Adolescent Depression: Stressful Interpersonal Contexts and Risk for Recurrence

Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics

BACKGROUND

Substance use disorders (SUDs) and mental health disorders (MHDs) are significant public health challenges with far-reaching consequences on individuals and society. Dual diagnosis, the coexistence of SUDs and MHDs, poses unique complexities and impacts treatment outcomes. A research landscape analysis was conducted to explore the growth, active countries, and active journals in this field, identify research hotspots, and emerging research topics.

METHOD

A systematic research landscape analysis was conducted using Scopus to retrieve articles on dual diagnosis of SUDs and MHDs. Inclusion and exclusion criteria were applied to focus on research articles published in English up to December 2022. Data were processed and mapped using VOSviewer to visualize research trends.

RESULTS

A total of 935 research articles were found. The number of research articles on has been increasing steadily since the mid-1990s, with a peak of publications between 2003 and 2012, followed by a fluctuating steady state from 2013 to 2022. The United States contributed the most articles (62.5%), followed by Canada (9.4%). The Journal of Dual Diagnosis, Journal of Substance Abuse Treatment, and Mental Health and Substance Use Dual Diagnosis were the top active journals in the field. Key research hotspots include the comorbidity of SUDs and MHDs, treatment interventions, quality of life and functioning, epidemiology, and the implications of comorbidity. Emerging research topics include neurobiological and psychosocial aspects, environmental and sociocultural factors, innovative interventions, special populations, and public health implications.

CONCLUSIONS

The research landscape analysis provides valuable insights into dual diagnosis research trends, active countries, journals, and emerging topics. Integrated approaches, evidence-based interventions, and targeted policies are crucial for addressing the complex interplay between substance use and mental health disorders and improving patient outcomes.

Stress exposure in at-risk, depressed, and suicidal adolescents

BACKGROUND

Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High-Risk [HR]) and without (Low-Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC).

METHOD

Study 1 included LR (n = 65) and HR (n = 22) 12- to 14-year-olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid-to-late adolescents (64 females; 73.56%), including 57 MDD youth from a short-term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies.

RESULTS

We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β = .22, CI95 = 0.01-0.42, p = .041), independent (β = .34, CI95 = 0.12-0.56, p = .003), and interpersonal (β = .23, CI95 = 0.004-0.45, p = .047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β = .62, CI95 = 0.45-0.79, p < .001) and dependent (β = .41, CI95 = 0.21-0.61, p < .001) stress than the HC group, but not independent (p = .083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17-10.70, p = .026).

CONCLUSIONS

Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course.

Neural and affective responses to prolonged eye contact with parents in depressed and nondepressed adolescents

Eye contact improves mood, facilitates connectedness, and is assumed to strengthen the parent-child bond. Adolescent depression is linked to difficulties in social interactions, the parent-child bond included. Our goal was to elucidate adolescents' affective and neural responses to prolonged eye contact with one's parent in nondepressed adolescents (HC) and how these responses are affected in depressed adolescents. While in the scanner, 59 nondepressed and 19 depressed adolescents were asked to make eye contact with their parent, an unfamiliar peer, an unfamiliar adult, and themselves by using videos of prolonged direct and averted gaze, as an approximation of eye contact. After each trial, adolescents reported on their mood and feelings of connectedness, and eye movements and BOLD-responses were assessed. In HCs, eye contact boosted mood and feelings of connectedness and increased activity in inferior frontal gyrus (IFG), temporal pole, and superior frontal gyrus. Unlike HCs, eye contact did not boost the mood of depressed adolescents. While HCs reported increased mood and feelings of connectedness to the sight of their parent versus others, depressed adolescents did not. Depressed adolescents exhibited blunted overall IFG activity. These findings show that adolescents are particularly sensitive to eye contact and respond strongly to the sight of their parents. This sensitivity seems to be blunted in depressed adolescents. For clinical purposes, it is important to gain a better understanding of how the responsivity to eye contact in general and with their parents in particular, can be restored in adolescents with depression.

Characterizing Life Stress Exposure Among Sexual Minority Adolescents: Temporality, Content, And Mediating Role in Mental Health Disparities

Though sexual minority adolescents face a wide array of deleterious stressors, few studies have examined the role of specific types of stress exposure (i.e., chronic vs. episodic, interpersonal vs. non-interpersonal) on mental health disparities. This study utilizes a contextual threat-based assessment to (a) compare levels of stress exposure types between sexual minority and non-sexual minority adolescents, and (b) examine stress type as a mediator between sexual orientation and two outcomes: depressive symptoms and emotion dysregulation. Data comes from a longitudinal sample (14-17 years-old, N = 241; 17.6% sexual minority; 54% assigned female at birth; 73.9% White), with two time-points (T1 and T2) utilized. Sexual minority adolescents reported higher chronic interpersonal stress, but no differences in non-interpersonal chronic or episodic stress, relative to non-sexual minority adolescents. Chronic interpersonal stress exposure mediated the link between membership in an oppressed group (i.e., sexual minority teens) and the primary outcomes (emotion dysregulation and depressive symptoms) at both T1 and T2. Findings demonstrate the utility of contextual threat-based assessments within sexual minority research.

Longitudinal associations between sense of belonging, imposter syndrome, and first-year college students' mental health

Objective: The first year of college is a time of major changes in social dynamics, raising questions about ways to promote students' mental health. We examined longitudinal associations between students' sense of belonging, imposter syndrome, depressive symptoms, and well-being. Participants: Fifty-eight first-year college students at a university in the United States participated in the study. Methods: Students completed questionnaires during the first 6 months of college (T1) and at the end of the academic year (T2). Results: Greater sense of social and academic belonging was correlated with lower imposter syndrome, depression, and greater well-being at T1. Accounting for T1 measures, lower imposter syndrome predicted greater well-being but not depression at T2. Accounting for T1 mental health, belonging was not a significant predictor of depression or well-being at T2. Conclusion: Increasing sense of belonging and addressing imposter syndrome early in the transition to college may be critical in promoting mental health.

Annual Research Review: Neuroimmune network model of depression: a developmental perspective

Depression is a serious public health problem, and adolescence is an 'age of risk' for the onset of Major Depressive Disorder. Recently, we and others have proposed neuroimmune network models that highlight bidirectional communication between the brain and the immune system in both mental and physical health, including depression. These models draw on research indicating that the cellular actors (particularly monocytes) and signaling molecules (particularly cytokines) that orchestrate inflammation in the periphery can directly modulate the structure and function of the brain. In the brain, inflammatory activity heightens sensitivity to threats in the cortico-amygdala circuit, lowers sensitivity to rewards in the cortico-striatal circuit, and alters executive control and emotion regulation in the prefrontal cortex. When dysregulated, and particularly under conditions of chronic stress, inflammation can generate feelings of dysphoria, distress, and anhedonia. This is proposed to initiate unhealthy, self-medicating behaviors (e.g. substance use, poor diet) to manage the dysphoria, which further heighten inflammation. Over time, dysregulation in these brain circuits and the inflammatory response may compound each other to form a positive feedback loop, whereby dysregulation in one organ system exacerbates the other. We and others suggest that this neuroimmune dysregulation is a dynamic joint vulnerability for depression, particularly during adolescence. We have three goals for the present paper. First, we extend neuroimmune network models of mental and physical health to generate a developmental framework of risk for the onset of depression during adolescence. Second, we examine how a neuroimmune network perspective can help explain the high rates of comorbidity between depression and other psychiatric disorders across development, and multimorbidity between depression and stress-related medical illnesses. Finally, we consider how identifying neuroimmune pathways to depression can facilitate a 'next generation' of behavioral and biological interventions that target neuroimmune signaling to treat, and ideally prevent, depression in youth and adolescents.

