The temporal relation between depression and comorbid psychopathology in adolescents at varied risk for depression

Characteristics of oxyhemoglobin during the verbal fluency task in subthreshold depression: A multi-channel near-infrared spectroscopy study

OBJECTIVE

Subthreshold depression is an essential precursor and risk factor for major depressive disorder, and its accurate identification and timely intervention are important for reducing the prevalence of major depressive disorder. Therefore, we used functional near-infrared spectroscopic imaging (fNIRS) to explore the characteristics of the brain neural activity of college students with subthreshold depression in the verbal fluency task.

METHODS

A total of 72 subthreshold depressed college students (SDs) and 67 healthy college students (HCs) were recruited, and all subjects were subjected to a verbal fluency task (VFT) while a 53-channel fNIRS device was used to collect the subjects' cerebral blood oxygenation signals.

RESULTS

The results of the independent samples t-test showed that the mean oxyhemoglobin in the right dorsolateral prefrontal (ch34, ch42, ch45) and Broca's area (ch51, ch53) of SDs was lower than that of HCs. The peak oxygenated hemoglobin of SDs was lower in the right dorsolateral prefrontal (ch34) and Broca's area (ch51, ch53).The brain functional connectivity strength was lower than that of HCs. Correlation analysis showed that the left DLPFC and Broca's area were significantly negatively correlated with the depression level.

CONCLUSION

SDs showed abnormally low, inadequate levels of brain activation and weak frontotemporal brain functional connectivity. The right DLPFC has a higher sensitivity for the differentiation of depressive symptoms and is suitable as a biomarker for the presence of depressive symptoms. Dysfunction in Broca's area can be used both as a marker of depressive symptoms and as a biomarker, indicating the severity of depressive symptoms.

Systematic Review and Meta-Analysis: Risks of Anxiety Disorders in Offspring of Parents With Mood Disorders

OBJECTIVE

To examine the risk of anxiety disorders in offspring of parents with mood disorders.

METHOD

We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors.

RESULTS

A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders.

CONCLUSION

Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

STUDY PREREGISTRATION INFORMATION

Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.

Social and sex differences in psychiatric comorbidity and psychosocial functioning among adolescents with depression

BACKGROUND

To determine social and sex differences in psychosocial functioning and psychiatric comorbidity among adolescents with depression.

METHODS

A cohort-based study in Stockholm, Sweden. Adolescents who turned 13 years during 2001-2007, were followed in registers until they turned 18 in 2005-2011, (n = 169,262). In the current study, those with depression at age 13-17 were included (n = 6,439).

RESULTS

Adolescents with parents with low (OR=1.5, CI 1.1-2.2) education were more likely to have low psychosocial functioning. Those with parents with low education and low household income were more likely to have comorbid internalizing (OR=1.3, CI 1.0-1.7/1.3, CI 1.0-1.7) and externalizing disorders (OR=2.5, CI 1.5-4.0/2.4, CI 1.4-4.2). Adolescents with parents born outside the Nordic countries were more likely to have comorbid externalizing disorders (OR=1.6, CI 1.1-2.4). No social differences were evident in relation to family receipt of unemployment benefits. Social differences were found for both girls and boys in relation to psychosocial functioning and comorbidity but the magnitude of social differences in depression with comorbidity was overall larger for boys than girls.

LIMITATIONS

The findings of the current study can only be generalized to adolescents that have sought care for and been diagnosed with depression, within a setting similar to this study, e.g. with free access to care.

CONCLUSION

Adolescents with depression and with more disadvantaged social circumstances in the childhood run a higher risk of psychiatric comorbidity and low psychosocial functioning, which can indicate a lengthy clinical course and poorer response to treatment. Both boys and girls follow this path but partly in different kinds of psychiatric comorbidity.

