whether altered affect dynamics in daily life precede depression onset to understand their utility for developing preventive interventions.

Passively administered fluoxetine reaches the juvenile brain of FSL rats and reduces antioxidant defences, without altering serotonin turnover

BACKGROUND

Fluoxetine is present in breast milk, yet it is unclear to what extent it, or its active metabolite, norfluoxetine, reaches the brain of the infant and what the effects of such exposure on neurobiological processes are. We therefore aimed to quantify the concentration of passively administered fluoxetine and norfluoxetine in the whole brains of exposed Flinders sensitive line (FSL) offspring and establish their influence on serotonergic function and redox status.

METHODS

Adult FSL dams received fluoxetine (10 mg/kg/day), or placebo for fourteen days, beginning on postpartum day 04. Offspring were passively exposed to fluoxetine until postnatal day 18 and euthanized on postnatal day 22. Whole brain fluoxetine, norfluoxetine, serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), and reduced (GSH) and oxidized glutathione (GSSG) concentrations were measured via liquid chromatography-mass spectrometry (LC-MS) analysis.

RESULTS

Whole-brain serotonin and 5-hydroxyindoleacetic acid concentrations, and serotonin turnover (5-HIAA/5-HT) were comparable between strains. Treatment-naïve FSL rats had lower GSH and higher GSSG whole-brain concentrations, relative to FRL controls, and an overall decreased GSH/GSSG ratio. Passively administered fluoxetine resulted in undetectable whole-brain concentrations, while norfluoxetine averaged 41.28 ± 6.47 ng/g. Serotonin turnover of FSL rats was unaffected by passively administered fluoxetine, while redox status (GSH/GSSG) was decreased.

CONCLUSION

Our findings confirm that passively administered fluoxetine reaches the infant brain in the form of norfluoxetine and may manipulate processes of oxidative stress regulation. Further studies into the long-term bio-behavioural effects are however needed to effectively inform breast feeding mothers on the safety of antidepressant-use.

Child temperament as a longitudinal predictor of mother-adolescent interaction quality: are effects independent of child and maternal mental health?

Adaptive parent-child interaction plays a major role in healthy child development. Caregiver mental health problems can negatively impact parent-child interaction. In turn, interactional quality is often studied as a predictor of child outcome. However, child characteristics supposedly shape parent-child interactions as well. Given associations between child and caregiver mental health and child temperament, this study aimed at differentiating their effects on dyadic interaction quality in adolescence. Child temperament and character at age 5 were investigated as longitudinal predictors of observed mother-adolescent interactional quality at age 14 in a community sample (N = 76). It was examined whether these effects were independent of maternal and child mental health and earlier dysfunctional interaction. Lower novelty seeking, higher reward dependence, and higher cooperativeness separately predicted higher dyadic interactional quality at age 14. Controlling regressions for dysfunctional interaction at age 5, which was a significant negative predictor of later interactional quality, cancelled out the effects of novelty seeking and cooperativeness. Past or concurrent maternal or child psychopathology did not explain variance in mother-adolescent interaction. Applying backward selection, a model including reward dependence and dysfunctional interaction at age 5 and concurrent maternal stress showed the best fit for explaining dyadic interaction quality. Results suggest that enduring rather than transient child features predict interactional quality in a community sample. Effects of temperament are not better explained by those of psychopathology, but a combination of child, maternal, and dyadic features predicted dyadic behaviour best. Selective prevention should target parenting in the context of challenging child characteristics specifically.

Genetically predisposed and resilient animal models of depression reveal divergent responses to early-life adversity

OBJECTIVE

Early-life adversity (ELA) is one of the strongest predictors of childhood depression that may be exacerbated by a genetic predisposition to develop depression. We therefore investigated the bio-behavioural effects of an early-life stressor in an accepted rodent model of depression.

METHODS

The Flinders sensitive line (FSL) and resistant line (FRL) rats were subjected to an early-life stressor, whereafter their bio-behavioural response during pubertal onset was evaluated. Male and female pups were maternally separated for 3 h per day from postnatal day 02 (PND02) to 17, when they were also weaned. Control animals were left undisturbed, until weaning on PND21. Depressive-like behaviour was analysed on PND21 and reassessed on PND36. Hippocampal monoamine levels, markers of oxidative stress and metabolic markers implicating mitochondrial function were also measured.

RESULTS

On PND21, the non-maternal separation and early weaning (non-MSEW) FSL rats spent 10% more time mobile than their FRL controls in the tail suspension test (TST) yet displayed increased depressive-like behaviour in the forced swim test (FST) on PND36. This depressive-like behaviour coincided with increased hippocampal norepinephrine levels, serotonin turnover and a dysfunctional redox state. Maternal separation and early weaning (MSEW) appeared to initially reduce early-life (PND21) depressive-like behaviour in the TST but then induced depressive-like behaviour on PND36 and increased norepinephrine levels more profoundly in the FRL rats.

CONCLUSION

These findings highlight the need to further investigate the stress response pathway in these animals and that the absence or presence of genetic susceptibility may influence the presentation of ELA effects.

Maternal symptoms of depression and anxiety during the postpartum period moderate infants' neural response to emotional faces of their mother and of female strangers

Affective exchanges between mothers and infants are key to the intergenerational transmission of depression and anxiety, possibly via adaptations in neural systems that support infants' attention to facial affect. The current study examined associations between postnatal maternal symptoms of depression, panic and social anxiety, maternal parenting behaviours, and infants' neural responses to emotional facial expressions portrayed by their mother and by female strangers. The Negative Central (Nc), an event-related potential component that indexes attention to salient stimuli and is sensitive to emotional expression, was recorded from 30 infants. Maternal sensitivity, intrusiveness, and warmth, as well as infant's positive engagement with their mothers, were coded from unstructured interactions. Mothers reporting higher levels of postnatal depression symptoms were rated by coders as less sensitive and warm, and their infants exhibited decreased positive engagement with the mothers. In contrast, postnatal maternal symptoms of panic and social anxiety were not significantly associated with experimenter-rated parenting behaviours. Additionally, infants of mothers reporting greater postnatal depression symptoms showed a smaller Nc to their own mother's facial expressions, whereas infants of mothers endorsing greater postnatal symptoms of panic demonstrated a larger Nc to fearful facial expressions posed by both their mother and female strangers. Together, these results suggest that maternal symptoms of depression and anxiety during the postpartum period have distinct effects on infants' neural responses to parent and stranger displays of emotion.