Relationship between positive parenting and adolescents' depressive symptoms: Evidence from a Chinese research survey

BACKGROUND

Adolescents often carry their depression well into their adulthood. This creates perpetual difficulties for their family and society. Research on the relationship between positive parenting and adolescent depressive symptoms is rare. The protective effect of positive parenting on adolescent depressive symptoms also remains underexplored. Parents are a vital source of feedback that shapes adolescents' self-view in crucial ways.

AIMS

This study examines the latent relationships between four factors related to positive parenting and adolescent depressive symptoms.

METHOD

Using data from the Chinese Family Panel Studies (CFPS), Stata MP 17.0 was used for preliminary data processing and descriptive statistics. The structural equation model (SEM) was adopted to test the seven proposed hypotheses.

RESULTS

The study participants were 2,816 adolescents (52.34% male). The SEM showed that positive communication and parental praise can directly reduce depressive symptoms in adolescents (path coefficients of -0.24 and -0.13 [p < .001], respectively). Additionally, both positive communication and positive parent-adolescent interactions can reduce adolescents' depressive symptoms by heightening the intermediate factor of parental praise (path coefficients of 0.30 and 0.44 [p < .001], respectively). Conversely, positive parent-adolescent interactions did not negatively affect adolescents' depressive symptoms, as we hypothesized.

CONCLUSIONS

High level of positive parenting negatively predicts the level of depressive symptoms among adolescents. Specifically, positive communication, positive parent-adolescent communication, and parental praise are the main protective factors related to positive parenting for adolescents' depressive symptoms.

Protocol for teen inflammation glutamate emotion research (TIGER): Toward predictors of treatment response and clinical course in depressed adolescents

Adolescent-onset depression is a prevalent and debilitating condition commonly associated with treatment refractory depression and non-response to first-line antidepressants. There are, however, no objective tests to determine who may or may not respond to antidepressants. As depressed adolescents are especially vulnerable to the lifelong consequences of ineffectively-treated depression, it is critical to identify neurobiological predictors of treatment non-response in this population. Here, we describe the scientific rationale and protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) study, a prospective 18-month investigation of 160 depressed adolescents who will be assessed before and after treatment with selective serotonin reuptake inhibitors. TIGER will be using ultra-high field imaging to test the effects of acute stress and antidepressant treatment on inflammatory and glutamatergic processes hypothesized to underlie depression maintenance. Results from this work will motivate future studies testing alternative therapeutics for depressed adolescents at risk for treatment resistant depression. ClinicalTrials.gov Identifier: NCT05329441.

A transactional mediation model of risk for the intergenerational transmission of depression: The role of maternal criticism

In this study, we sought to combine two lines of research to better understand risk for the intergenerational transmission of depression. The first focuses on the role of maternal criticism as a potential mechanism of risk for depression in youth while the second builds from interpersonal and stress generation models regarding the potential impact of youth depression on future escalations in maternal criticism. Specifically, we examined the role of maternal criticism within a transactional mediation model using data from a multi-wave study. Participants were 251 mother-offspring pairs consisting of mothers with (n = 129) and without (n = 122) a history of major depressive disorder (MDD) during their child's lifetime who completed assessments every 6 months for 2 years. We found support for the hypothesized transactional mediational model in which maternal expressed emotion-criticism (EE-Crit) mediated the link between maternal history of MDD and residual change in youth's depressive symptoms over the previous 6 months and, reciprocally, youth depressive symptoms mediated the relation between maternal MDD history and residual change in EE-Crit 6 months later. These results indicate that maternal criticism and offspring depressive symptoms may contribute to a vicious cycle of depression risk, which should be considered for interventions targeted toward youth at risk of developing MDD.

The Ripple Effect: Unveiling the Bidirectional Relationship Between Negative Life Events and Depressive Symptoms in Medical Cadets

Background

Previous studies have explored the relationship between negative life events and depression, but little is known about the bidirectional relationship between negative life events and depression, particularly in specific groups of medical cadets.

Purpose

This study aimed to explore the relationship between negative life events and depressive symptoms among medical cadets during their four years of college.

Methods

An analysis of 4-wave longitudinal data collected from 2015-2018 was conducted using a cross-lagged panel network (CLPN) model to explore the complex causal relationship between negative life events and depressive symptoms in medical cadets (N=433).

Results

We found differences in negative life events and depressive symptoms among medical cadets across four network models over four years of university. Nodes A-21, A-20, A-23 and A-24, and depressive symptoms D-6 showed greater lagged effect values.

Conclusion

Our findings suggest that there is a lagged and mutually causal interaction between negative life events and depressive symptoms in medical cadets over 4 years of college, but that the predictability of negative life events is more important. However, more attention needs to be paid to the predictive role of depressive symptoms, especially those in early life which are often overlooked. Our study provides new insights into the relationship between negative life events and depressive symptoms in university students and helps to refine strategies for prevention and intervention of depression.

Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life?

Objectives

To investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians.

Methods

The sample included data from 39,538 older adults (aged 55-80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017-2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling.

Results

Low participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a "joint" household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing.

Discussion

The direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing.

Social threat, fronto-cingulate-limbic morphometry, and symptom course in depressed adolescents: a longitudinal investigation

BACKGROUND

Psychosocial stressors characterized by social threat, such as interpersonal loss and social rejection, are associated with depression in adolescents. Few studies, however, have examined whether social threat affects fronto-cingulate-limbic systems implicated in adolescent depression.

METHODS

We assessed lifetime stressor severity across several domains using the Stress and Adversity Inventory (STRAIN) in 57 depressed adolescents (16.15 ± 1.32 years, 34 females), and examined whether the severity of social threat and non-social threat stressors was associated with gray matter volumes (GMVs) in the anterior cingulate cortex (ACC), amygdala, hippocampus, and nucleus accumbens (NAcc). We also examined how lifetime social threat severity and GMVs in these regions related to depressive symptoms at baseline and over 9 months.

RESULTS

General stressor severity was related to greater depression severity at baseline and over 9 months. Moreover, greater severity of social threat (but not non-social threat) stressors was associated with smaller bilateral amygdala and NAcc GMVs, and smaller bilateral surface areas of caudal and rostral ACC (all pFDR ⩽ 0.048). However, neither social threat nor non-social threat stressor severity was related to hippocampal GMVs (all pFDR ⩾ 0.318). All fronto-cingulate-limbic structures that were associated with the severity of social threat were negatively associated with greater depression severity over 9 months (all pFDR ⩽ 0.014). Post-hoc analyses suggested that gray matter morphometry of bilateral amygdala, NAcc, and rostral and caudal ACC mediated the association between social threat and depression severity in adolescents over 9 months (all pFDR < 0.048).

CONCLUSIONS

Social threat specifically affects fronto-cingulate-limbic pathways that contribute to the maintenance of depression in adolescents.