Exposure to maternal depressive symptoms and growth in adolescent substance use: The mediating role of delay discounting

Maternal depression is associated with instability within the family environment and increases in offspring substance use across adolescence. Rates of delay discounting, or the tendency to select smaller rewards that are immediately available relative to larger, but delayed rewards, are also associated with steeper increases in substance use among youth. Moreover, recent research suggests that early unstable environments may reinforce youths' propensity towards opportunistic decision making and delay discounting specifically. The current prospective, longitudinal study examined links between maternal depressive symptoms, adolescent delay discounting, and subsequent substance use. Participants included 247 adolescents and their mothers who were assessed annually over a 6-year period (from ages 13 to 19 years). Results supported a small but significant mediation effect. Specifically, maternal depressive symptoms predicted increases in adolescent delay discounting, which, in turn, predicted steeper increases in adolescent substance use over time. Thus, youth decision making may represent a mechanism linking maternal depression and adolescent risk behaviors. Findings indicate the potential for interventions targeting parental psychopathology to prevent subsequent adolescent substance use.

Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence

OBJECTIVE

Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples.

METHODS

304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis.

RESULTS

Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents.

CONCLUSIONS

Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders.

Prospective predictors of first-onset depressive disorders in adolescent females with anxiety disorders

BACKGROUND

Anxious youth are at increased risk for later depressive disorders, but not all anxious youth develop depression. Sequential comorbidity models emphasize shared risk factors and anxiety sequelae, but some anxious youth who later develop depression may have risk factors that are relatively specific to depression, in addition to a liability to anxiety. We examined several variables that appear relatively specific to risk for depression-the personality traits of low positive affectivity and high sadness, and an electrophysiological measure of blunted response to reward - in predicting first-onset depressive disorders and depressive symptoms in clinically anxious adolescent girls.

METHODS

A sample of 114 adolescents with baseline anxiety disorders completed personality and psychopathology measures, psychophysiology tasks, and diagnostic interviews. Interviews and a measure of depressive symptoms were re-administered over 27 months.

RESULTS

After controlling for baseline depressive symptoms, blunted reward sensitivity uniquely predicted first-onset depressive disorders and depressive symptoms 27 months later. Post-hoc analyses indicated that blunted reward sensitivity only predicted first-onset depressive disorders and depressive symptoms in girls with high social anxiety symptoms.

LIMITATIONS

Analyses were unable to account for concurrent anxiety symptoms and disorders.

CONCLUSIONS

The depression-specific risk factor, blunted reward sensitivity, may comprise one pathway to subsequent depressive disorders and symptoms in anxious youth and indicate which anxious youth need intervention to prevent later depression, particularly in socially anxious girls.

Offspring of parents with mood disorders: time for more transgenerational research, screening and preventive intervention for this high-risk population

PURPOSE OF REVIEW

Offspring of parents with mood disorders (major depressive and bipolar disorder) are at increased risk for developing mood disorders. In this review, an overview regarding the intergenerational transmission of mood disorders, screening, and preventive intervention is given for this vulnerable group.

RECENT FINDINGS

Offspring of parents with depression have a 40% chance of developing a depression, whereas offspring of parents with bipolar disorder have a 10% chance of developing a bipolar disorder by adulthood. Studies into the intergenerational transmission of mood disorders show that children of parents with mood disorders have increased biological dysregulation and neuropsychosocial impairments. Although there is a clear need for early identification of those at the highest risk, there are few systematic attempts in mental health care to screen children of parents with mood disorders. Lastly, preventive interventions seem to be effective in reducing depressive symptoms of children of parents with depression; however, those effects are small and short-lived.

SUMMARY

Offspring of parents with mood disorders constitute a vulnerable group at high risk of mood disorders. More research needs to be conducted regarding mechanisms of the intergenerational transmission. Moreover, screening and preventive interventions for these offspring should be systematically evaluated and implemented.

Understanding comorbidity among internalizing problems: Integrating latent structural models of psychopathology and risk mechanisms