Trajectories of positive and negative affect across adolescence: Maternal history of depression and adolescent sex as predictors

BACKGROUND

Trajectories of affect vary across development, with normative increases in positive affect occurring during childhood and declines in positive affect appearing across adolescence. Little is known, however, about predictors of the trajectories of affect across adolescence. The present study examined associations between changes in adolescent affect across adolescence and maternal history of depression and child sex.

METHODS

Participants were 240 adolescents and their mothers; 185 mothers had a history of depression (i.e., high risk) and 55 mothers did not (i.e., low risk). Youth were assessed annually from 6th grade (meanage = 11.86 years, SD = 0.57, 54.2 % female, 82 % White) through 12th grade. Latent growth models tested the relation of maternal depression history and adolescent sex with trajectories of adolescent affect.

RESULTS

High-risk adolescents exhibited lower levels of PA as compared to low-risk youth (coefficient = -3.51, p = .008, 95 % CI [-6.11, -0.91]). Girls experienced earlier increases in negative affect (NA) as compared to boys, with more positive linear (coefficient = 2.07, p = .002, 95 % CI [0.774, 3.368]) and quadratic (coefficient = -0.29, p = .025, 95 % CI [-0.55, -0.04]) slopes.

LIMITATIONS

Use of self-report measures and limited generalizability.

CONCLUSION

Maternal depression significantly predicted decreases in offspring PA and distinct trajectories of NA in girls and boys. Interventions aimed at reducing risk in adolescent offspring of depressed parents may benefit from targeting PA and supporting girls in early adolescence.

Trajectories of perceived economic hardship: Relations with mother's and child's mental health and the role of self-esteem

Trajectories of poverty influence the mental health of mothers and children. Previous studies utilize objective measures despite the importance of subjective measures of poverty. Furthermore, chronic economic hardship may erode personal resources such as self-esteem which increases vulnerability to mental health issues. Trajectories of perceived family economic hardship and their relationship with common mental health disorders, as mediated by self-esteem, were investigated in 511 mother-child dyads from Singapore. Three distinct groups of economic hardship trajectories were delineated, namely the low stable, high stable and moderate decreasing group. The high stable group was found to be associated with a greater likelihood of mother's depression, mother's anxiety and child's anxiety when compared to the low stable group. The moderate decreasing group was found to be associated with a greater likelihood of mother's anxiety when compared to the low stable group. Mother's self-esteem was found to mediate all the significant relations found. These findings indicate the existence of distinct trajectories of perceived economic hardship within low-income families and their relation with mental health outcomes in mothers and children. The mediation of these relations by mother's self-esteem suggests the importance of enhancing self-esteem in mothers from low-income backgrounds.

How biopsychosocial depressive risk shapes behavioral and neural responses to social evaluation in adolescence

INTRODUCTION

Understanding the emotional responsivity style and neurocognitive profiles of depression-related processes in at-risk youth may be helpful in revealing those most likely to develop affective disorders. However, the multiplicity of biopsychosocial risk factors makes it difficult to disentangle unique and combined effects at a neurobiological level.

METHODS

In a population-derived sample of 56 older adolescents (aged 17-20), we adopted partial least squares regression and correlation models to explore the relationships between multivariate biopsychosocial risks for later depression, emotional response style, and fMRI activity, to rejecting and inclusive social feedback.

RESULTS

Behaviorally, higher depressive risk was associated with both reduced negative affect following negative social feedback and reduced positive affect following positive social feedback. In response to both cues of rejection and inclusion, we observed a general neural pattern of increased cingulate, temporal, and striatal activity in the brain. Secondly, in response to rejection only, we observed a pattern of activity in ostensibly executive control- and emotion regulation-related brain regions encompassing fronto-parietal brain networks including the angular gyrus.

CONCLUSION

The results suggest that risk for depression is associated with a pervasive emotional insensitivity in the face of positive and negative social feedback.

Systematically Defined Informative Priors in Bayesian Estimation: An Empirical Application on the Transmission of Internalizing Symptoms Through Mother-Adolescent Interaction Behavior

BACKGROUND

Bayesian estimation with informative priors permits updating previous findings with new data, thus generating cumulative knowledge. To reduce subjectivity in the process, the present study emphasizes how to systematically weigh and specify informative priors and highlights the use of different aggregation methods using an empirical example that examined whether observed mother-adolescent positive and negative interaction behavior mediate the associations between maternal and adolescent internalizing symptoms across early to mid-adolescence in a 3-year longitudinal multi-method design.

METHODS

The sample consisted of 102 mother-adolescent dyads (39.2% girls, M age T1 = 13.0). Mothers and adolescents reported on their internalizing symptoms and their interaction behaviors were observed during a conflict task. We systematically searched for previous studies and used an expert-informed weighting system to account for their relevance. Subsequently, we aggregated the (power) priors using three methods: linear pooling, logarithmic pooling, and fitting a normal distribution to the linear pool by means of maximum likelihood estimation. We compared the impact of the three differently specified informative priors and default priors on the prior predictive distribution, shrinkage, and the posterior estimates.

RESULTS

The prior predictive distributions for the three informative priors were quite similar and centered around the observed data mean. The shrinkage results showed that the logarithmic pooled priors were least affected by the data. Most posterior estimates were similar across the different priors. Some previous studies contained extremely specific information, resulting in bimodal posterior distributions for the analyses with linear pooled prior distributions. The posteriors following the fitted normal priors and default priors were very similar. Overall, we found that maternal, but not adolescent, internalizing symptoms predicted subsequent mother-adolescent interaction behavior, whereas negative interaction behavior seemed to predict subsequent internalizing symptoms. Evidence regarding mediation effects remained limited.