Epidemiology of depressive disorders among youth during Gaokao to college in China: results from Hunan Normal University mental health survey

BACKGROUND

Given the serious consequences of depression and the lack of information about it during the crucially developmental period from the National College Entrance Exam (CEE, i.e., Chinese gaokao) to college, this study aimed to estimate the cumulative incidence, prevalence, age of onset, correlates, and service use of depressive disorders (DDs) among youth who passed the CEE and were enrolled at Hunan Normal University in China.

METHODS

A two-stage cross-sectional epidemiological survey of DDs was conducted from October to December, 2017 among 6,922 incoming college students (98.5% effective response, N = 6,818, 71.4% female, age range: 16-25 years, mean age = 18.6). Using a stratified sampling method based on the risk of depression, 926 participants (mean age = 18.5, 75.2% female) were selected and subsequently interviewed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and lifetime version (K-SADS-PL).

RESULTS

The sex-adjusted 9-month (i.e., 3 months pre-CEE, 3 months after CEE, and 3 months post-matriculation) incidence of new-onset DDs was 2.3% (standard error [S.E.] 0.3%), and the sex-adjusted 1-month, 6-month and lifetime prevalence were 0.7 (S.E. 0.3%), 1.7 (S.E. 0.2%) and 7.5% (S.E. 1.3%), respectively. The median age of onset was 17 (interquartile range: 16-18) years. Critically, over one-third (36.5%, S.E. 0.6) of depressed youth had their new onset during the 9-month period. The risk factors for depression included having mothers with higher education, experiencing major life events, being female, and experiencing parental divorce or death. The adjusted lifetime treatment rate was 8.7%.

CONCLUSION

The 9-month incidence of new-onset depression from gaokao to college among the youth sample in China is similar to the global annual incidence (3.0%), but the 1-month and lifetime prevalence are significantly lower than the global point (7.2%) and lifetime prevalence (19%). These findings suggest a high proportion of new-onset depression during the CEE to college among the sample youth in China. The risk of depression is associated with familial and stress correlates. Low treatment is a serious concern. Emphasis on early prevention and available treatment for adolescent and young adult depression is a critical need in China.

Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes

BACKGROUND

Adolescents with type 1 diabetes (T1D) are at increased risk for depression. A history of recurrent depression (HRD) may relate to worse health outcomes than single-episode depression. However, no study has explored this issue among T1D adolescents.

PARTICIPANTS AND PROCEDURE

We examined differences in psychosocial and diabetes-related outcomes between T1D adolescents with (G1; n = 33) and without (G2; n = 18) HRD. Participants were 51 youths (aged 12-17 years) enrolled in a depression treatment study. Youths and one caregiver each completed several measures. Using MANOVA, followed by individual ANOVAs, and chi-square tests, we compared groups in continuous and categorical variables, respectively.

RESULTS

MANOVA results were significant, F(7, 43) = 3.97, p = .002. Adolescents from G1 obtained higher scores than youths in G2 in self-esteem/guilt problems, cognitive alterations, and sadness due to T1D. Their caregivers reported more burden and rated their offspring as having more internalizing problems, facing more barriers to complying with T1D treatment, and using a medical ID less frequently than their counterparts did. A higher percentage of G1 participants presented clinical anxiety and inadequate glycemic control, and reported a history of major depression. According to caregivers, a higher proportion of G1 members had experienced multiple diabetes-related hospitalizations, were non-compliant with insulin treatment, and lived in homes with a conflictive environment.

CONCLUSIONS

Our study documents important differences in outcomes between T1D youths with vs. without any HRD. Clinicians may need an intensive and integrative approach to treat mental and physical aspects of health among these patients.

Associations between parental conflict and social and monetary reward responsiveness in adolescents with clinical depression

Increased rates of depression beginning in adolescence are thought to be attributed in part to marked developmental changes in reward systems and interpersonal relationships. Blunted reward response has been observed in depression and this may be shaped in part by social experiences, raising questions about the combined associations of parental conflict, depression, and reward response in both social and monetary domains. The present study used the reward positivity (RewP), an event-related potential that indexes both monetary and social reward processing, to examine the unique and combined associations of parental conflict and depressive symptoms on reward responsiveness in adolescents with clinical depression (N = 70) 14-18 years of age (M = 15.81, SD = 1.46; 65.7% female). Results indicated that depressive symptoms interacted with maternal conflict in characterizing the RewP to social, but not monetary, rewards. Specifically, higher levels of current depressive symptoms and potentiated maternal conflict together were associated with an attenuated RewP to social rewards in this clinical sample. We found no significant effects of paternal conflict. This investigation highlights maternal conflict as an important environmental factor for reward responsiveness and also emphasizes the utility of examining social reward responsiveness in depression in order to better understand the impacts of contextual factors.

Emotional Responses to Social Media Experiences Among Adolescents: Longitudinal Associations with Depressive Symptoms

OBJECTIVE

The degree to which adolescent social media use is associated with depressive symptoms has been the source of considerable debate. Prior studies have been limited by a reliance on cross-sectional data and measures of overall "screen time." This study examines prospective associations between adolescents' emotional responses to social media experiences and depressive symptoms, and examines gender differences in these processes.

METHOD

A school-based sample of 687 adolescents (48.6% girls; Mage = 14.3; 38.1% White, 29.4% Hispanic, 23.0% Black) completed measures of positive and negative emotional responses to social media experiences and depressive symptoms at two time points, one year apart.

RESULTS

Higher levels of depressive symptoms were associated with more frequent negative emotional responses to social media experiences one year later, whereas greater positive emotional responses to social media were associated with later depressive symptoms. Girls reported overall greater emotional responses to social media experiences, but gender did not moderate associations between these emotional responses and depressive symptoms.

CONCLUSION

Findings highlight the importance of examining adolescents' positive and negative emotional experiences in the context of social media use, and the ways in which these experiences intersect with depressive symptoms, so as to identify youth who may be most vulnerable to negative effects of social media use.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

The Effect of Child Abuse and Neglect on Trajectories of Depressive Symptoms and Aggression in Korean Adolescents: Exploring Gender Differences

We analyzed gender differences in the effects of child abuse and neglect experienced during adolescence on depressive symptoms and aggression in Korean adolescents using a representative sample of participants over a three-year period. We applied a latent growth model to a sample of 1797 adolescents aged 14–16 from the Korean Children and Youth Panel Survey. Our findings revealed that abuse increased depressive symptoms in early adolescence, while lowering the rate of increase in depressive symptoms over time. Neglect adversely affected depressive symptoms in boys, but not in girls. Abuse increased the initial value of aggression in girls more than in boys, but reduced the increase rate of aggression over time in girls. Neglect increased the initial value of aggression only in boys. Consequently, abuse and neglect experienced during adolescence can affect depressive symptoms and aggression in the individual differently, depending on gender. This study suggests that, in order to reduce depressive symptoms and aggression in adolescents, work should be undertaken to solve the problems of abuse and neglect, and different approaches should be taken according to the gender of the individual.

After-School Extracurricular Activities Participation and Depressive Symptoms in Chinese Early Adolescents: Moderating Effect of Gender and Family Economic Status

Although Western studies showed that participation in extracurricular activities was intimately linked to adolescents’ psychological adjustment, very few studies have addressed this issue among early adolescents in China. Based on a nationally representative sample of 9672 Chinese junior high school students (M_age = 14.54 years, SD = 0.70 years), this study investigated the relationship between participation in different extracurricular activities and depressive symptoms among Chinese early adolescents, and the moderating role of gender and family economic status. Results indicated that time spent completing homework, attending extracurricular tutoring, and playing online games after school was positively related to students’ depressive symptoms, whereas time spent on participating in physical exercise was negatively associated with students’ depressive symptoms. Besides, the relationships between after-school activities participation and student depressive symptoms were moderated by gender and family economic status. The theoretical and practical implications for the arrangement of after-school activities for Chinese early adolescents are discussed.

