Strategies and challenges in the management of adolescent depression

Global, regional, and national burden of depressive disorders among young people aged 10-24 years, 2010-2019

OBJECTIVE

To describe the latest disease burden, temporal trends, and risk factors of depressive disorders among young people.

METHODS

Data from the Global Burden of Disease Study 2019 was utilized to analyze depressive disorders among individuals aged 10-24 years. The study focused on describing the incidence, prevalence, disability-adjusted life years (DALYs), and their attributable risk factors across 204 countries and territories from 2010 to 2019. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends.

RESULTS

Globally, the incidence, prevalence, and DALYs rate of depressive disorders per 100 000 young people increased from 3003.01, 2445.69, and 448.61 in 2010 to 3035.26, 2470.67, and 452.58 in 2019, indicating a slight upward trend (EAPC = 0.11 for incidence and prevalence; EAPC = 0.09 for DALYs rate). Notably, the percentage of DALYs of depressive disorders among young people increased substantially from 3.24% in 2010 to 3.66% in 2019, an increase of 13.06% (EAPC = 1.26, 95%CI: 1.08-1.44), and the burden of depressive disorders among young people rose from fouth to second in females, and from tenth to fifth in males. Social demographic index (SDI) and other indicators were positively correlated with the percentage of DALYs of depressive disorder and negatively correlated with the EAPC of DALYs.

CONCLUSION

The global burden of depressive disorders among young people is on the rise. The regional differences in depressive disorders among young people suggest the need for enhanced screening efforts in low-SDI areas, along with the adoption of more effective prevention and control measures.

Identifying Transformative Sequences in the Psychotherapeutic Interaction With Chinese Adolescents With Depression: A Conversation Analysis Approach

Previous studies seldom touch on aspects of psychotherapeutic encounters between therapists and clients with particular disorders (such as depression). Little attention has been paid to the sequence organization of psychotherapeutic interaction between therapists and clients with depression in Chinese medical settings. By adopting conversation analysis, we investigated the specifics of psychotherapeutic encounters, specifically, the transformative sequences of psychotherapeutic interaction between therapists and Chinese adolescents with depression. We identified the fourth aspect of clients’ experience transformed in the Chinese psychotherapeutic interaction with adolescents with depression: cognition, and described how the sequential organization of therapists’ actions facilitates the momentary transformation of clients’ experience (i.e., the transformation of cognition, referent, emotion, and relation) in the psychotherapeutic processes. This study not only adds to the conversation analytic study on the transformative sequences in psychotherapeutic interaction but also sheds some light on the study of how therapists transform clients’ experience in Chinese psychotherapeutic interaction.

Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults

OBJECTIVE

Suicides and other sudden violent deaths are the most common causes of death among young people worldwide. This case-control study compared risk factors for suicide and other sudden violent death among young people.

METHOD

A total of 436 psychological autopsy interviews with next of kin were performed. The samples aged 10-25 years included 63 cases of suicide, 62 cases of other sudden violent death, and 104 matched living controls. Two stepwise multiple logistic regression analyses were performed.

RESULTS

The number of recent stressful life events was the only common risk factor for suicide and other sudden violent death. Specific risk factors for suicide were any form of addiction and being an inpatient in adult psychiatric care. Specific risk factors for other sudden violent death were lower elementary school results, lower educational level, and abuse of psychoactive drugs.

CONCLUSIONS

The suicide group seems to have been more vulnerable and exposed to different kinds of stressors, whereas the sudden violent death group seems to have been more acting out and risk-taking. Both groups must be the subject of prevention and intervention programs.

Being bullied and depressive symptoms in Chinese high school students: The role of social support

The aims of this study were to: 1) examine the relationship between being bullied and depressive symptoms; 2) explore whether the three mentioned sources of social support moderated this association; and 3) examine gender differences in the moderating effects of social support on bullying-associated depressive symptoms among Chinese high school students. A total of 1252 students were selected from three high schools in Zhenping County of Henan Province in China. The results suggest that bullying victimization is significantly associated with depressive symptoms among high school students. In addition, we found that only school-type social support had a moderating effect on depressive symptoms. Those who had been bullied but who had high levels of school support had lower levels of depressive symptoms than those with less school support. However, moderating effects of this support were only found for girls, not for boys. This study empirically supports that programs aimed at boosting social support for students from teachers and classmates, could help protect high school students from depressive symptoms.

The Natural Course of Adolescent Depression Treatment in the Primary Care Setting

INTRODUCTION

Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting.

METHODS

Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation. Descriptive statistics were calculated, and a qualitative content analysis was conducted to determine the reasons for treatment discontinuation.