It is well known that comorbidity is the rule, not the exception, for categorically defined psychiatric disorders, and this is also the case for internalizing disorders of depression and anxiety. This theoretical review paper addresses the ubiquity of comorbidity among internalizing disorders. Our central thesis is that progress in understanding this co-occurrence can be made by employing latent dimensional structural models that organize psychopathology as well as vulnerabilities and risk mechanisms and by connecting the multiple levels of risk and psychopathology outcomes together. Different vulnerabilities and risk mechanisms are hypothesized to predict different levels of the structural model of psychopathology. We review the present state of knowledge based on concurrent and developmental sequential comorbidity patterns among common discrete psychiatric disorders in youth, and then we advocate for the use of more recent bifactor dimensional models of psychopathology (e.g., p factor; Caspi et al., 2014) that can help to explain the co-occurrence among internalizing symptoms. In support of this relatively novel conceptual perspective, we review six exemplar vulnerabilities and risk mechanisms, including executive function, information processing biases, cognitive vulnerabilities, positive and negative affectivity aspects of temperament, and autonomic dysregulation, along with the developmental occurrence of stressors in different domains, to show how these vulnerabilities can predict the general latent psychopathology factor, a unique latent internalizing dimension, as well as specific symptom syndrome manifestations.

Factors predicting depression across multiple domains in a national longitudinal sample of Canadian youth

This prospective longitudinal study aimed to investigate the strength and relative importance of multiple predictors of depression in youth aged 16 to 20 years. Data were drawn from Statistics Canada's National Longitudinal Survey of Children and Youth (Statistics Canada 2007a, b). Hierarchical regressions were conducted separately by child gender (N = 796 boys; N = 919 girls) for two overlapping samples: mixed parent-child dyads (e.g., biological mothers, fathers and other caregivers; N = 1,715) and a subsample containing only biological mother-child dyads (N = 1,425). Parent-reported data were used from Cycle 1 when the children were aged 4 to 8 years. Parent and child-reported data were used from Cycle 4 when children were aged 10 to 14 years. The outcome measure of depressive symptoms was taken from Cycle 7 when the youth were aged 16 to 20 years. Adolescents reported more depression symptoms than young adults and girls reported more than boys. For boys, higher anxiety/depression scores at ages 4 to 8 years and 10 to 14 years, along with lower self-esteem at 10 to 14 years, predicted higher depression scores. Girls' depression was predicted by loss of a parent by ages 4 to 8 years and higher self-reported anxiety/depression and aggression at ages 10 to 14 years. Among biological mother-child dyads, maternal depression reported by mother when child was aged 4 to 8 years and 10 to 14 years significantly predicted depression for girls. At 10 to 14 years, child-reported lower parental monitoring (girls only) and greater parental rejection (boys and girls) predicted depression at ages 16 to 20 years.

Prospective relations between family conflict and adolescent maladjustment: security in the family system as a mediating process

Conflict in specific family systems (e.g., interparental, parent-child) has been implicated in the development of a host of adjustment problems in adolescence, but little is known about the impact of family conflict involving multiple family systems. Furthermore, questions remain about the effects of family conflict on symptoms of specific disorders and adjustment problems and the processes mediating these effects. The present study prospectively examines the impact of family conflict and emotional security about the family system on adolescent symptoms of specific disorders and adjustment problems, including the development of symptoms of anxiety, depression, conduct problems, and peer problems. Security in the family system was examined as a mediator of these relations. Participants included 295 mother-father-adolescent families (149 girls) participating across three annual time points (grades 7-9). Including auto-regressive controls for initial levels of emotional insecurity and multiple adjustment problems (T1), higher-order emotional insecurity about the family system (T2) mediated relations between T1 family conflict and T3 peer problems, anxiety, and depressive symptoms. Further analyses supported specific patterns of emotional security/insecurity (i.e., security, disengagement, preoccupation) as mediators between family conflict and specific domains of adolescent adjustment. Family conflict was thus found to prospectively predict the development of symptoms of multiple specific adjustment problems, including symptoms of depression, anxiety, conduct problems, and peer problems, by elevating in in adolescent's emotional insecurity about the family system. The clinical implications of these findings are considered.