Factors Associated with Cyberbullying Victimisation among Colombian High-School Adolescents

The study's purpose was to examine the prevalence and explore some factors associated with cyberbullying in high-school adolescents at ​​Santa Marta, Colombia. A cross-sectional study was designed, which participated in students between 13 and 17 years. Participants completed the item for being a victim of cyberbullying of the Youth Risk Behavior Survey for high school students designed by the Center for Disease Control of the United States. A total of 1462 students answered the questionnaire (M = 14.4 years, SD = 0.8). 19.6% (n = 287) reported lifetime cyberbullying victimisation. Cyberbullying victimisation was associated with post-traumatic stress disorder risk (OR = 2.05, 95%CI 1.51-2.79), lifetime cigarette smoking (OR = 1.91, 95%CI 1.42-2.57), female gender (OR = 1.68, 95%CI 1.25-2.26), family dysfunction (OR = 1.68, 95%CI 1.18-2.41), and poor-fair health condition (OR = 1.45, 95%CI 1.08-1.95). Being a victim of cyberbullying is frequent among Colombian high-school adolescents. It is associated with post-traumatic stress disorder risk, cigarette smoking, female gender, family dysfunction, and poor-fair general health condition. Longitudinal investigations are needed to measure better the dynamics of cyberbullying and the nature of such associations.

The time course of reactivity to social acceptance and rejection feedback: An examination of event-related potentials and behavioral measures in a peer interaction task

Measurement of social processes is of interest across areas of research. Event-related potentials (ERPs) measured using electroencephalography (EEG) offer high temporal resolution, but little work has leveraged this strength to characterize the time course of social feedback processing. The present study aimed to replicate and extend previous research by systematically identifying the temporal dynamics of responses to both social acceptance and rejection feedback relative to neutral feedback, examining internal consistency of ERPs, and exploring correspondence with behavioral measures elicited during a peer interaction task. Emerging adults (N = 118) completed a computerized peer interaction task in which they made decisions to accept or reject peers and received rejection, acceptance, and neutral feedback while EEG data were recorded. Principal component analysis was used to derive temporally and spatially distinct ERP components sensitive to positive and negative social feedback. Participant voting patterns and post-task liking ratings for computer-controlled peers were also examined. Replicating prior work, components consistent with N1, P2, reward positivity (RewP), and P3 emerged, but distinct patterns of modulation by acceptance and rejection relative to neutral feedback were observed. Most components showed acceptable internal consistency. Sensitivity to peer feedback assessed through participant voting patterns and liking ratings for peers was correlated with RewP and P3 components. Results highlight the complexity of social feedback processing observable in a computerized peer interaction task and offer promising neural and behavioral measures that can be used to examine individual differences in sensitivity to both social acceptance and rejection feedback.

A daily level analysis of drinking to cope motivation and interpersonal stress

Interpersonal stress is a commonly reported drinking-related problem and evidence indicates that it is associated with drinking to cope (DTC) motivation. The preponderance of evidence for DTC motivation as a risk factor for increased interpersonal stress, however, comes mainly from studies examining between-person associations. Findings suggest that individuals who commonly report drinking to cope with stress show higher average levels of drinking-related interpersonal problems. To better understand the dynamic processes linking DTC motivation with interpersonal stress, we used a micro-longitudinal design to examine whether nighttime drinking-episode specific levels of three subtypes of DTC motivation (DTC related to anxiety, depressive affect and anger) were associated with concurrent and next-day levels of interpersonal stress, controlling for drinking levels. Participants (N = 939) reported their drinking motives, drinking level, and drinking-related problems daily for 30 days during college and again approximately five years later (post-college). Results indicated that, controlling for drinking levels, DTC motivation associated with depressive affect and anger, but not anxiety, were positively associated with concurrent nighttime interpersonal stress. Only DTC related to anger was associated with higher levels of next-day interpersonal stress, controlling for previous night's stress. The only other motive to predict next-day interpersonal stress was conformity motivation. None of the effects of motives varied across study wave. Findings are discussed in terms of how DTC anger might exacerbate interpersonal problems via processes associated with alcohol myopia.

A Lifespan Development Theory of Insecure Attachment and Internalizing Symptoms: Integrating Meta-Analytic Evidence via a Testable Evolutionary Mis/Match Hypothesis

Attachment scholars have long argued that insecure attachment patterns are associated with vulnerability to internalizing symptoms, such as depression and anxiety symptoms. However, accumulating evidence from the past four decades, summarized in four large meta-analyses evaluating the link between insecure attachment subtypes and internalizing symptoms, provide divergent evidence for this claim. This divergent evidence may be accounted for, at least in part, by the developmental period under examination. Specifically, children with histories of deactivating (i.e., insecure/avoidant) but not hyperactivating (i.e., insecure/resistant) attachment patterns in infancy and early childhood showed elevated internalizing symptoms. In contrast, adolescents and adults with hyperactivating (i.e., insecure/preoccupied) but not deactivating (i.e., insecure/dismissing) attachment classifications showed elevated internalizing symptoms. In this paper, we summarize findings from four large meta-analyses and highlight the divergent meta-analytic findings that emerge across different developmental periods. We first present several potential methodological issues that may have contributed to these divergent findings. Then, we leverage clinical, developmental, and evolutionary perspectives to propose a testable lifespan development theory of attachment and internalizing symptoms that integrates findings across meta-analyses. According to this theory, subtypes of insecure attachment patterns may be differentially linked to internalizing symptoms depending on their mis/match with the developmentally appropriate orientation tendency toward caregivers (in childhood) or away from them (i.e., toward greater independence in post-childhood). Lastly, we offer future research directions to test this theory.

A cross-lagged panel model for testing the bidirectional relationship between depression and smartphone addiction and the influences of maladaptive metacognition on them in Chinese adolescents

AIMS

Despite the high prevalence of both depression and smartphone addiction among Chinese adolescents, research examining their bidirectional relationship has been limited. Moreover, longitudinal research regarding the influence of maladaptive metacognitive beliefs on smartphone addiction is scarce. This 6-month longitudinal study aimed to address these research gaps by testing a cross-lagged panel model of maladaptive metacognition, depression, and smartphone addiction.

METHODS

Four hundred and fifty-nine Chinese high school students voluntarily completed an anonymous questionnaire at baseline, and 313 of them (36.1% male; age = 14 to 18; M = 16.88, SD = 0.62) completed the same questionnaire at follow-up.

RESULTS

Positive correlations were shown among depression, smartphone addiction, and maladaptive metacognition at both waves (r = 0.16 to 0.57, p < .01). The results of the cross-lagged analysis demonstrated only the prospective effect of depression on smartphone addiction (β = 0.18, p < .001) but not vice versa. Moreover, maladaptive metacognition assessed at baseline significantly predicted subsequent depression (β = 0.14, p < .01) but not smartphone addiction (p>.05). Additional path analysis showed a significant indirect effect of baseline maladaptive metacognition (0.099 [95% CI = 0.042, 0.183]) on subsequent smartphone addiction, via depression.