RESULTS

Eighty records were reviewed (mean age = 15.3, 73% female, 59% Black). Treatment was initiated for 83% (n = 66) of patients, and 45% (n = 30) of patients discontinued treatment during the review period for a variety of reasons.

DISCUSSION

To improve adolescents' adherence to depression treatment, providers should address factors that contribute to treatment discontinuation and use tools to manage depression follow-up care.

Computer-Assisted Cognitive-Behavioral Therapy to Treat Adolescents With Depression in Primary Health Care Centers in Santiago, Chile: A Randomized Controlled Trial

Introduction: Evidence from developed countries shows the efficacy of computer-assisted cognitive-behavioral therapy (cCBT) in addressing adolescent depression in home and/or school settings. This paper presents the results of a randomized controlled trial (RCT) of a brief therapist-guided cCBT intervention for adolescent depression in resource-constrained primary health care (PHC) settings. Material and methods: A multicenter, two-arm parallel-group, individually RCT with a 1:1 allocation ratio assigned 216 depressed adolescents (aged 15-19) attending four PHC centers in a low-income municipality of Santiago, Chile, to receive eight weekly face-to-face therapist-guided cCBT sessions by study therapists (N = 108), or to receive an enhanced usual care (EUC) intervention by trained PHC psychologists, encouraged to adhere to the national clinical guidelines for the management of depression (N = 108). Both groups received pharmacotherapy concordant with these guidelines. The primary outcome was the Beck Depression Inventory (BDI) at 4 months post-randomization, to assess depressive symptoms. BDI at 6 months post-randomization was a secondary outcome. Additional measures included patients' compliance, and satisfaction with different treatment components, at 6 months post-randomization. Main Results: The adjusted difference in mean BDI score between groups was -3.75 (95% CI -6.23 to -1.28; p = 0.003) at 4 months post-randomization. At 6 months post-randomization, the adjusted difference in mean BDI score between groups was -2.31 (95% CI -4.89 to 0.27; p = 0.078). The effect size was small-to-medium at 4 months post-randomization, d = 0.39 (0.12 to 0.67), and small and non-significant at 6 months post-randomization d = 0.29 (-0.00 to 0.59). Adolescents in the experimental treatment group were significantly more satisfied with treatment, with the PHC centers' facilities, with the psychological care received, and with non-professional staff than those in the comparator treatment group. Discussion: A brief therapist-guided cCBT eight-session intervention improves the response of depressed adolescents attending PHC centers at 4 months post-randomization. At 6 months post-randomization, the differences of between groups were not significant. Future research may focus on exploring strategies to sustain and increase response. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT01862913 and URL: https://clinicaltrials.gov/ct2/show/NCT01862913.

Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: A cross-sectional study

Objectives

The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents.

Methods

A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method.

Results

Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]).

Conclusions

Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events.

Prevalence of depressive symptoms among adolescents in secondary school in mainland China: A systematic review and meta-analysis

BACKGROUND

The objective of the study reported here is to systematically estimate the prevalence of depressive symptoms among adolescents in secondary schools in mainland China.

METHOD

Literature searches were conducted in both English and Chinese databases from database inception to January 2018. This meta-analysis used a random-effects model to estimate the prevalence of depressive symptoms.

RESULTS

Fifty-one eligible studies (n = 144,060) using probability sampling were identified. The results revealed a pooled prevalence of depressive symptoms of 24.3% (95% CI, 21.3%-27.6%), with high between-studies heterogeneity (Q = 9909, I² = 99.5%, p < 0.001). The prevalence estimates reported by the individual studies ranged from 6.2% to 64.8%. There was an increased prevalence with increasing grades from year 1 in junior secondary school (24.5%; 95% CI, 17.8%-32.8%) to year 3 in senior secondary school (40.1%; 95% CI, 29.4%-51.9%) (Q = 7.1, p < 0.01). Potential sources of high heterogeneity of prevalence among studies can be accounted for by screening instruments with different cutoffs. Further analysis stratified by gender, grade, household registration (hukou) and number of children in the household were performed.

LIMITATIONS

Limitations include the high level of heterogeneity between studies (mainly from the heterogeneity of measurement tools) and stringent inclusion and exclusion criteria.

CONCLUSIONS

This study suggests that depressive symptoms are common among Chinese secondary school students. Further research is needed to identify the risk factors and effective strategies for preventing and treating depression among adolescents in secondary schools.

Response Shifts in Depression Intervention for Early Adolescents

OBJECTIVE

Patient-reported outcome measures are increasingly required as metrics for determining the efficacy of depression interventions. However, the scores obtained from self-reports over the course of treatment may be biased because respondents restructured the factors of the depression symptoms (reconceptualization), changed their values of the symptoms in reflecting depression (reprioritization), or adjusted their standards of assessing the levels of symptoms (recalibration). The aim of present study is to assess response shifts on the depression measure.

