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Clauss JA, Bhiku K, Burke A, Pimentel-Diaz Y, DeTore NR, Zapetis S, Zvonar V, Kritikos K, Canenguez KM, Cather C, Holt DJ. Development of a transdiagnostic, resilience-focused intervention for at-risk adolescents. J Ment Health 2023; 32:592-601. [PMID: 36369940 PMCID: PMC10175511 DOI: 10.1080/09638237.2022.2140790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Environmental adversity and subclinical symptoms of psychopathology in adolescents increase their risk for developing a future psychiatric disorder, yet interventions that may prevent poor outcomes in these vulnerable adolescents are not widely available. AIMS To develop and test the feasibility and acceptability of a prevention-focused program to enhance resilience in high-risk adolescents. METHOD Adolescents with subclinical psychopathology living in a predominantly low-income, Latinx immigrant community were identified during pediatrician visits. A group-based intervention focused on teaching emotion recognition and regulation skills was piloted in three cohorts of adolescents (n = 11, 10, and 7, respectively), using a single arm design. The second and third iterations included sessions with parents. RESULTS Eighty-eight percent of participants completed the program, which was rated as beneficial. Also, from baseline to end of treatment, there was a significant decrease in subclinical symptoms and a significant increase in the adolescents' positive social attribution bias (all p < 0.05). CONCLUSIONS A resilience-focused intervention administered to high-risk adolescents was found to be feasible and acceptable to participants. Future work is needed to determine whether such a program can reduce the incidence of negative outcomes, such as the development of psychiatric disorders and related disability, in this population.
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Affiliation(s)
- Jacqueline A Clauss
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kamila Bhiku
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Anne Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ylira Pimentel-Diaz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nicole R DeTore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sarah Zapetis
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Vanya Zvonar
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Kritikos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Katia M Canenguez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Daphne J Holt
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Halbmeijer NM, Onland W, Cools F, Swarte RM, van der Heide-Jalving M, Dijk P, Mulder-de Tollenaer S, Tan RNGB, Mohns T, Bruneel E, van Heijst AFJ, Kramer B, Debeer A, van Weissenbruch MM, Marechal Y, Blom H, Plaskie K, Offringa M, van Wassenaer-Leemhuis AG, van Kaam AH, Aarnoudse-Moens CSH. Effect of systemic hydrocortisone in ventilated preterm infants on parent-reported behavioural outcomes at 2 years' corrected age: follow-up of a randomised clinical trial. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324179. [PMID: 36593110 DOI: 10.1136/archdischild-2022-324179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To report the parent-reported behavioural outcomes of infants included in the Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants study at 2 years' corrected age (CA). DESIGN Randomised placebo-controlled trial. SETTING Dutch and Belgian neonatal intensive care units. PATIENTS Infants born <30 weeks' gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life. INTERVENTION Infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190). MAIN OUTCOME MEASURES Parent-reported behavioural outcomes at 2 years' CA assessed with the Child Behavior Checklist (CBCL 1½-5). RESULTS Parents completed the CBCL of 183 (70% (183/262)) infants (hydrocortisone group, n=96; placebo group, n=87). Multiple imputation was used to account for missing data. Infants with critically elevated T-scores (>55) were found in 22.9%, 19.1% and 29.4% of infants for total, internalising and externalising problems, respectively; these scores were not significantly different between groups (mean difference -1.52 (95% CI -4.00 to 0.96), -2.40 (95% CI -4.99 to 0.20) and -0.81 (95% CI -3.40 to 1.77), respectively). In the subscales, we found a significantly lower T-score for anxiety problems in the hydrocortisone group (mean difference -1.26, 95% CI -2.41 to -0.12). CONCLUSION This study found high rates of behaviour problems at 2 years' CA following very preterm birth, but these problems were not associated with hydrocortisone treatment initiated between 7 and 14 days after birth in ventilated preterm infants. TRIAL REGISTRATION NUMBER NTR2768; EudraCT 2010-023777-19.