CONCLUSIONS

Findings of this study showed that the relationship between depression and smartphone addiction was unidirectional rather than bidirectional among Chinese adolescents. Specifically, depression predicted smartphone addiction, while maladaptive metacognition predicted depression. Depression also mediated the relationship between maladaptive metacognition and smartphone addiction. The findings suggest that incorporating metacognition and depression interventions into smartphone addiction prevention designs for adolescents may be beneficial.

Canadian Adolescents' Internalized Symptoms in Pandemic Times: Association with Sociodemographic Characteristics, Confinement Habits, and Support

Adolescence is a time of increased risk for developing symptoms of anxiety and depression, especially for girls. The stress and social isolation experienced during confinement add new threats to already vulnerable adolescents' daily lives. This study is aimed at determining which sociodemographic characteristics (age, family composition, achievement), confinement habits (schedule, new hobby, sleep duration, cellphone and computer use, sports, schoolwork), and sources of support (parents and teachers) are associated with more or less internalized symptoms in Canadian adolescents. Differences between boys and girls are also investigated. Between April 8 and 30 (2020) and through an online survey, 895 Canadian adolescents (74% girls) aged between 12 and 17 years (M = 14.7) were recruited. Path analysis was performed to identify significant associations between sociodemographic characteristics, confinement habits, support variables, and internalized symptoms. Independent samples t-tests and invariance tests were conducted to compare boys and girls. Results suggest that certain confinement habits (time spent using cellphones, doing sports and schoolwork, finding a new hobby) and support variables (parents working outside the home) were significantly and negatively associated with internalized symptoms. Regarding the sex differences, girls used their cellphones more and invariance test results showed that all associations between predictors and symptoms were statistically similar for boys and girls. This study's results help understand better adolescents' experience in confinement. It sheds light on the habits likely to characterize those who are less at risk of experiencing distress, making it possible to better support adolescents during this challenging period.

Adolescent and Maternal Anxiety Symptoms Decreased but Depressive Symptoms Increased before to during COVID-19 Lockdown

Mothers (n = 155) and their adolescent children (n = 146; aged 12-13 at pre-COVID wave [Time 1, September 2019 to March 2020]) repeated measures of anxiety and depressive symptoms, and details about the impacts of the pandemic and social distancing at Time 2 (May-June 2020). Average slopes of mother and adolescent depression increased but anxiety symptoms decreased from Time 1 to Time 2. Adolescent decreases in anxiety symptoms were driven by males, whereas depression increase was driven by females. Adolescents' depression slopes were steeper for those who reported more negative changes. Implications are discussed relative to findings from other regions and later phases of the pandemic.

Impact of stress and parenting on respiratory sinus arrythmia trajectories in early adolescence

The effects of stress and parenting on 1-year trajectories of physiological emotion regulation capacity among adolescents were examined. Consistent with the vulnerability-stress and allostatic load models, stress (chronic family and marital) was hypothesized to be associated with less favorable trajectories of basal respiratory sinus arrhythmia (RSA) over 1 year. This relationship was further hypothesized to be moderated by parenting practices (warmth, neglect, and rejection) and adolescent sex. Participants included 150 adolescents (51.3% female), 11-15 years of age (M = 13.04, SD = 0.89). Basal RSA and stress were assessed four times across 1 year. Results indicated a significant decrease in RSA over the course of 1 year (β = -0.15, p = .010). Warm parenting style was associated with lower RSA in environments of low marital stress and was also related with higher RSA in environments of high marital stress (β = 0.86, p = .021). Rejecting parenting styles were associated with higher RSA in environments of low family stress and lower RSA in environments of high family stress (β = -0.60, p = .014). These findings may be explained by the Yerkes-Dodson law of optimal stress, suggesting that sufficient environmental challenge is needed to catalyze regulatory development.

Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder

In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.

Facilitating improvements in young people's social relationships to prevent or treat depression: A review of empirically supported interventions

Interpersonal difficulties are often implicated in the onset of depressive disorders, and typically exacerbate depressive symptoms. This is particularly true for young people, given rapid changes in, and the increased importance of, their social relationships. The purpose of this narrative review was to identify empirically supported interventions that aim to prevent or treat depression in young people by facilitating improvements in their social environment. We conducted a search of controlled trials, systematic reviews and meta-analyses of such interventions, published between 1980 and June 2020. Our literature search and interpretation of results was informed by consultations with clinical experts and youth consumers and advocates. A number of promising approaches were identified with respect to prevention and treatment. Preliminary evidence was identified suggesting that school- and Internet-based approaches present a viable means to prevent the worsening of depressive symptoms in young people. Notably, delivering interpersonal psychotherapy-adolescent skills training (IPT-AST) in schools appears to be a promising early intervention strategy for young people at risk of full-threshold depressive disorder. In terms of treating depressive disorders in young people, there is strong evidence for the efficacy of interpersonal psychotherapy for adolescents (IPT-A), and preliminary evidence in favour of attachment-based family therapy (ABFT). Results are discussed with respect to recommendations for future research and practice.

Parent-Adolescent Communication and Early Adolescent Depressive Symptoms: The Roles of Gender and Adolescents' Age

Positive parent-adolescent communication has been found to be negatively related to adolescent depressive symptoms; however, few studies have investigated the moderating effects of adolescent gender and age on this relationship, especially during early adolescence in China. The present study investigated the joint moderating effects of adolescent gender and age on the linkage of father-adolescent and mother-adolescent communication with adolescents' depressive symptoms. A total of 11,455 Chinese junior high school students (M age = 14.15 years, SD = 1.22 years; 49.86% boys; N grade7 = 5712, N grade9 = 5743) completed ad hoc questionnaires of parent-adolescent communication and depressive symptoms. Multiple linear regression analyses were conducted. Results indicated that gender and age jointly moderated the association between parental communication and adolescent depressive symptoms. Specifically, for girls, the negative effects of both father-adolescent and mother-adolescent communication on depressive symptoms were stronger in 9th grade students than in 7th grade students, while for boys, the negative effects were not different between 7th grade students and 9th grade students. These findings suggest that in China, the protective effects of positive parent-adolescent communication on adolescents' depressive symptoms may be most salient among senior-grade girls in junior high school.

Zoom or In-Person: An Ecological Momentary Assessment Study of Time with Friends and Depressive Symptoms on Affect in Emerging Adults

INTRODUCTION

Depression is associated with increased negative affect (NA) and low positive affect (PA), as well as interpersonal difficulties. Although most studies examine symptoms and affect at only one time point, ecological momentary assessment (EMA) captures data on affect and activity in real time and across contexts. The present study used EMA to explore the links between in-person and virtual social interactions, depressive symptoms, and momentary affect.

METHODS

Emerging adults (N=86) completed a self-report measure of both general depression and dysphoria symptoms, followed by EMA surveys 8 times daily for one week, reporting momentary affect (PA and NA) and social context (in-person and virtual interactions with friends).

RESULTS

In-person, but not virtual, presence of friends was associated with increased PA overall. Depressive symptoms were linked to less time with in-person friends and elevated NA. There was also a significant interaction between in-person presence of friends and dysphoria in predicting NA, such that presence of in-person friends was associated with lower NA only for those low in dysphoria.