CONCLUSION

A systematic search for previous information and an expert-built weighting system contribute to a clear specification of power priors. How information from multiple previous studies should be included in the prior depends on theoretical considerations (e.g., the prior is an updated Bayesian distribution), and may also be affected by pragmatic considerations regarding the impact of the previous results at hand (e.g., extremely specific previous results).

Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis

IMPORTANCE

Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood.

OBJECTIVE

To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring.

DATA SOURCES

A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019.

STUDY SELECTION

A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression.

MAIN OUTCOMES AND MEASURES

Offspring depression was evaluated using standardized depression scales or clinical interviews.

RESULTS

Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31).

CONCLUSIONS AND RELEVANCE

In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.

The persistence of hedonically-based mood repair among young offspring at high- and low-risk for depression

The aim of the present study was to examine whether offspring at high and low familial risk for depression differ in the immediate and more lasting behavioural and physiological effects of hedonically-based mood repair. Participants (9- to 22-year olds) included never-depressed offspring at high familial depression risk (high-risk, n = 64), offspring with similar familial background and personal depression histories (high-risk/DEP, n = 25), and never-depressed offspring at low familial risk (controls, n = 62). Offspring provided affect ratings at baseline, after sad mood induction, immediately following hedonically-based mood repair, and at subsequent, post-repair epochs. Physiological reactivity, indexed via respiratory sinus arrhythmia (RSA), was assessed during the protocol. Following mood induction and mood repair, high- and low-risk (control) offspring reported comparable changes in levels of sadness and RSA. However, sadness increased among high-risk offspring following the post-repair epoch, whereas low-risk offspring maintained mood repair benefits. High-risk/DEP offspring also reported higher levels of sadness following the post-repair epoch than did low-risk offspring. Change in RSA did not differ across the three offspring groups. Self-ratings confirm that one source of difficulty associated with depression risk is diminished ability to maintain hedonically-based mood repair gains, which were not apparent at the physiological level.

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.

The Family Stress Model as it Applies to Custodial Grandfamilies: A Cross Validation

There is scant research on how the parenting practices of custodial grandmothers affect the psychological adjustment of grandchildren in their care. Yet, the findings from a handful of prior studies suggest the relevance of the Family Stress Model (FSM) to these caregivers. The present study further tested the FSM with baseline data from 343 custodial grandmothers (Mage= 58.5 years) enrolled in a clinical trial of the efficacy of interventions for improving the well-being of their families. Not only was this "help-seeking" sample atypical of prior FSM studies, but also unique to the present study was our addition of multiple parenting practices, self-reported and clinical ratings of grandmothers' distress, and reports of grandchildren's internalizing and externalizing difficulties from grandchildren and grandmothers. Mplus 7.31 was used to test a model where the effect of grandmother distress on grandchildren's internalizing and externalizing difficulties was hypothesized to be indirect through five distinct parenting practices. The findings regarding both the measurement and structural models fit the observed data well, and invariance was largely found across grandchildren's gender and age (4-7 vs. 8-12). Although grandchildren's self-reported internalizing and externalizing difficulties were unrelated to grandmothers' distress and parenting practices, the grandmothers' reports of these outcomes were generally related to their own distress and parenting practices as hypothesized. However, considerable variation was found across the five parenting practices in terms of their relationships to the other FSM constructs. We conclude that data from multiple informants and measures of assorted parenting practices are essential to future research and practice.

Family functioning as perceived by parents and young offspring at high and low risk for depression

BACKGROUND

Family dysfunction has been proposed as one of the environmental mechanisms whereby risk of depression is transmitted from mothers to their children. Using our sample of offspring at high and low familial risk for depression, we hypothesized that: a) high-risk offspring (n = 79) and their mothers will report more extensive family dysfunction than low-risk offspring (n = 82) and their mothers, b) family dysfunction will predict the extent of offspring's depressive symptoms, and c) family dysfunction will mediate the impact of mother's depression on offspring's depressive symptoms.

METHODS

The study enrolled 161 offspring of parents who, in a previous study, were ascertained to have either childhood onset mood disorder or no history of a major psychiatric disorder. Parents completed questionnaires and a clinical interview about themselves, their offspring, and the family, while offspring also completed questionnaires about themselves and the family.

RESULTS

We found support for all three hypotheses. The significant indirect effect between maternal depression and offspring depressive symptoms was driven primarily by offspring's, but not mothers', reports of family dysfunction.

LIMITATIONS

Although our assessment of mother's early history of depression was done in a previous study, it is important to note that our results do not inform about causality because of the present study's cross-sectional nature.

CONCLUSIONS

The results highlight the importance of detecting and treating family dysfunction, particularly via offspring report, as one way to lower the risk of depression transmission from mothers to their children.

Emotion dysregulation mediates the longitudinal relation between peer rejection and depression

The goal of the current investigation was to test emotion dysregulation as a mechanism explaining the longitudinal association between peer rejection and depressive symptoms across 1 school year in middle childhood and to determine whether this process differed based on gender and grade. Youth in Grades 3 through 6 ( N = 131; 71 girls) and their primary school teachers ( n = 8) were recruited from a Midwestern elementary school. Youth reported on their emotion dysregulation and depressive symptoms at two time points (T1 and T2), approximately 6 months apart. Teachers completed ratings of peer rejection at T1. Peer rejection at T1 predicted youth-report of depressive symptoms at T2, even after controlling for depression at T1. Moderated mediation suggested that change in emotion dysregulation mediated the relation of peer rejection to depressive symptoms over time, but only for older boys. Results underscore the importance of considering gender-specific processes within interpersonal risk models of depression, and provide support for peer rejection as a critical social process shaping emotion regulation in middle childhood.

