Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis

Prenatal Antidepressant Exposure and Risk of Depression and Anxiety Disorders: An Electronic Health Records-Based Cohort Study

OBJECTIVE

To examine the associations of serotonergic antidepressant exposure during pregnancy with the risk of depression and anxiety disorders in offspring.

METHOD

The Mayo Clinic Rochester Epidemiology Project medical records-linkage system was used to study offspring born to mothers who were prescribed selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (S/NRI users, n=837) during pregnancy (1997-2010). Cox regression models were used to calculate hazard ratios (HRs) to examine associations of S/NRIs with diagnosed depression and anxiety, defined based on a review of medical records by two board-certified psychiatrists, using no maternal antidepressant use during pregnancy (non-users, n=863) and maternal antidepressant use in the year prior to pregnancy (former users, n=399) as control groups.

RESULTS

After all adjustments for covariates, children born to S/NRI users during pregnancy did not differ in onset of depression or anxiety than the children of non-users (Adjusted Hazard Ratios, (aHR [95% CI]=1.00 [0.74, 1.85]) or former users (aHR=0.94 [0.69, 1.27]). The above associations were similar when exposure was limited only to SSRIs.

CONCLUSION

Our results suggest that the higher rates of childhood and adolescent depression or anxiety conditioned on maternal S/NRI use in pregnancy are more likely to be driven by maternal depression or underlying propensity for depression rather than direct pharmacological effects of in utero S/NRI exposure.

Mental Distress Among Youths in Low-Income Urban Areas in South America

Importance

Improving mental health of young people is a major societal challenge, particularly among the high numbers of young people living in deprived urban areas.

Objective

To identify factors associated with depression and anxiety among young people in deprived urban areas in South America.

Design, Setting, and Participants

This case-control study recruited adolescents (age 15-16 years) and young adults (age 20-24 years) from education and community settings in deprived areas in Bogotá, Colombia; Buenos Aires, Argentina; and Lima, Peru, between April 2021 and November 2022. Participants who met threshold criteria for self-reported depression or anxiety. Community controls who did not meet the criteria were identified.

Exposures

Sociodemographic characteristics, stressful life events before and during the past year, substance use, social capital, sports and arts activities, social media engagement.

Main Outcomes and Measures

Depression, assessed using the 8-item Patient Health Questionnaire (range, 0-24, with higher scores indicating greater symptom severity), and anxiety, assessed using the 7-item Generalized Anxiety Disorder questionnaire (range, 0-21, with higher scores indicating greater symptom severity), were defined by threshold scores higher than 9. Various factors were compared between groups with and without anxiety and depression in multivariable logistic regression, testing for interactions by age group.

Results

Of 2402 analyzed participants, 1560 (64.9%) were female, 1080 (45.0%) were adolescents, and 1322 (55.0%) were young adults; 1437 (59.8%) met the criteria for depression and/or anxiety, and 965 (40.2%) were controls. In a multivariable model, female gender (OR, 1.99 [95% CI, 1.65-2.40), more than 2 stressful life events in the previous year (OR, 1.67 [95% CI, 1.40-2.01]), more than 7 stressful life events before the previous year (OR, 1.52 [95% CI, 1.27-1.81), lifetime consumption of sedatives (OR, 2.26 [95% CI, 1.65-3.14]), participating in arts activities in the past 30 days (OR, 1.22 [95% CI, 1.01-1.48]), and stronger engagement with social media (OR, 1.59 [95% CI, 1.34-1.89]) were independently associated with increased odds of depression and anxiety, while sports activities were associated with reduced odds (OR, 0.80 [95% CI, 0.67-0.96]). The odds of having depression and/or anxiety symptoms associated with lifetime use of sedatives were higher among adolescents (OR, 6.54 [95% CI, 3.33-14.27]) than among young adults (OR, 2.54 [95% CI, 1.79-3.66]) (P = .01 for interaction).

Conclusions and Relevance

In this case-control study, female gender, stressful life events, substance use, arts activities, and social media engagement were associated with greater odds of depression and anxiety, while sport activities were associated with lesser odds. The findings suggest that policies for improving mental health in deprived urban neighborhoods in South America and related research should consider similar factors associated with mental distress in adolescents and young adults.

Depression symptoms are associated with demographic characteristics, nutritional status, and social support among young adults in Chile: a latent class analysis

BACKGROUND

Depressive disorders are a critical public health concern in Chile. Nonetheless, there is a lack of evidence regarding the identification of depressive symptom clusters. The objective was to identify depressive symptom clusters among Chilean young adults and examine how demographic, and lifestyle factors as well as social support can influence and predict them.