DISCUSSION

Findings suggest that time with in-person friends is associated with increased PA overall and decreased NA only for those lower in depressive symptoms, but these effects do not generalize to virtual interactions. Those with greater depressive symptoms may be less responsive to positive stimuli and experience less of an effect of friends' presence on affect. Alternatively, maladaptive social behaviors characteristic of depression may influence the effect of social interactions on affect.

Higher Levels of Pro-inflammatory Cytokines Are Associated With Higher Levels of Glutamate in the Anterior Cingulate Cortex in Depressed Adolescents

Animal models of stress and related conditions, including depression, have shown that elevated peripheral levels of inflammatory cytokines have downstream consequences on glutamate (Glu) in the brain. Although studies in human adults with depression have reported evidence of higher inflammation but lower Glu in the anterior cingulate cortex (ACC), the extent to which peripheral inflammation contributes to glutamatergic abnormalities in adolescents with depression is not well-understood. It is also unclear whether antioxidants, such as ascorbate (Asc), may buffer against the effects of inflammation on Glu metabolism. Fifty-five depressed adolescents were recruited in the present cross-sectional study and provided blood samples, from which we assayed pro-inflammatory cytokines, and underwent a short-TE proton magnetic spectroscopy scan at 3T, from which we estimated Glu and Asc in the dorsal ACC. In the 31 adolescents with usable cytokine and Glu data, we found that IL-6 was significantly positively associated with dorsal ACC Glu (β = 0.466 ± 0.199, p = 0.029). Of the 16 participants who had usable Asc data, we found that at higher levels of dorsal ACC Asc, there was a negative association between IL-6 and Glu (interaction effect: β = -0.906 ± 0.433, p = 0.034). Importantly, these results remained significant when controlling for age, gender, percentage of gray matter in the dorsal ACC voxel, BMI, and medication (antidepressant and anti-inflammatory) usage. While preliminary, our results underscore the importance of examining both immune and neural contributors to depression and highlight the potential role of anti-inflammatory compounds in mitigating the adverse effects of inflammation (e.g., glutamatergic neuroexcitotoxicity). Future studies that experimentally manipulate levels of inflammation, and of ascorbate, and that characterize these effects on cortical glutamate concentrations and subsequent behavior in animals and in humans are needed.

The relationship between stressful events, emotion dysregulation, and anxiety symptoms among youth: longitudinal support for stress causation but not stress generation

INTRODUCTION

There is a clear bi-directional link between stressful events and depressive symptoms in adolescence, but the directionality of this link for anxiety symptoms remains underexamined. We critically evaluate the longitudinal relationship between stressors and anxiety among youth. Specifically, we examine whether stressors predict anxiety symptoms over a 1.5-year period (stress causation), and whether anxiety symptoms predict stressors over this period (stress generation). We examine potential influencing factors, including stressor type (independent vs. dependent) and emotion dysregulation (nonacceptance; goal-directed difficulty).

METHODS

Social, separation, and physical anxiety symptoms, and frequency and stressor type, were assessed every 3 months for 1.5 years among community youth (n = 528, ages 8-17). Baseline emotion dysregulation was assessed. Time-lagged analyses evaluated the bi-directional relationship of stress and anxiety over time, controlling for previous anxiety and depression.

RESULTS

Interpersonal stressors predicted subsequent physical and social anxiety symptoms, but anxiety did not predict subsequent stressors. Both nonacceptance and goal-directed difficulties predicted subsequent anxiety symptoms and stressors, but did not moderate the relationship.

CONCLUSION

The findings supported the stress causation model for youth anxiety, but not the stress generation model. Nonacceptance and goal-directed difficulty predicted greater subsequent anxiety symptoms and stressors. We discuss implications for prevention and intervention.

miR-218 in Adolescence Predicts and Mediates Vulnerability to Stress

BACKGROUND

Adolescence is a period of increased vulnerability to psychiatric disorders, including depression. Discovering novel biomarkers to identify individuals who are at high risk is very much needed. Our previous work shows that the microRNA miR-218 mediates susceptibility to stress and depression in adulthood by targeting the netrin-1 guidance cue receptor gene Dcc in the medial prefrontal cortex (mPFC).

METHODS

Here, we investigated whether miR-218 regulates Dcc expression in adolescence and could serve as an early predictor of lifetime stress vulnerability in male mice.

RESULTS

miR-218 expression in the mPFC increases from early adolescence to adulthood and correlates negatively with Dcc levels. In blood, postnatal miR-218 expression parallels changes occurring in the mPFC. Notably, circulating miR-218 levels in adolescence associate with vulnerability to social defeat stress in adulthood, with high levels associated with social avoidance severity. Indeed, downregulation of miR-218 in the mPFC in adolescence promotes resilience to stress in adulthood.

CONCLUSIONS

miR-218 expression in adolescence may serve both as a marker of risk and as a target for early interventions.

Sympathetic arousal during the processing of dysphoric affect by youths at high and low familial risk for depression

Youths at high risk for depression have been shown to have problems in repairing their own sad mood. Given that sympathetic arousal has been implicated both in the experience and regulation of affect, an atypical pattern of arousal may be one of the factors that contribute to mood repair problems. In the current study, we measured sympathetic arousal of never-depressed youths at high (n = 56) and low (n = 67) familial risk for depression during sad mood induction and instructed mood repair. Sympathetic arousal was indexed by skin conductance level (SCL) and cardiac pre-ejection period (PEP); mood repair outcome was indexed by self-rated affect. High-risk youths demonstrated increased SCL during sadness induction, which persisted during mood repair; low-risk youths evidenced increased SCL only during mood repair. Shortened PEP was evident only among high-risk youths and only during mood repair. Furthermore, shortened PEP during mood induction predicted less successful mood repair in the low-risk but not in the high-risk group. The findings suggest that: (a) depression-prone youths differ from control peers in patterns of sympathetic responses to emotional stimuli, which may impair their ability to relieve sadness, and (b) activation patterns differ across subsystems (SCL vs. PEP) of sympathetic activity, in conjunction with depression risk status.

A Two-way Street: Mentor Stress and Depression Influence Relational Satisfaction and Attachment in Youth Mentoring Relationships

Over the past two decades, youth mentoring programs have increased in popularity as an intervention for children exposed to a range of stressful life circumstances. Such programs have been shown to promote positive youth development and reduce risk for emotional and behavioral problems; yet, the effect size of youth gains remains small. The current study examined the influence of college student mentors' history of early life stress and baseline depressive symptoms on their effectiveness in youth mentoring relationships using 340 randomized mentor-youth pairs from College Mentors for Kids, a well-established mentoring program with chapters across the United States. Hierarchical linear models revealed that mentors with higher levels of depressive symptoms reported lower relationship satisfaction and increased avoidance in the mentoring relationship. In contrast, mentors who experienced higher levels of early life stress had youth who reported greater satisfaction in the mentoring relationship and decreased relational anxiety. These findings are some of the first to examine the impact of mentor characteristics on mentor-youth relationships and highlight the importance of considering factors relevant to psychosocial functioning and emotional distress when recruiting, training, and supporting college student mentors.