Positive Affectivity is Dampened in Youths with Histories of Major Depression and Their Never-Depressed Adolescent Siblings

While hedonic capacity is diminished during clinical depression, it is unclear whether that deficit constitutes a risk factor and/or persists after depression episodes remit. To examine these issues, adolescents with current/past major depression (probands; n=218), never depressed biological siblings of probands (n=207), and emotionally-well controls (n=183) were exposed to several positively valenced probes. Across baseline and hedonic probe conditions, controls consistently reported higher levels of positive affect than high-risk siblings, and siblings reported higher levels of positive affect than probands (remitted and depressed probands' reports were similar). Extent of positive affect across the protocol predicted adolescents' self-reports of social support network and parental reports of offspring's use of various adaptive mood repair responses in daily life. Attenuated hedonic responding among youths remitted from depression offers partial support for anhedonia as a trait, while its presence among never depressed high-risk siblings argues for anhedonia as a potential diathesis for clinical depression.

An increase in joy after two weeks is more specific of later antidepressant response than a decrease in sadness

BACKGROUND

Early improvement in positive emotions-more than decreases in negative emotions-was highly predictive of treatment response in an ecologically valid prospective manner. This result needs replication with simpler assessments to determine whether it can be translated into clinical practice.

METHODS

2049 adult depressed outpatients receiving agomelatine were assessed at inclusion, week 2, and week 6 using the clinician-rated Quick Inventory of Depressive Symptomatology, Sheehan Disability Scale, Clinical Global Impression scale, and Multidimensional Assessment of Thymic States (MATHYS), an auto-questionnaire rating the frequency of emotions, including sadness and joy, over the previous week.

RESULTS

Joy and sadness had a relatively low correlation coefficient at baseline (r=-0.277), joy (r=-0.160) being less correlated with clinical severity than sadness (r=0.317). An increase in joy at week 2 had higher specificity (85.04%) and positive predictive value (70.55%) for treatment response than decreased sadness (57.92% and 66.04%, respectively), and the global capacity of the former to predict remission, either clinical (Yule Q coefficient, 39.96%) or functional (44.35%), was even better compared to the prediction of clinical response (37.38%).

LIMITATIONS

MATHYS retrospectively assesses emotions, with five possible ratings only, relying on self-rated frequencies. With only a 6-week follow-up, conclusions are limited to short-term aspects of clinical and functional remission.

CONCLUSIONS

Early improvement in joy during the first 2 weeks of treatment is strongly specific for treatment response and remission. The frequency of joy captures the predictivity and may deserve further study regarding inclusion in depressive rating scales.

Focusing on the positive: a review of the role of child positive affect in developmental psychopathology

This review proposes a transactional model of child positive affect (PA) to reflect the ways that PA, in various contexts, may confer both risk and protection for psychosocial adjustment. Though research has largely explored the ways that low PA relates to maladjustment in youth, much less research has focused on the ways that PA can facilitate adjustment, particularly under conditions of risk. Yet, theory suggests that a greater emphasis on PA as a protective factor is an important endeavor in developmental psychopathology research; such conceptual issues are explored in this review. This review also seeks to spur a more nuanced approach to the study of child PA through the use of increased multi-method, longitudinal assessments as well as the consideration of contextual factors. Building upon this research base is important for aiding in the development of intervention and prevention efforts that attempt to promote positive psychosocial development and mitigate the course of psychopathology in youth at risk for PA difficulties.

Antidepressant drug development: Focus on triple monoamine reuptake inhibition

Many patients with major depressive disorder (MDD) only partially respond, and some have no clinically meaningful response, to current widely used antidepressant drugs. Due to the purported role of dopamine in the pathophysiology of depression, triple-reuptake inhibitors (TRIs) that simultaneously inhibit serotonin (5-HT), norepinephrine (NE) and dopamine reuptake could be a useful addition to the armamentarium of treatments for MDD. A TRI should more effectively activate mesolimbic dopamine-related reward-networks, restore positive mood and reduce potent 5-HT reuptake blockade associated "hypodopaminergic" adverse effects of decreased libido, weight gain and "blunting" of emotions. On the other hand, dopaminergic effects raise concern over abuse liability and TRIs may have many of the cardiovascular effects associated with NET inhibition. Several clinical development programs for potential TRI antidepressants have failed to demonstrate significantly greater efficacy than placebo or standard of care. Successful late-stage clinical development of a TRI is more likely if experimental research studies in the target population of depressed patients have demonstrated target engagement that differentially and dose-dependently improves assessments of reward-network dysfunction relative to existing antidepressants. TRI treatment could be individualized on the basis of predictive markers such as the burden of decreased positive mood symptoms and/or neuroimaging evidence of reward network dysfunction. This review focuses on how the next generation of monoamine-based treatments could be efficiently developed to address unmet medical need in MDD.

The role of the mother-child relationship for anxiety disorders and depression: results from a prospective-longitudinal study in adolescents and their mothers

This study aims to examine whether (a) low child valence (emotional connectedness) within the mother-child relationship increases the risk for offspring depression, (b) low child potency (individual autonomy) increases the risk for offspring anxiety, and (c) maternal psychopathology pronounces these associations. We used data from a prospective-longitudinal study of adolescents (aged 14-17 at baseline) and their mothers (N = 1,015 mother-child dyads). Anxiety disorders and depression were assessed repeatedly over 10 years in adolescents (T0, T1, T2, T3) and their mothers (T1, T3) using the DSM-IV/M-CIDI. Valence and potency were assessed in mothers (T1) with the Subjective Family Image Questionnaire. Odds ratios (OR) from logistic regression were used to estimate associations between low child valence/potency and offspring psychopathology (cumulated lifetime incidences; adjusted for sex and age). In separate models (low valence or low potency as predictor), low child valence predicted offspring depression only (OR = 1.26 per SD), while low child potency predicted offspring anxiety (OR = 1.24) and depression (OR = 1.24). In multiple models (low valence and low potency as predictors), low child valence predicted offspring depression only (OR = 1.19), while low child potency predicted offspring anxiety only (OR = 1.22). Low child potency interacted with maternal anxiety on predicting offspring depression (OR = 1.49), i.e. low child potency predicted offspring depression only in the presence of maternal anxiety (OR = 1.33). These findings suggest that low child valence increases the risk for offspring depression, while low child potency increases the risk for offspring anxiety and depression and interacts with maternal psychopathology on predicting offspring depression.