METHOD

This study uses the procedures for assessing longitudinal measurement invariance to evaluate response shift effects on the Beck Depression Inventory II (BDI-II) with 320 early adolescents suffering from depression (43.8% boys and 56.2% girls) over the course of their treatment in the school settings.

RESULTS

The findings reveal clear signs of response shifts (recalibration) in the BDI-II for depressed students. Compared with the factor scores before treatment, the factor scores after treatment were underestimated, especially on the negative attitude and performance difficulty factors.

CONCLUSIONS

Estimates of treatment efficacy based on observed test scores appear to be confounded by response shifts.

Shame and Gender Differences in Paths to Youth Suicide: Parents' Perspective

Risk factors, suicidal behavior, and help-seeking patterns differ between young women and men. We constructed a generic conceptual model of the processes underlying youth suicide, grounded in 78 interviews with parents in 52 consecutive cases of suicide (19 women, 33 men) identified at forensic medical autopsy and compared by sex. We found different forms of shame hidden behind gender-specific masks, as well as gender differences in their paths to suicide. Several interacting factors formed negative feedback loops. Finding no way out, the young persons looked for an "emergency exit." Signs and preparations could be observed at different times but recognized only in retrospect. Typically, the young persons and their parents asked for professional help but did not receive the help they needed. We discuss parents' experiences from the theoretical perspective on gender identity and developmental breakdown. Giving voice to the parents' tacit knowledge can contribute to better prevention and treatment.

The role of maternal obesity in the risk of neuropsychiatric disorders

Recent evidence indicates that perinatal exposure to maternal obesity, metabolic disease, including diabetes and hypertension, and unhealthy maternal diet has a long-term impact on offspring behavior and physiology. During the past three decades, the prevalence of both obesity and neuropsychiatric disorders has rapidly increased. Epidemiologic studies provide evidence that maternal obesity and metabolic complications increase the risk of attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety, depression, schizophrenia, eating disorders (food addiction, anorexia nervosa, and bulimia nervosa), and impairments in cognition in offspring. Animal models of maternal high-fat diet (HFD) induced obesity also document persistent changes in offspring behavior and impairments in critical neural circuitry. Animals exposed to maternal obesity and HFD consumption display hyperactivity, impairments in social behavior, increased anxiety-like and depressive-like behaviors, substance addiction, food addiction, and diminished cognition. During development, these offspring are exposed to elevated levels of nutrients (fatty acids, glucose), hormones (leptin, insulin), and inflammatory factors (C-reactive protein, interleukin, and tumor necrosis factor). Such factors appear to permanently change neuroendocrine regulation and brain development in offspring. In addition, inflammation of the offspring brain during gestation impairs the development of neural pathways critical in the regulation of behavior, such as serotoninergic, dopaminergic, and melanocortinergic systems. Dysregulation of these circuits increases the risk of mental health disorders. Given the high rates of obesity in most developed nations, it is critical that the mechanisms by which maternal obesity programs offspring behavior are thoroughly characterized. Such knowledge will be critical in the development of preventative strategies and therapeutic interventions.

Associations between school-related factors and depressive symptoms among children: A comparative study, Finland and Norway

This study compares school-related associations in depressive symptoms among children aged between 9–13 years from four schools in Finland and Norway. A total of 523 pupils participated in the cross-sectional survey. The connections between depressive symptoms and school factors were analysed using hierarchical regression analyses. School variables were self-perceived peer victimization, teacher and peer social support, school performance, and teachers’ reports on competence in core subjects; these variables explain 30% of the variance of the children’s depressive symptoms in Norway and 26% in Finland beyond that afforded by differences in the background characteristics and protective factors in the family. A trend was found in the Norwegian data which showed that poor relationships at school are connected more strongly with depressive symptoms than poor school performance, but the Finnish data did not confirm this. The results support the importance of taking various school factors into account with children suffering depressive symptoms, and not merely a dysfunctional domestic situation. The implications for school psychology practice are also discussed.

Depression among last-year high school students in Vientiane, capital city of Lao PDR

In spite of being a major public health issue, no data on depression in young people exist in Laos. Decision makers are therefore poorly equipped to define the degree of prioritization of this pathology among their preoccupations. This study aimed at estimating the prevalence of depression among last-year high schools students and exploring some of its determinants with a qualitative approach. The quantitative component was based on a survey of a representative sample consisting of 210 students studying in 30 schools in the capital city, Vientiane, using the Beck Depression Inventory validated in the Lao language. The qualitative component was based on interviews with 5 nondepressive and 5 depressive students. Clinical depression prevalence was 24%. Depressed students were aware of the effectiveness of available medication and its importance in controlling the disease. The other students had little knowledge about the disease and how to handle it.