Effects of Maternal Depression and Mother-Child Relationship Quality in Early Childhood on Neural Reactivity to Rejection and Peer Stress in Adolescence: A 9-Year Longitudinal Study

Problems in mother-child relationships are thought to be key to intergenerational transmission of depression. To evaluate neural and behavioral processes involved in these pathways, we tested effects of maternal depression and maternal-child relationship quality in early childhood on neural and interviewer-based indicators of social processes in adolescence. At age 3, children and mothers (N=332) completed an observational parenting measure and diagnostic interviews with mothers. At age 12, adolescents completed a task in which event-related potentials (ERPs) were recorded to peer acceptance and rejection feedback and interviews to assess peer stress. Lower mother-child relationship quality at age 3 was associated with enhanced reactivity to rejection, as measured by N1, and greater peer stress at age 12. Indirect effects of maternal depression through mother-child relationship quality were observed for N1 and peer stress. Findings inform understanding of disruptions in social functioning that are likely relevant to the intergenerational transmission of depression.

Differences in Internalizing Symptoms Anticipate Adolescent Friendship Dissolution

This study examined the degree to which internalizing symptoms predict adolescent friendship instability. A total of 397 adolescents identified 499 same-sex reciprocated friendships that originated in the seventh grade (M = 13.18 years). Discrete-time survival analyses were conducted with Grade 7 peer, teacher, and self-reports of internalizing symptoms as predictors of friendship dissolution across Grades 8-12. Differences between friends in depressive symptoms, anxiety symptoms, and (for boys only) submissiveness predicted subsequent friendship dissolution. Individual levels of these variables did not predict friendship dissolution, even at extreme or clinical levels. The findings suggest that friendship instability arising from internalizing problems stems from dissimilarity between friends rather than the presence of psychopathological symptoms on the part of one friend.

Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review

BACKGROUND

Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence.

METHODOLOGY

A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria.

RESULTS

Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences.

LIMITATIONS

Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability.

CONCLUSION

Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.

Blunted Social Reward Responsiveness Moderates the Effect of Lifetime Social Stress Exposure on Depressive Symptoms

Exposure to social stress is a well-established risk factor for the development and recurrence of depression. Reduced neural responsiveness to monetary reward has been associated with greater symptoms following stress exposure. However, it remains unclear whether reduced reward responsiveness serves as a mediator or moderator of the effects of stress on internalizing symptoms or whether similar patterns emerge with responses to social reward. We addressed this issue by measuring lifetime stress exposure and event-related potentials (ERPs) to social reward in 231 emerging adults (M = 18.16, SD = 0.41 years old). Participants completed the Stress and Adversity Inventory (STRAIN) to assess severity of lifetime stressors and self-report measures of current internalizing symptoms. In addition, participants completed the Island Getaway task in which the reward positivity (RewP) ERP was recorded in response to social acceptance, adjusting for responses to rejection (RewP residual). In this task, participants vote to accept or reject peers and receive reward/acceptance and rejection feedback. Stressors were divided into social and non-social stress severity scores. Analyses were conducted to test social reward responsiveness as a mediator or moderator of the effects of social and non-social stress on internalizing symptoms. Both social and non-social stress exposure over the life course predicted symptoms of depression (ps < 0.001) and social anxiety (ps < 0.002). The effect of social stress on depression was moderated by the residual RewP to social reward, adjusting for responses to social rejection (p =0.024), such that greater lifetime social stress exposure and a relatively blunted RewP to social reward were associated with greater depressive symptoms. Social reward responsiveness did not mediate effects of stress on internalizing symptoms. Reduced processing of social reward may be a vulnerability for depression that increases risk for symptoms following exposure to social stress. Blunted social reward responsiveness appears to be a relatively unique vulnerability for depression, rather than social anxiety. Results support the utility of ERP measures in measuring individual differences in social reward processing that can be applied to better understand neural processes involved in the development of depression, and highlight the importance of considering specific dimensions of stressful life experiences.

Depression: Latinx Adolescent Girls’ Perceived Triggers

Research on depression among Latinx populations is increasing; however, a focus on what triggers depression among this community is lacking. This study aims to identify perceived triggers for depression through a secondary analysis of 28 adolescent girls who self-identified as Latinx (mean age = 17.07 years, SD = 0.77). Sixty-one percent of the girls reported being first generation (born in Mexico), having lived in Mexico an average of 8.95 years and the primary language at home being Spanish (63%). Of these, the associated triggers of 20 major depression episodes (MDE) and eight minor depressive episodes (i.e., two to four MDE criteria endorsed) were examined. Seventy-five triggers were identified with a majority reflecting family/parent relationships, romance/friendship issues, and self and others’ expectations/pressures. These findings suggest that certain life events and stressors precede depressive symptoms among Latinx adolescent girls.

The connecting adolescents to reduce relapse (CARR) trial: study protocol for a randomized controlled trial comparing the efficacy of Groups 4 Health and cognitive behaviour therapy in young people

BACKGROUND

Depression is the leading cause of disability in young people (aged 15-25) globally. Loneliness is a major factor in the development and relapse of depression in young people, yet few interventions directly address loneliness. Groups 4 Health (G4H) - a novel, theoretically derived group psychotherapy intervention - may address this disconnect. Previous trials (Phase I and Phase II) have found G4H to be efficacious in reducing symptoms of depression. However, the efficacy of G4H compared to current evidence-based treatments (Phase III) has not been investigated. This protocol details the design and methodology of the Connecting Adolescents to Reduce Relapse (CARR) trial, a randomised control trial assessing the efficacy of G4H in young people relative to cognitive behavioural therapy (CBT).

METHODS

The CARR trial is a two-arm non-inferiority randomised controlled trial that will compare the efficacy of G4H to the most widely used evidence-based treatment for depression, CBT, at program completion and 6- and 12-month follow up. Participants will be 200 young people (aged 15-25) with symptoms of depression and/or loneliness recruited from community and university mental health services. We hypothesise that the interventions will be comparable in reducing depression symptoms, but that G4H will be superior in reducing loneliness. Because loneliness is a primary risk factor for depression relapse in young people, we therefore expect the benefits of Groups 4 Health to be particularly apparent at 12-month follow up.

DISCUSSION

This trial will be the first to evaluate an intervention that targets loneliness, in comparison to the current gold standard treatment approach - CBT. If found to be effective, this program offers a new approach to treatment and relapse prevention of depression among young people.

TRIAL REGISTRATION

Trial prospectively registered on ANZCTR ( ACTRN12618000440224 ), registered on 27/03/2018.

Suicidal behavior and stress generation in adolescents

Stress generation has potential to account for recurrent suicidal behavior. The current study represents a first step toward evaluating this possibility in a sample of adolescent psychiatric inpatients (n = 99; 79.80% female) followed over six months. At index admission, participants completed baseline measures of depressive symptom severity, suicidal ideation, lifetime history of suicide attempts, and negative life events using a contextual threat life stress interview. Negative life events since baseline were assessed at the follow-up assessment. Consistent with the stress generation hypothesis, lifetime number of suicide attempts prospectively predicted higher rates of dependent, but not independent, stress. Bayesian analyses also yielded substantial support for an association with overall dependent stress, but provided more modest support for specificity to this form of life stress relative to independent stress. Implications of these findings and directions for future research further clarifying the role of stress generation in suicidal behavior are discussed.