Maternal Depression, Parenting, and Youth Depressive Symptoms: Mediation and Moderation in a Short-Term Longitudinal Study

Although multiple studies find that offspring of depressed mothers are at risk for depressive disorders, there is uncertainty about the specific mechanisms that are at work--particularly with respect to modifiable factors that might be targeted for early intervention. The present work examines that parenting behaviors may operate as mediators, moderators, or independent influences on the development of youth depressive symptoms. One hundred one mothers and their early adolescent children participated in positive and negative interaction tasks. Maternal and youth self-reports of youth depressive symptoms were collected at baseline, 9-month, and 18-month assessments. Maternal history of depression was significantly associated with maternal-reported, but not youth self-reported, depressive symptomatology. Maternal positive and negative interaction behaviors in positive contexts were associated with higher youth self-reported depressive symptoms. Maternal positive interaction behaviors in positive contexts and maternal negative interactive behaviors in conflict contexts were associated with higher youth self-reported depressive symptoms. We found no evidence for maternal interaction behaviors serving as a mediator and little evidence of maternal interaction behaviors serving as a moderator of the relationship between maternal and offspring depression. Low maternal positive engagement tended to be more consistently associated with maternal- and self-reported youth depressive symptoms. The present findings suggest that characteristics of mother-child interactions that are associated with youth depressive symptomatology are pertinent to youth with and without a mother with a history of depression.

Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states

BACKGROUND

Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM).

METHOD

In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18).

RESULTS

EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time.

CONCLUSION

This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.

Practitioner review: Dysphoria and its regulation in child and adolescent depression

BACKGROUND

By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression.

METHOD

We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression.

RESULTS

Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers.

CONCLUSION

The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.

Restoration of positive mood states in major depression as a potential drug development target

Restoration of positive mood, in addition to reducing negative mood, is an important treatment goal in the management of depression. The need to restore positive mood states in depressed patients is not adequately addressed by available treatments for major depressive disorder (MDD), suggesting that this mood dimension could be a useful target for drug development. However, for positive mood restoration to become a valid target for antidepressant drug development certain questions should be answered: are symptoms of decreased positive mood phenomenologically distinct from other symptoms of MDD? Should they be considered a distinct aspect of MDD in the diagnostic nomenclature? Is there evidence for differential responsiveness to treatment? Is the underlying pathophysiology understood and different from that of other MDD symptoms? Is low positive mood specific to depression or does it contribute to psychopathology in other disorders? Beyond these basic questions, this review identifies a number of design issues that need to be considered when conducting studies that target improving positive mood. These design issues include (1) what population to study, (2) what line of treatment to target, (3) the appropriateness and validation of methods and measures to evaluate positive mood and its restoration, (4) the role of functional outcome measures in determining success of the treatment, and (5) optimal designs for add-on therapy versus monotherapy agents.

Associations between maternal negative affect and adolescent's neural response to peer evaluation

Parenting is often implicated as a potential source of individual differences in youths' emotional information processing. The present study examined whether parental affect is related to an important aspect of adolescent emotional development, response to peer evaluation. Specifically, we examined relations between maternal negative affect, observed during parent-adolescent discussion of an adolescent-nominated concern with which s/he wants parental support, and adolescent neural responses to peer evaluation in 40 emotionally healthy and depressed adolescents. We focused on a network of ventral brain regions involved in affective processing of social information: the amygdala, anterior insula, nucleus accumbens, and subgenual anterior cingulate, as well as the ventrolateral prefrontal cortex. Maternal negative affect was not associated with adolescent neural response to peer rejection. However, longer durations of maternal negative affect were associated with decreased responsivity to peer acceptance in the amygdala, left anterior insula, subgenual anterior cingulate, and left nucleus accumbens. These findings provide some of the first evidence that maternal negative affect is associated with adolescents' neural processing of social rewards. Findings also suggest that maternal negative affect could contribute to alterations in affective processing, specifically, dampening the saliency and/or reward of peer interactions during adolescence.

Social problem solving among depressed adolescents is enhanced by structured psychotherapies

OBJECTIVE

Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior.

METHOD

Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined.

RESULTS

Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low.

CONCLUSIONS

Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT.

Maternal depression and warmth during childhood predict age 20 neural response to reward

OBJECTIVE

Early parenting experiences likely shape children's brain development, with consequences potentially extending into adulthood. Parents' affective disorders and expressions of positive affect could exert an influence on affect-related circuitry. The current study evaluated how maternal depression and maternal warmth assessed in early childhood and early adolescence were related to boys' reward function during early adulthood.

METHOD

Participants were 120 boys at socioeconomic risk for emotional problems. Mothers' history of depression during the child's lifetime was measured when boys were 42 months old and 10 and 11 years old. Maternal warmth was observed during mother-child interactions at 18 and 24 months and at 10 and 11 years.

RESULTS

Maternal warmth during early childhood was associated with less activation in the medial prefrontal cortex (mPFC) when anticipating and experiencing reward loss. Maternal warmth during early adolescence was associated with less activation in the mPFC when winning rewards and greater activation in the caudate when experiencing loss. The association between maternal warmth during early childhood and early adolescence and reward function in the striatum and mPFC was stronger for boys exposed to maternal depression relative to boys who were not.

CONCLUSIONS

The experience of warmth and affection from mothers may be a protective factor for reward function in boys exposed to maternal depression, possibly by engaging vulnerable neural reward systems through affiliation.

Childhood parental death and lifetime suicide attempt of the opposite-gender offspring in a nationwide community sample of Korea

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one-person-per-household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32-15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97-16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13-4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite-gender offspring, especially when exposure occurs before age 10.