Depressogenic vulnerability and gender-specific patterns of neuro-immune dysregulation: What the ratio of cortisol to C-reactive protein can tell us about loss of normal regulatory control

We examined whether the ratio of cortisol (CORT) to high-sensitivity C-reactive protein (hsCRP), an index that captures the integrity of homeostatic regulation between the hypothalamic-pituitary-adrenal (HPA) axis and inflammatory processes, is associated with vulnerability to depression in a gender specific manner and whether glucocorticoid receptor (GR) sensitivity plays a role in these associations. Fasting blood samples were collected between 08:45 and 09:15 and assayed for CORT, hsCRP, and leukocyte count in 213 healthy, medication-free men and women. The NEO-Personality Inventory was used to assess neuroticism, extraversion and anxiety. We used the Hamilton Depression Interview to assess depressive symptoms, the Buss-Perry anger subscale to measure anger, and the Pittsburgh Sleep Quality Index to evaluate subjective sleep quality and its components. Log-transformed CORT/CRP values were analyzed using multiple regression with Holms' adjusted p-values and age, body mass index (BMI), and race as covariates. GR sensitivity was estimated using the log-transformed ratio of neutrophils (N)-to-monocytes (M). The log-transformed ratio of CORT/CRP did not differ between men and women but was significantly and negatively associated with age and BMI. Severity of depressive symptoms, extraversion, anxiety, and sleep quality were associated with the CORT/CRP ratio in a gender-specific manner. For women, decreasing CORT/CRP ratios, suggestive of an insufficient release of CORT coupled with a heightened inflammatory state, were associated with increasing severity of depressive symptoms, decreasing quality of sleep, increasing frequency of sleep disturbance, and decreasing extraversion. For men, increasing frequency of daytime disturbance and levels of anxiety were associated with increasing CORT/CRP ratio, suggestive of an enhanced release of CORT relative to attenuated levels of hsCRP. For both genders, increasing anger was associated with decreasing CORT/CRP ratios. Although results suggested GR downregulation in women but not men, such differences did not mediate the observed associations. With the use of the CORT/CRP ratio, we showed that vulnerability factors for depression are associated with a loss of normal regulatory controls resulting in gender-specific patterns of neuro-immune dysregulation. That GR downregulation did not influence these associations suggests that the loss of regulatory controls in at risk individuals is primarily at the level of the hormone. Beyond the individual contribution of each component of the CORT/CRP ratio, disruption of normal neuroimmune regulatory feedback provides a plausible biological framework useful in understanding biobehavioral vulnerabilities to depression in a gender specific manner. The CORT/CRP ratio may be a viable biomarker not only for delineating risk for MDD but also progression and treatment responses among patients with MDD; possibilities that are testable in future studies.

Maternal caregiving and girls' depressive symptom and antisocial behavior trajectories: an examination among high-risk youth

Past research has identified maternal depression and family of origin maltreatment as precursors to adolescent depression and antisocial behavior. Caregiving experiences have been identified as a factor that may ameliorate or accentuate adolescent psychopathology trajectories. Using a multilevel approach that pools the unique attributes of two geographically diverse, yet complementary, longitudinal research designs, the present study examined the role of maternal caregiver involvement as a factor that promotes resilience-based trajectories related to depressive symptoms and antisocial behaviors among adolescent girls. The first sample comprises a group of US-based adolescent girls in foster care (n = 100; mean age = 11.50 years), each of whom had a history of childhood maltreatment and removal from their biological parent(s). The second sample comprises a group of UK-based adolescent girls at high familial risk for depression (n = 145; mean age = 11.70 years), with all girls having biological mothers who experienced recurrent depression. Analyses examined the role of maternal caregiving on girls' trajectories of depression and antisocial behavior, while controlling for levels of co-occurring psychopathology at each time point. Results suggest increasing levels of depressive symptoms for girls at familial risk for depression but decreasing levels of depression for girls in foster care. Foster girls' antisocial behavior also decreased over time. Maternal caregiver involvement was differentially related to intercept and slope parameters in both samples. Results are discussed with respect to the benefits of applying multilevel (multisample, multiple outcome) approaches to identifying family-level factors that can reduce negative developmental outcomes in high-risk youth.

Externalizing disorders in adolescence mediate the effects of maternal depression on substance use disorders

Maternal depression has been linked to increased risk of substance use disorders (SUDs) in offspring. Cross-sectional studies have identified relationships among maternal depression, externalizing disorders and SUDs, but no longitudinal examination of causality has been undertaken. In order to address this gap in the literature, depression and externalizing disorders at or prior to age 15 were tested as mediators of the relationship between maternal depression and SUDs diagnosed between ages 16 and 20 in a sample of 702 Australian youth (363 women) using path models. Mothers' and fathers' substance diagnoses and earlier onset of substance abuse in youth were controlled for in all analyses. Consistent with previous work, maternal depression predicted SUDs between ages 16 and 20. An indirect effect of maternal depression through youth externalizing disorders diagnosed by age 16 was detected for alcohol and cannabis use disorders, but not drug disorders. Early adolescent depression was not a mediator of the relationship between maternal depression and any of the substance outcomes measured. To our knowledge, this study is the first to examine depression and externalizing disorders in early adolescence as mediators of the effect of maternal depression on psychopathology in later adolescence. Further work is needed to understand how family environment and genetic factors may explain the mediation by externalizing disorders.