Being Bullied at School: Gratitude as Potential Protective Factor for Suicide Risk in Adolescents

Bullying victimization has been recognized as a risk factor for social, physical, and psychological problems in adolescence. One promising resource that seems to protect adolescents from adversity and traumatic events is gratitude. However, no analysis of the specific role of gratitude in bullying context has been performed as yet. Thus, the aim of this research was to explore the associations between bullying victimization, gratitude and suicide risk (i.e., depressive symptoms and suicidal thoughts and behaviors) and gender-based differences. We also investigated whether levels of gratitude moderated the relationship between victimization and suicide risk for girls and boys. A convenience sample of 1,617 adolescents (50.5% girls; M age = 14.02) participated in this research. Adolescents completed a paper-and-pencil questionnaire about their bullying victimization, gratitude, depressive symptoms and suicidal thoughts and behaviors. Gratitude was found to be negatively related to victimization and suicide risk. While no gender differences were found in gratitude, it was observed that girls reported higher levels of suicide risk. However, the victimization × gratitude interaction contributed to variance in suicide risk, but only for girls: Those girls who were victims of bullying with high gratitude scores reported lower suicide risk than their counterparts who showed less gratitude. Thus, the findings from this present cross-sectional study suggest that gratitude is related to suicide risk in the context of bullying victimization, especially among adolescent girls. Finally, the theoretical and practical implications of our novel contributions to the understanding of gratitude as a protective factor against consequences of bullying victimization are discussed.

Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study

OBJECTIVE

Depression is the most prominent mental health disorder among youth and has a profound impact with respect to morbidity and mortality if not addressed. The Treatment for Adolescent Depression Study (TADS) is one of the largest randomized controlled trials that compared the effectiveness of four treatments: cognitive-behavioral therapy (CBT); fluoxetine (FLX); combined cognitive-behavioral and fluoxetine treatment (COMB); and placebo (PBO). However, meaningful heterogeneous treatment courses are masked by these group mean comparisons of treatment impact. The present study sought to characterize the acute phase symptom trajectories of the depressed teens enrolled in TADS and to explore predictors of these trajectories, including TADS treatment condition.

METHOD

The TADS sample of 439 adolescent participants diagnosed with major depressive disorder was subjected to growth mixture modeling (GMM) to evaluate subgroups of adolescents with unique trajectories of depression symptom change.

RESULTS

Growth mixture modeling revealed three unique classes of adolescents: (1) a high-severity class with early significant improvement; (2) a high-severity class with limited symptom change; and (3) a moderate severity class with late significant improvement. Baseline predictors of class membership included treatment condition, sex, age, stage of change, depression severity, number of comorbid disorders, hopelessness, melancholia, suicidality, and cognitive distortions.

CONCLUSION

Results of this study may have implications for the selection of which treatment to use for which depressed adolescent.

CLINICAL TRIAL REGISTRATION INFORMATION

Treatment for Adolescents With Depression Study (TADS); https://clinicaltrials.gov/; NCT00006286.

Does Less Optimal Nonverbal Communication with Peers Predict the Development of Depression in Adolescent Boys and Girls?

A Social Skills Deficit Model for depression in adolescence was tested, proposing that less optimal nonverbal behavior elicits negative reactions in peer partners, which in turn result in depressive symptoms. Adolescents (12–17 years of age) participated in videotaped same-sex interactions. Several positive and negative nonverbal behaviors were coded. Two analyses were conducted using longitudinal data collected in four waves. First, the predictive role of nonverbal communication for depressive symptoms was tested in a normative sample of 170 adolescent dyads without (mild) depression at wave 1 (48% girls). Second, in a subsample of 31 adolescents who developed (sub)clinical depression in wave 2–4, behaviors during peer interactions prior to the development of depression were compared with behaviors of 31 matched controls that did not show mild depression in any wave (55% girls). Only gazing behavior showed the expected relationships. In girls, less gazing in targets was related to less gazing in peers, and if this response occurred, it subsequently predicted later depressive symptoms of targets. The importance of gazing behavior was confirmed in the (sub)clinical sample where girls, prior to increases in depressive symptoms, gazed less and boys gazed more as compared to controls. Interaction partners of these girls and boys also responded with less gazing. The findings indicate that nonverbal social skills are related to the development of depression in youth, particularly in girls.

Sex Differences in the Association Between Cyberbullying Victimization and Mental Health, Substance Use, and Suicidal Ideation in Adolescents

OBJECTIVE

To examine sex differences in the association between cyberbullying victimization and mental health (psychological distress and delinquency), substance use-related outcomes (drug and tobacco use, binge drinking), and suicide ideation among adolescents.

METHOD

Data were obtained from the Ontario Student Drug Use and Health Survey (OSDUHS; 2013, N=10,272, grade 7 to 12). The sample for analysis included 4,940 students with a mean age of 15.1 years (43.3% male). A series of multi-level, binary, logistic regression models were conducted separately for female and male adolescents to quantify the strength of associations between cyberbullying victimization and study outcomes, after accounting for traditional forms of bullying and demographic covariates.

RESULTS

Female adolescents reported significantly higher prevalence of cyberbullying victimization (once, 9.4%; twice or more, 13.3%) as compared with male adolescents (once, 8.3%, twice or more, 7.8%). Exposure to cyberbullying victimization was associated with an increased odds for psychological distress, suicide ideation, and delinquency among both female and male adolescents (adjusted odds ratios ranged from 1.76 to 4.63); although, the effects were more pronounced in females. Among females, but not males, the odds of reporting psychological distress, suicide ideation, and delinquency increased (in a step-wise fashion) with more frequent exposure to cyberbullying victimization. Cyberbullying victimization was associated with an increased odds of adolescent substance use only among females.

CONCLUSION

Adolescents exposed to cyberbullying victimization demonstrate an increased odds of poorer mental health, substance use outcomes, and suicide ideation. The current study reveals increased risk among female adolescents as compared with male adolescents. These findings lend support for the need to develop and evaluate targeted preventative interventions specifically tailored for female and male adolescents.

Psychosocial profiles of adolescents from dissolved families: Differences in depressive symptoms in emerging adulthood

BACKGROUND

When parents separate, on average, children are at greater risk for concurrent and subsequent depression; however, mean outcomes mask substantial variation in depressive risk. This study aimed to (1) identify multivariate risk profiles (classes) in adolescents from separated families and (2) prospectively estimate class risk for depressive symptoms in emerging adulthood.

METHODS

The sample comprised 449 participants with separated parents from an Australian population based longitudinal cohort study established in 1983. Classes were explored using 17, theoretically germane, self- and parent-reported indicators of adolescent risk assessed at three points in adolescence (13-14, 15-16 and 17-18 years), spanning three domains of assessment: individual, relational, contextual. Distinct profiles of adolescents were identified using Latent Class Analysis. Class differences on depressive symptoms in emerging adult (19-20 years) were then examined.

RESULTS

Three multivariate profiles, differentiated by patterns of risk severity, were observed: Adjusted (n = 253), Moderate Risk (n = 156), and High Risk (n = 40). Compared to the Adjusted class, participants in the Moderate Risk, but not High Risk class had notably elevated depressive symptomatology in emerging adulthood (d = 0.35). In contrast, High Risk class membership in adolescence predicted antisocial behavior in emerging adulthood.

LIMITATIONS

Risk for depressive symptoms in emerging adulthood may be under-estimated due to a disproportionate loss of participants from low socio-economic backgrounds.

CONCLUSIONS

We found most adolescents from dissolved families to be well-adjusted. Differences between Moderate Risk and High Risk adolescents signal differentiated pathways to subsequent mental health problems. Our findings are relevant for targeted therapeutic strategies for adolescents from dissolved families.