Depressão materna e riscos para o comportamento e a saúde mental das crianças: uma revisão

A depressão materna tem sido considerada um fator de risco para a saúde mental das crianças. Objetivou-se identificar e analisar na literatura indexada artigos empíricos recentes (2005 a 2012), que abordaram as associações da depressão materna ao comportamento e à saúde mental de crianças, escolares. Procedeu-se a uma busca sistemática nas bases PubMed, PsycInfo e LILACS, por meio das palavras-chave "Maternal Depression or Depression" e "Risk Factors". Foram selecionados e analisados 68 artigos, 23 transversais e 45 longitudinais. Independentemente dos delineamentos adotados, a depressão materna mostrou-se associada à presença de dificuldades emocionais e comportamentais em geral, de manifestações depressivas e de ansiedade. Além da depressão materna, outras variáveis contextuais mostraram-se associadas às dificuldades das crianças. O reconhecimento da ação de múltiplas variáveis permitiu a verificação de indicadores diversos, o que pode favorecer o planejamento de intervenções.

Role of maternal childhood trauma on parenting among depressed mothers of psychiatrically ill children

BACKGROUND

Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors.

METHOD

Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting.

RESULTS

Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors.

CONCLUSIONS

When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting.

Examining the Quality of Adolescent-Parent Relationships Among Chilean Families

The purpose of this study was to examine if adolescents reports of warm and harsh parenting practices by their mothers and fathers varied as a function of demographic, youth and their mothers or mother figures' individual and family characteristics. Data are from 707 community-dwelling adolescents (mean age=14, SD=1.4) and their mothers or mother figures in Santiago, Chile. Having a warmer relationship with both parents was inversely associated with the adolescents' age and positively associated with adolescents' family involvement and parental monitoring. Both mothers' and fathers' harsh parenting were positively associated with adolescent externalizing behaviors and being male and inversely associated with youth autonomy and family involvement. These findings suggest that net of adolescent developmental emancipation and adolescent behavioral problems, positive relationships with parents, especially fathers, may be nurtured through parental monitoring and creation of an interactive family environment, and can help to foster positive developmental outcomes.

Family functioning and the course of adolescent bipolar disorder

The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning data were collected from 58 families of adolescents with bipolar disorder (mean age =14.48±1.60; 33 female, 25 male) who participated in a 2-year randomized trial of family-focused treatment for adolescents (FFT-A). Cohesion and adaptability scores did not significantly change over the course of the study. Parent-reported conflict prior to psychosocial treatment moderated the treatment responses of families, such that high-conflict families participating in FFT-A demonstrated greater reductions in conflict over time than low-conflict families. Moreover, adolescent mania symptoms improved more rapidly in low-conflict than in high-conflict families. For all respondents, cohesion, adaptability, and conflict were longitudinally correlated with adolescents' depression scores. Finally, decreases in parent-reported conflict also predicted decreases in adolescents' manic symptoms over the 2-year study. Findings suggest that family cohesion, adaptability, and conflict may be useful predictors of the course of adolescent mood symptoms. Family conflict may be an important target for family intervention in early onset bipolar disorder.

Adversidades e resiliência no contexto da depressão materna: estudos de casos comparativos

A depressão materna, associada a outros estressores, configura cenários contextuais familiares que podem influenciar o desenvolvimento infantil. Neste trabalho, objetivou-se caracterizar e comparar, por meio do método de estudo de caso, condições favorecedoras de resiliência ou de adversidade para crianças em idade escolar que convivem com a depressão materna recorrente, focalizando os processos-chave da resiliência, analisados em cenários familiares diversos. Foram avaliadas seis duplas mãe-criança, sendo mães com depressão recorrente e episódios moderados ou graves, três crianças com dificuldades escolares e comportamentais e três crianças sem tais dificuldades. Foram aplicados entrevistas, questionário e testes psicológicos, integrando-se os dados em três cenários familiares associados à depressão materna. Para crianças sem dificuldades, foram identificadas como condições favorecedoras dos processos-chave da resiliência a organização da rotina familiar com a efetiva participação paterna, bem como a postura próativa materna no enfrentamento cotidiano de adversidades.

Mothers with depression, school-age children with depression? A systematic review

PURPOSE

To carry out a systematic review of the association between maternal and school-age children depression and covariate factors.

DESIGN AND METHODS

The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004-2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used.

FINDINGS

Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis.

PRACTICE IMPLICATIONS

  Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression.

The neglected role of positive emotion in adolescent psychopathology

Adolescence is a developmental period characterized by elevated stress, heightened risky behaviors, and increases in psychopathology. Emotion dysregulation is a hypothesized contributor to negative outcomes and to the onset of psychopathology during adolescence. However, the dysregulation of negative emotion has been the focus of research while the literature on positive emotion in adolescent psychopathology is limited. This review highlights both the development of normative and dysregulated positive emotion during adolescence. First, the literature on normative adolescent emotional development and on negative emotional regulation is briefly reviewed, followed by a discussion of current theories of positive emotion, which are grounded in the adult literature. From a developmental perspective, the dimension of approach motivation within positive emotion is emphasized throughout and frames the review. This conceptualization guides organization of literatures on normative experiences of positive emotion in adolescence and the role of dysregulated positive emotion in adolescent psychopathology, specifically adolescent depression, anxiety, bipolar disorder, externalizing disorders and eating disorders. Last, future directions in the study of adolescent positive emotion and its regulation and the implications of highlighting approach motivation in normative and dysregulated positive emotion in adolescence are detailed.

Maternal depression and child BMI: longitudinal findings from a US sample

OBJECTIVE

To examine the association between maternal depression and child body mass index (BMI) from Kindergarten (K) to fifth grade.

METHODS

Analysis of four waves of data from the Early Childhood Longitudinal Study - Kindergarten spanning K to fifth grade. Maternal depressive symptoms (MDSs) were measured by a brief version of the Center for Epidemiological Studies Depression scale. Data were analyzed using multiple regression analyses, adjusting for key covariates and potential confounders. The analytic sample was restricted to children of normal birth weight.