Risk factors for current smoking among American and South Korean adolescents, 2005-2011

PURPOSE

Population data concerning smoking rates of adolescents and adults in the United States and Korea (South Korea) has highlighted the need for attention to this age group. This study compared the risk factors related to smoking and examined the gender differences with other risk factors in smoking among American and Korean adolescents between 2005 and 2011.

ORGANIZING CONSTRUCT AND METHODS

Participants were students in grades 9-11 selected from nationally representative surveys conducted in 2005 and 2011.

FINDINGS

In 2011, similar risk factors for current smoking were identified in American and Korean adolescents. These included male gender, school grade, depression, experience of alcohol drinking, current use of alcohol, use of glue or other inhalants, and experience of sexual intercourse. Among Korean adolescents, weight perception and weight control were unique risk factors for current smoking. Interactions with gender and other risk factors in each nation were revealed.

CONCLUSIONS

These risk factors, their change from earlier years, and gender differences should be recognized in the screening of vulnerable individuals for smoking and formulating effective intervention programs.

CLINICAL RELEVANCE

These results will provide information for the design and implementation of cessation programs for adolescents in these countries.

The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review

BACKGROUND

To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources.

METHODS

A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations.

RESULTS

Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality.

CONCLUSIONS

Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.

Relationships among factors related to body mass index, healthy lifestyle beliefs and behaviors, and mental health indicators for youth in a title 1 school

INTRODUCTION

The effect of being overweight in childhood has both physical and psychological implications. The purpose of this study was to determine the relationships among body mass index (BMI), healthy lifestyle beliefs and behaviors, and mental health indicators for 5th- and 6th-grade children in a Title I school.

METHODS

This is a cross-sectional, descriptive correlational design on a convenience sample of youth in an urban school. BMI was calculated. Participants completed surveys that assessed healthy beliefs and behaviors, activity and nutrition knowledge, and mental health indicators.

RESULTS

Children with higher BMIs reported difficulty in living a healthy lifestyle. This perceived difficulty affected their ability to make healthy choices. Belief in the ability to live a healthy lifestyle resulted in reported healthier behaviors. Anxiety and depression symptomatology were not significantly related to healthy lifestyle indicators.

DISCUSSION

The results demonstrate that the proposed thinking, feeling, behavior triangle model was supported in this population.

Comorbidity of anxiety and depression in children and adolescents: 20 years after

Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.

[The temporal relationship between anxiety and depression during the school transition between primary and high-school]

Depression and anxiety are among the most prevalent disorders in the adolescent population. An increase of the prevalence of these disorders is taking place during adolescence, this developmental period being experienced in synchronicity with the high school transition. Also, some studies suggested the existence of a developmental trend between the onset of anxiety and depression. This longitudinal study explored the temporal relationship between anxiety and depression during the transition from primary to high school.

GOALS

first, this study examined whether the presence of anxiety in grade 6 (Time 1) increases the risk of depression in grade 8 (Time 2). Then a subgroup of comorbid students, who presented anxiety and depression, was compared with a subgroup of anxious ones on the presence of cognitive distortions. It was assessed whether cognitive distortions in the anxious group in Time 1 influenced the development of comorbidity between anxiety and depression in Time 2.