METHODS

Cross-sectional study conducted among 1,000 participants from the Limache cohort 2. A latent class analysis (LCA) was performed to identify depressive symptom clusters, using the Patient Health Questionnaire (PHQ-9). Multinomial logistic regression was then applied to explore the associations between identified classes and potential predictors. The models were adjusted by age and sex.

RESULTS

Three latent classes of depressive symptoms were identified: minimal (25.7%); somatic (50.7%) and severe (23.6%). In the severe class for eight out nine depressive symptoms the probabilities were above 50%, and the probability of suicidal ideation was almost a third in this class. Being female (Adjusted Odds ratio [AOR], 2.49; 95% confidence interval [CI] [1.63-3.81]), current smoker (AOR, 1.74; 95% CI [1.15-2.65]), having basic education (AOR, 3.12; 95% CI [1.30-7.53]) and obesity (AOR, 2.72; 95% CI [1.61-4.59]) significantly increased the likelihood of belonging to severe class. Higher social support decreased the odds of being in the somatic (OR, 0.96; 95% CI [0.93-0.98]) and severe (OR, 0.92; 95% CI [0.90-0.94]) classes.

CONCLUSIONS

These findings highlight the importance of individualized intervention strategies for depression management. Also, the study suggests that nutritional status and social support should be considered when addressing depression in this population.

Differences in bacterial taxa between treatment-naive patients with major depressive disorder and non-affected controls may be related to a proinflammatory profile

BACKGROUND

Major depressive disorder (MDD) is characterized by sadness and anhedonia, but also physical symptoms such as changes in appetite and weight. Gut microbiota has been hypothesized to be involved in MDD through gut-brain axis signaling. Moreover, antidepressants display antibacterial properties in the gastrointestinal tract. The aim of this study was to compare the gut microbiota and systemic inflammatory profile of young patients with MDD before and after initiation of antidepressant treatment and/or psychotherapy in comparison with a non-depressed control group (nonMDD).

METHODS

Fecal and blood samples were collected at baseline and at follow-up after four and twelve weeks, respectively. Patients started treatment immediately after collection of the baseline samples. The gut microbiota was characterized by 16 S rRNA gene sequencing targeting the hypervariable V4 region. Plasma levels of 49 unique immune markers were assessed using Mesoscale.

RESULTS

In total, 27 MDD patients and 32 nonMDD controls were included in the study. The gut microbiota in the baseline samples of MDD versus nonMDD participants did not differ regarding α- or β-diversity. However, there was a higher relative abundance of the genera Ruminococcus gnavus group, and a lower relative abundance of the genera Desulfovibrio, Tyzzerella, Megamonas, Olsenella, Gordonibacter, Allisonella and Rothia in the MDD group compared to the nonMDD group. In the MDD group, there was an increase in the genera Rothia, Desulfovibrio, Gordinobacteer and Lactobacillus, while genera belonging to the Firmicutes phylum were found depleted at twelve weeks follow-up compared to baseline. In the MDD group, IL-7, IL-8 and IL-17b levels were elevated compared to the nonMDD group at baseline. Furthermore, MDI score in the MDD group was found to correlate with Bray-Curtis dissimilarity at baseline, and several inflammatory markers at both baseline and after initiation of antidepressant treatment.

CONCLUSION

Several bacterial taxa differed between the MDD group and the nonMDD group at baseline and changed in relative abundance during antidepressant treatment and/or psychotherapy. The MDD group was furthermore found to have a pro-inflammatory profile compared to the nonMDD group at baseline. Further studies are required to investigate the gut microbiota and pro-inflammatory profile of patients with MDD.

Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study

BACKGROUND

This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents' cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers.

METHODS

The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children's Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews.

RESULTS

Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents' and mothers' perspectives as associated with adolescents' MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility.

CONCLUSIONS

This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence.