RESULTS

The relationship between MDS and child BMI varies by child gender and age. Among girls, severe MDS at K was related to lower BMI at third grade (but not later at fifth grade) and to an increase in BMI from K to third and K to fifth grades. Among boys, severe MDS at K was related to higher boys' BMI at fifth grade. When severe MDS occurred at third grade, it was related to higher BMI at fifth grade among girls whereas no statistically significant relationship was found for boys. Low levels of physical activity in comparison to peers at fifth grade and more screen time on weekends at third grade are likely mediators of the relationship between MDS and child BMI among girls, while among boys the relationship appears to be mediated by unhealthy eating habits.

CONCLUSIONS

Our findings, indicating developmental and gender differences in the relationship between maternal depression and child BMI, if confirmed, suggest that interventions addressing maternal depression may have concomitant impact on childhood obesity.

A novel early intervention for preschool depression: findings from a pilot randomized controlled trial

BACKGROUND

Validation for depression in preschool children has been established; however, to date no empirical investigations of interventions for the early onset disorder have been conducted. Based on this and the modest efficacy of available treatments for childhood depression, the need for novel early interventions has been emphasized. Large effect sizes (ES) for preschool psychotherapies for several Axis I disorders suggest that earlier intervention in depression may also be promising. Therefore, a novel form of treatment for preschool depression, Parent-Child Interaction Therapy Emotion Development (PCIT-ED) was developed and tested.

METHODS

A preliminary randomized controlled trial (RCT) was conducted comparing PCIT-ED to psycho-education in depressed 3- to 7-year-olds and their caregivers. A total of 54 patients met symptom criteria for DSM-IV major depressive disorder and were randomized, 19 patients completed the active treatment (n = 8 dropouts) and 10 completed psycho-education (n = 17 dropouts).

RESULTS

Both groups showed significant improvement in several domains, with PCIT-ED showing significance in a greater number of domains. An intent-to-treat analysis suggested that PCIT-ED was significantly more effective than psycho-education on executive functioning (p = .011, ES = 0.12) and emotion recognition skills (p = .002, ES = 0.83).

CONCLUSIONS

The RCT proved feasible and suggests an individual control condition should be used in future trials to minimize differential dropout. These pilot data, although limited by power, suggest that PCIT-ED may be a promising early intervention for depression. Larger scale randomized controlled trials of PCIT-ED for depressed preschoolers are now warranted.

Affective functioning among early adolescents at high and low familial risk for depression and their mothers: a focus on individual and transactional processes across contexts

This study aimed to characterize affective functioning in families of youth at high familial risk for depression, with particular attention to features of affective functioning that appear to be critical to adaptive functioning but have been underrepresented in prior research including: positive and negative affect across multiple contexts, individual and transactional processes, and affective flexibility. Interactions among early adolescents (ages 9-14) and their mothers were coded for affective behaviors across both positive and negative contexts. Primary analyses compared never-depressed youth at high (n = 44) and low (n = 57) familial risk for depression. The high risk group showed a relatively consistent pattern for low positive affect across negative and positive contexts at both the individual and transactional level. In contrast to prior studies focusing on negative contexts that did not support disruptions in negative affect among high risk youth, the data from this study suggest variability by context (i.e. increased negativity in a positive, but not negative, context), and individual vs. transactional processes (e.g., negative escalation). Findings are discussed in concert with attention to affect flexibility, contextual and transactional factors.

Transmission and prevention of mood disorders among children of affectively ill parents: a review

OBJECTIVE

To provide a conceptual review of the literature on children of depressed parents over the past 12 years.

METHOD

This selective review focused on published studies that delineate the diagnosis of depression in parents, have large samples, describe children 6 to 17 years old, and are methodologically rigorous. The review emphasized conceptual advances and major progress since 1998. Recent efforts in prevention research were discussed, gaps in the existing literature were noted, and directions for targeted research on children of depressed parents were highlighted.

RESULTS

Over the past 12 years there has been considerable progress in delineating the gene-by-environment interplay in determining the range of outcomes in children. In addition, progress has been made in identifying risk mechanisms and moderators that underlie the transmission of disorder and in developing effective prevention programs.

CONCLUSIONS

This review highlights directions for further research, including different areas affected by parental depression in parents and children, and in understanding the underlying mechanisms involved in the intergenerational transmission of depression, so that preventive and treatment efforts can be tailored effectively.

Developmental trajectories of positive and negative affect in children at high and low familial risk for depressive disorder

BACKGROUND

Although low positive affect (PA) and high negative affect (NA) have been posited to predispose to depressive disorders, little is known about the developmental trajectories of these affects in children at familial risk for mood disorders.

METHODS

We examined 202 offspring of mothers who had a history of juvenile-onset unipolar depressive disorder (n = 60) or no history of major psychopathology (n = 80). Offspring participated in up to seven annual, structured laboratory tasks that were designed to elicit PA and NA.

RESULTS

Growth curve analyses revealed that PA increased linearly and similarly for all children from late infancy through age 9. However, there also were individual differences in early PA. Relative to control peers, offspring of mothers with lifetime unipolar depression had consistently lower levels of PA, and this association remained significant even when controlling for current maternal depression and maternal affect displays. Growth curve analyses also revealed a significant linear decrease in NA in children across time; however, there was no significant inter-individual variation either in early NA or rate of change in NA.

CONCLUSION

Attenuated PA (rather than excessive NA) may be an early vulnerability factor for eventual unipolar depressive disorder in at-risk children and may represent one pathway through which depression is transmitted.

The effects of nonshared environments on adolescent depression: findings from a sample of monozygotic twins

PURPOSE

Behavioral genetic research has revealed that nonshared environments are associated with depression and depressive symptomatology. Research examining specific nonshared environments related to adolescent depression remains relatively limited. To address this gap in the published data, we analyzed a sample of monozygotic (MZ) twin pairs from the National Longitudinal Study of Adolescent Health (Add Health) to examine the effects of nonshared environmental variables on adolescent depression.