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Affiliation(s)
- Nienke Marjolein Halbmeijer
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Wes Onland
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Filip Cools
- Neonatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Renate M Swarte
- Section of Neonatology, Pediatrics Department, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Peter Dijk
- Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands
| | | | - Ratna N G B Tan
- Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Thilo Mohns
- NICU, Woman-Mother-Child Center, Màxima Medical Centre, Veldhoven, Netherlands
| | - Els Bruneel
- Department of Neonatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud Universiteit Nijmegen, Nijmegen, Netherlands
| | - Boris Kramer
- Pediatrics, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anne Debeer
- Neonatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Mirjam M van Weissenbruch
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.,Neonatology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yoann Marechal
- Department of Neonatology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Henry Blom
- Neonatology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Katleen Plaskie
- Department of Neonatology, GZA Ziekenhuizen Campus Sint-Augustinus, Wilrijk, Belgium
| | - Martin Offringa
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.,Child Health Evaluative Sciences, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aleid G van Wassenaer-Leemhuis
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Anton H van Kaam
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands .,Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.,Psychosocial Department, Universiteit van Amsterdam, Amsterdam, Netherlands
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Liang K, Zhao L, Lei Y, Zou K, Ji S, Wang R, Huang X. Nonsuicidal self-injury behaviour in a city of China and its association with family environment, media use and psychopathology. Compr Psychiatry 2022; 115:152311. [PMID: 35395465 DOI: 10.1016/j.comppsych.2022.152311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION It is not clear whether there are differences in the risk factors for nonsuicidal self-injury (NSSI) between children and early adolescents. Clarifying this question is crucial for identifying actionable prevention strategies for NSSI in these two age groups. METHOD The study, comprising 8611 children and early adolescents (4409 (51.2%) children, 4202 (48.8%) early adolescents), was based on the baseline data of the Chengdu Positive Child Development (CPCD) in China. NSSI behaviours, emotional and behavioural problems and family environment were assessed and obtained via self-reports and parent reports. RESULTS Overall, 2520 (29.26%) participants reported having ever engaged in NSSI. There was a higher lifetime NSSI rate in males than in females during childhood, contrasting with higher NSSI rates in females than in males during early adolescence. Furthermore, NSSI shared similar risk factors, including major family conflict and poor relationships with caregivers, in both age groups. Specifically, in children, the risk of NSSI increased along with thought and attention problems (OR, 95% CI: 1.194, 1.106-1.288 and 1.114, 1.028-1.207, respectively), whereas in early adolescents, it increased with anxiety and depressive problems (OR, 95% CI: 1.259, 1.116-1.422). CONCLUSIONS The findings suggested the need for difference in preventive strategies for NSSI in the two age groups. It may be more efficacious to screen for NSSI in children with thought and attention problems and in early adolescents with anxiety and depressive problems.
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Affiliation(s)
- Kaili Liang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yalin Lei
- Department of Health-Related Social and Behavioural Sciences, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Kun Zou
- Department of Child, Adolescent and Maternal Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan 610041, China; Institute for Healthy Cities, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shuming Ji
- Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Ruiou Wang
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Further Evidence that Subsyndromal Manifestations of Depression in Childhood Predict the Subsequent Development of Major Depression: A Replication Study in a 10 Year Longitudinally Assessed Sample. J Affect Disord 2021; 287:101-106. [PMID: 33774317 PMCID: PMC8085095 DOI: 10.1016/j.jad.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We have previously shown that subsyndromal scores on the Child Behavior Checklist (CBCL)-Anxiety/Depression (Anx/Dep) scale at baseline predicted the subsequent development of Major Depressive Disorder (MDD) in youth with ADHD. The present study aimed to replicate these findings in a separate, long-term, longitudinal sample of children at high- and low- risk for depression. METHODS 219 children of parents with and without depression and/or anxiety, ages 2-25, were stratified into 3 groups: 1) children with familial risk for depression (by presence of parental MDD) plus subsyndromal scores on the CBCL-Anx/Dep scale, 2) children with familial risk for depression without subsyndromal scores, and 3) children with neither familial risk for depression nor subsyndromal scores. Subjects were reassessed at both 5 and 10 year follow-ups. RESULTS Children with both subsyndromal scores on the CBCL-Anx/Dep plus a familial risk for depression were at greater risk for developing MDD at the 10 year follow-up when compared with all other groups. Those with familial risk but no subsyndromal scores had an intermediate risk that was greater than the controls, who had the lowest risk. LIMITATIONS The recruitment of the study included families with parental panic disorder, so the sample likely included more families with anxiety disorders than the general population. CONCLUSIONS Our results showed that subsyndromal scores of the CBCL-Anx/Dep scale increased the risk for the subsequent development of MDD, particularly in children at high risk for depression. These results confirm the CBCL-Anx/Dep scale's utility in identifying children at high risk for developing MDD.