Neurocognitive risk phenotyping to predict mood symptoms in adolescence

Predicting mood disorders in adolescence is a challenge that motivates research to identify neurocognitive predictors of symptom expression and clinical profiles. This study used machine learning to test whether neurocognitive variables predicted future manic or anhedonic symptoms in two adolescent samples risk-enriched for lifetime mood disorders (Sample 1, n = 73, ages = 13-25, M [SD] = 19.22 [2.49] years, 68% lifetime mood disorder) or familial mood disorders (Sample 2, n = 154, ages = 13-21, M [SD] = 16.46 [1.95] years, 62% first-degree family history of mood disorder). Participants completed cognitive testing and functional magnetic resonance imaging at baseline, for behavioral and neural measures of reward processing and executive functioning. Next, participants completed a daily diary procedure for 8-16 weeks. Penalized mixed-effects models identified neurocognitive predictors of future mood symptoms and stress-reactive changes in mood symptoms. Results included the following. In both samples, adolescents showing ventral corticostriatal reward hyposensitivity and lower reward performance reported more severe stress-reactive anhedonia. Poorer executive functioning behavior was associated with heightened anhedonia overall in Sample 1, but lower stress-reactive anhedonia in both samples. In Sample 1, adolescents showing ventral corticostriatal reward hypersensitivity and poorer executive functioning reported more severe stress-reactive manic symptoms. Clustering analyses identified, and replicated, five neurocognitive subgroups. Adolescents characterized by neural or behavioral reward hyposensitivities together with average-to-poor executive functioning reported unipolar symptom profiles. Adolescents showing neural reward hypersensitivity together with poor behavioral executive functioning reported a bipolar symptom profile (Sample 1 only). Together, neurocognitive phenotypes may hold value for predicting symptom expression and profiles of mood pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Strengthening self-regulation and reducing poverty to prevent adolescent depression and anxiety: Rationale, approach and methods of the ALIVE interdisciplinary research collaboration in Colombia, Nepal and South Africa

AIMS

Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the 'Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)' study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa.

METHODS

This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites.

RESULTS

The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach.

CONCLUSIONS

By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.

Fortifying the Foundations: A Comprehensive Approach to Enhancing Mental Health Support in Educational Policies Amidst Crises

In recent times, global crises such as the COVID-19 pandemic, climate change, and geopolitical conflicts have significantly impacted pupils' mental health. This opinion article presents evidence-based recommendations to bolster mental health support within educational systems, aiming to alleviate the psychological burden faced by students during these challenging times. This article argues that a proactive, holistic approach to mental health is essential for building a resilient educational infrastructure. More than ever, we support the call for the integration of mental health education into the core curriculum, equipping students with vital coping skills and fostering emotional intelligence. Additionally, we emphasize the importance of training educators and staff to identify and address mental health issues. Furthermore, this article highlights the need for interdisciplinary collaboration involving general practitioners, mental health professionals, community organizations, and policymakers in crafting and implementing support strategies. Educational institutions can effectively leverage the expertise of diverse stakeholders to create targeted interventions by cultivating partnerships. Finally, the significance of continuously evaluating and refining mental health support policies to ensure their efficacy and adaptability in the face of evolving crises is emphasized. Through these comprehensive recommendations, this opinion article seeks to catalyze a transformation in educational policies, prioritize mental health support, and empower pupils to thrive during tumultuous times.

Identifying transdiagnostically relevant risk and protective factors for internalizing psychopathology: An umbrella review of longitudinal meta-analyses

Internalizing mental disorders are highly comorbid with one another, and evidence suggests that etiological processes contributing to these disorders often overlap. This systematic umbrella review aimed to synthesize meta-analytic evidence from observational longitudinal studies to provide a comprehensive overview of potentially modifiable risk and protective factors across the depressive, anxiety, and eating disorder psychopathology domains. Six databases were searched from inception to August 2022. Only meta-analyses of longitudinal studies that accounted for baseline psychopathology (either via exclusion of baseline cases or statistical adjustment for baseline symptoms) were included. Methodological quality of meta-analyses was evaluated using the AMSTAR 2, and quality of evidence for each analysis was rated using GRADE. Study selection, quality assessment, and data extraction were conducted in duplicate by independent reviewers. The protocol for this review was registered with PROSPERO (CRD42020185575). Sixty-one meta-analyses were included, corresponding to 137 meta-analytic estimates for unique risk/protective factor-psychopathology relationships. Most potential risk/protective factors, however, were examined only in relation to depressive psychopathology. Concern over mistakes and self-esteem were the only risk and protective factors, respectively, identified as statistically significant across depressive, anxiety, and eating disorder psychopathology domains. Eight risk factors and four protective factors also emerged as having transdiagnostic relevance across depressive and anxiety domains. Results suggest intervention targets that may be valuable for preventing/treating the spectrum of internalizing psychopathology and reducing comorbidity. However, few factors were identified as transdiagnostically relevant across all three internalizing domains, highlighting the need for more research investigating similar sets of potential risk/protective factors across internalizing domains.