METHODS

We used the MZ-twin-difference-scores method on data from MZ twins (n = 289 twin pairs) drawn from the Add Health to examine the effect of specific nonshared environments on adolescent depression.

RESULTS

Findings from the MZ-difference-scores analyses revealed that between-twin differences in maternal disengagement were significantly related to differences in adolescent depression. Additional analyses revealed that the association between adolescent depression and maternal disengagement was largely a child-driven effect.

CONCLUSION

Compared with previous research that has implicated maternal socialization in the development of depression among adolescents, the results of the current study revealed that differences in maternal socialization were a response and not a cause of adolescent depression.

Coping and Positive Affect in Adolescents of Mothers With and Without a History of Depression

The adolescent children of depressed mothers are at increased risk for depression, but little is known about protective factors for these children. Maintenance of positive affect in a stressful context may be an important marker of resilience. Mothers with (n = 34) and without (n = 38) a history of depression and their adolescent children completed questionnaires regarding adolescents' coping and depressive symptoms and engaged in a 15 min videotaped interaction about family stress. Adolescents' observed behaviors were coded using the Iowa Family Interaction Rating Scales. No significant differences emerged in observed behavior between adolescents of mothers with and without a history of depression. Higher levels of primary and secondary control coping and lower levels of disengagement coping were related to higher levels of observed positive mood and fewer depressive symptoms in adolescents. Observed positive mood was related to fewer depressive symptoms in adolescents, even after accounting for maternal history of depression and current maternal depressive symptoms. Results suggest the importance of considering positive affect in the context of family stress as a marker of resilience in adolescents at risk for depression. The current study provides evidence for coping as a protective factor, related to higher levels of positive affect and fewer depressive symptoms, in adolescents exposed to maternal depressive symptoms.

Positive Affect Stimulation and Sustainment (PASS) Module for Depressed Mood: A preliminary investigation of treatment-related effects

Positive affective functioning (PAF) is critical to the development, course and treatment of depressive symptoms. Targeting key features of PAF during treatment may provide a new angle through which to improve affective functioning and reduce symptoms. The current study was a treatment development trial for the Positive Affect Stimulation and Sustainment (PASS) Module. PASS is conceptualized as a means of capitalizing on positive events (e.g. planned through behavioral activation) by enhancing and sustaining positive affective states through savoring, and establishing positive attributions and expectancies. Participants were 27 female college students with dysphoric symptoms. There was a moderate effect of PASS on depressive symptoms. There was also a significant within session increase in positive affect from pre to post session among the PASS group, relative to active control; and a significant decrease in positive affect from pre (baseline) to post (follow-up) treatment among the control group, relative to PASS. Results provide preliminary evidence for the efficacy of the treatment module among young adults with depressed mood, and lay the foundation for future research.

Prodromal symptoms and atypical affectivity as predictors of major depression in juveniles: implications for prevention

BACKGROUND

Given the long-term morbidity of juvenile-onset major depressive disorder (MDD), it is timely to consider whether more effort should be dedicated to its primary and secondary prevention.

METHODS

We reviewed studies of prodromal symptoms that may herald a first episode pediatric MDD and considered whether that literature has made an impact on secondary prevention (efforts to prevent progression from symptoms to full disorder). We also reviewed studies of children at familial risk for MDD that addressed atypical affectivity and the regulation of sad, dysphoric affect (mood repair) and related physiological systems, and considered whether research in those areas has made an impact on primary prevention of pediatric MDD (efforts to prevent the disorder).

RESULTS

A compelling body of literature indicates that depressive symptoms in youngsters predict subsequent MDD across the juvenile (and early adult) years and that any combination of several symptoms for at least one week is informative in that regard. These findings are echoed in the case selection criteria used by many secondary prevention programs. Convergent findings also indicate that (compared to typical peers) young offspring at familial risk for depression manifest low positive affectivity and compromised mood repair, along with signs of dysfunction in three intertwined physiological systems that contribute to affectivity and mood repair (the hypothalamic-pituitary-adrenal (HPA) axis, cerebral hemispheric asymmetry, and cardiac vagal control). While all these affect-related parameters are suitable for case selection and as intervention targets, they have not yet made an impact on primary prevention programs.

CONCLUSIONS

According to recent meta-analyses, attempts to prevent pediatric depression have not lived up to expectations. Based on our review, possible reasons for this include: (a) the use of case selection criteria that yield samples heterogeneous with regard to whether the symptoms are truly prodromal to an episode of MDD or are trait-like (which could affect response to the intervention), (b) failure to fully capitalize on the broad-ranging literature on vulnerability to pediatric MDD, as evidenced by the infrequent use of family history of depression (a robust index of vulnerability) or combined indices of vulnerability for case selection, and (c) lack of synchrony between dimensions of vulnerability and the content of the prevention program, as indicated by the overwhelming use of cognitive-behavioral interventions, irrespective of subjects' age, developmental readiness, and whether or not they evidenced the relevant cognitive vulnerability. Prevention trials of pediatric MDD could benefit from new approaches to case selection that combine various indices of vulnerability, more effective use of existing findings, and new or modified interventions that are developmentally sensitive.

Clinical implications of current findings in neurodevelopment

Research in the last decade has advanced our knowledge about biological factors underlying neurodevelopmental processes in childhood. Genetic research has gone beyond mapping the human genome to identifying epigenetic factors and explicating gene-environment interactions. Biological markers of vulnerability to specific disorders have been identified. The functions of and interactions between neuroanatomic regions have been illuminated by new imaging and other noninvasive techniques, such as EEG, event-related potentials, and functional magnetic resonance imaging, that allow us to link earliest signs of disorders to neurological changes. This article provides an overview of current findings in neurodevelopment, and discusses diagnostic factors, prevention and intervention, and clinical implications.