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Whitfield-Gabrieli S, Wendelken C, Nieto-Castañón A, Bailey SK, Anteraper SA, Lee YJ, Chai XQ, Hirshfeld-Becker DR, Biederman J, Cutting LE, Bunge SA. Association of Intrinsic Brain Architecture With Changes in Attentional and Mood Symptoms During Development. JAMA Psychiatry 2020; 77:378-386. [PMID: 31876910 PMCID: PMC6990753 DOI: 10.1001/jamapsychiatry.2019.4208] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/16/2019] [Indexed: 12/31/2022]
Abstract
Importance Understanding the neurodevelopmental trajectory of psychiatric symptoms is important for improving early identification, intervention, and prevention of mental disorders. Objective To test whether the strength of the coupling of activation between specific brain regions, as measured by resting-state functional magnetic resonance imaging (fMRI), predicted individual children's developmental trajectories in terms of attentional problems characteristic of attention-deficit/hyperactivity disorder and internalizing problems characteristics of major depressive disorder (MDD). Design, Setting, and Participants A community cohort of 94 children was recruited from Vanderbilt University between 2010 and 2013. They were followed up longitudinally for 4 years and the data were analyzed from 2016 to 2019. Based on preregistered hypotheses and an analytic plan, we examined whether specific brain connectivity patterns would be associated with longitudinal changes in scores on the Child Behavior Checklist (CBCL), a parental-report assessment used to screen for emotional, behavioral, and social problems and to predict psychiatric illnesses. Main Outcomes and Measures We used the strength of resting-state fMRI connectivity at age 7 years to predict subsequent changes in CBCL measures 4 years later and investigated the mechanisms of change by associating brain connectivity changes with changes in the CBCL. Results We analyzed data from a longitudinal brain development study involving children assessed at age 7 years (n = 94; 41 girls [43.6%]) and 11 years (n = 54; 32 girls [59.3%]). As predicted, less positive coupling at age 7 years between the medial prefrontal cortex and dorsolateral prefrontal cortex (DLPFC) was associated with a decrease in attentional symptoms by age 11 years (t49 = 2.38; P = .01; β = 0.32). By contrast, a less positive coupling between a region implicated in mood, the subgenual anterior cingulate cortex (sgACC), and DLPFC at age 7 years was associated with an increase in internalizing (eg, anxiety/depression) behaviors by age 11 years (t49 = -2.4; P = .01; β = -0.30). Logistic regression analyses revealed that sgACC-DLPFC connectivity was a more accurate predictor than baseline CBCL measures for progression to a subclinical score on internalization (t50 = -2.61; P = .01; β = -0.29). We then replicated and extended the sgACC-DLPFC result in an independent sample of children with (n = 25) or without (n = 18) familial risk for MDD. Conclusions and Relevance These resting-state fMRI metrics are promising biomarkers for the early identification of children at risk of developing MDD or attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Susan Whitfield-Gabrieli
- Helen Wills Neuroscience Institute & Department of Psychology, University of California at Berkeley, Berkeley
- Department of Psychology, Northeastern University and McGovern Institute for Brain Research, Boston, Massachusetts
- Massachusetts Institute of Technology, Cambridge
| | - Carter Wendelken
- Helen Wills Neuroscience Institute & Department of Psychology, University of California at Berkeley, Berkeley
- Vicarious FPC Inc, Union City, California
| | - Alfonso Nieto-Castañón
- Department of Psychology, Northeastern University and McGovern Institute for Brain Research, Boston, Massachusetts
| | - Stephen Kent Bailey
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Sheeba Arnold Anteraper
- Department of Psychology, Northeastern University and McGovern Institute for Brain Research, Boston, Massachusetts
- Massachusetts Institute of Technology, Cambridge
| | - Yoon Ji Lee
- Department of Psychology, Northeastern University and McGovern Institute for Brain Research, Boston, Massachusetts
| | - Xiao-qian Chai
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Joseph Biederman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Laurie E. Cutting
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Silvia A. Bunge
- Helen Wills Neuroscience Institute & Department of Psychology, University of California at Berkeley, Berkeley
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Uchida M, Fitzgerald M, Woodworth H, Carrellas N, Kelberman C, Biederman J. Subsyndromal Manifestations of Depression in Children Predict the Development of Major Depression. J Pediatr 2018; 201:252-258.e1. [PMID: 30007773 PMCID: PMC6153024 DOI: 10.1016/j.jpeds.2018.05.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/30/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the utility of assessing subsyndromal symptoms of major depressive disorder in childhood, indexed through the Child Behavior Checklist (CBCL) anxiety/depression scale, in predicting risk of developing major depressive disorder in adolescent and young adult years. STUDY DESIGN The sample consisted of 537 children, 6-17 years of age, originally ascertained for a longitudinal family genetic study of youth with and without attention-deficit hyperactivity disorder and their first-degree relatives who were followed prospectively and blindly for 10 years from childhood into young adult years. Children with full diagnosis major depressive disorder at baseline were excluded. For analysis, the sample was stratified into 4 groups based on the presence or absence of parental mood disorders and by the presence or absence of subsyndromal scores on the CBCL anxiety/depression scale at baseline assessment in childhood. RESULTS Children of parents with mood disorders plus subsyndromal scores on the CBCL anxiety/depression scale at baseline (n = 22) had the highest risk for developing major depressive disorder and anxiety disorders at the 10-year follow-up when compared with the other groups. Children with either subsyndromal scores on the CBCL anxiety/depression scale at baseline alone (n = 22) or parental mood disorders alone (n = 172) had intermediate outcomes. CONCLUSION The CBCL anxiety/depression scale was useful in identifying children at high risk for the development of major depressive disorder and anxiety disorders at the 10-year prospective follow-up. Furthermore, our results emphasized the importance of familial psychiatric history in youth with subthreshold symptoms of depression. Parental mood disorder and subthreshold anxiety/depressive symptoms were predictive of developing depression.
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Affiliation(s)
- Mai Uchida
- Department of Psychiatry, Clinical and Research Programs in Pediatric Psychopharmacology and Adult Attention-Deficit Hyperactivity Disorder, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Maura Fitzgerald
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Hilary Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Nicholas Carrellas
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Caroline Kelberman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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