METHOD

146 students from 12 public schools, 62 girls and 84 boys (mean = 11.22 years) participated in this study. This sub sample was drowned from a larger sample of 499 students, in a 9 years longitudinal study (2003-2012). Participants completed the questionnaire and were met for an interview at the beginning of each school year. Parents consent was obtained. In Time 1, students were divided into two subgroups, anxious and non-anxious students. At time 2, two subgroups of students were constituted, either anxious or comorbid anxious and depressed students. Depression was controlled at time 1.The Dominic Interactive for Adolescents (Valla, 2000) was used to measure the presence of anxiety and depression. The correlation (.34 to .62) between the three anxiety scales (separation anxiety, generalized anxiety and phobia) allowed to create an unique anxiety score. Cognitive distortions (related to dependence, achievement and self control) were measured by the Dysfunctional Attitudes Scale (Weisseman & Beck, 1978).

RESULTS

The hierarchical log linear analyse revealed a tendency between the presence of anxiety in Time 1 and the development of depression in Time 2, only for girls (p=.08), so that 25% of anxious girls at Time 1 became depressive at Time 2, compare to 0% of non anxious girls. For boys, whether anxiety is present or not, the two subgroups presented the same risk to develop depression. Then, results of a Manova analysis revealed that anxious students at time 1 already adopted cognitive distortions related to dependency and to achievement, usually associated with depression. At time 2, the result of the Manova revealed that comorbid students presented more cognitive distortions related to dependency then the anxious students. However, non significant results were found for the longitudinal analyse, which did not supported the existence of a predicting link between the presence of depressogenous cognitive distortions at Time 1 in the anxious subgroup of students and the emergence of comorbidity at Time 2.

CONCLUSION

The results of the present study testified the importance to prevent depression, especially for anxious school girls. Anxiety seems to have a different role for girls and boys. A trend was observed between the presence of an anxiety disorder in Grade 6 and the development of a depressive disorder 2 years later, among girls only. This result raises the importance to understand the role of anxiety in girls to reduce their risk to develop a depressive disorder. Our results also showed that anxious students in grade 6, already presented cognitive distortions related to dependency and achievement which are associated with depression while comorbid students in the second year of high school presented more cognitive distortions related to dependency only, when they were compared with the anxious group.

Subthreshold depression in adolescence: a systematic review

In adolescence, the number of depressive symptoms is rising notably. Individuals may have relevant depressive symptoms without meeting the full criteria of a major depressive episode (MDE), a condition referred to as subthreshold depression (sD). This article presents a review on adolescent sD examining the prevalence, the quality of life (QoL), the risk of developing MDE, and preventive programs available for adolescents living with sD. A systematic literature search from the year of the introduction of Diagnostic and Statistic Manual for Mental Disorders Fourth Edition (DSM-IV) until 2012 (18 years) was conducted with a special focus on adolescent sD. Data from 27 studies were included into this review. The results show high prevalence of sD among adolescents, with a negative impact on QoL, and provide evidence that sD is a significant risk indicator of later MDE; therefore, individuals with sD represent good targets for preventive interventions. Our review highlights the fact that sD is a significant health problem among adolescents indeed, and adolescents with sD could be a subgroup of youth, who need further help to reduce their clinically significant depressive symptoms for the successful prevention of a later MDE.

The relation of substance use with different levels of depressive symptoms and the moderating effect of sex and age in Taiwanese adolescents

BACKGROUND

The aim of this cross-sectional study was to examine (a) the relation of substance use with different levels of depressive symptoms and (b) the moderating effect of sex and age on the association between different levels of depressive symptoms and substance use in Taiwanese adolescents.

METHODS

The study group consisted of 9070 adolescent students in southern Taiwan aged 12 to 19 years who were sorted into 3 different levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale. The Questionnaire for Experience in Substance Use was used to assess each participant's experience with smoking, alcohol consumption, betel nut chewing, sedative/hypnotic use, and illicit drug use in the preceding year. The rates of substance use were compared among adolescents with different levels of depressive symptoms using generalized linear mixed-model analysis. The moderating effects of sex and age on the association between different levels of depressive symptoms and substance use were also examined.

RESULTS

Adolescents with severe depressive symptoms had higher rates of using all 5 kinds of substances than did nondepressed ones. Adolescents with minor depressive symptoms had higher rates of using all substances except for illicit drugs than did nondepressed ones. There was no significant difference in the rates of substance use between adolescents with severe and minor depressive symptoms. Sex and age had no moderating effect on the association between the level of depressive symptoms and substance use.

CONCLUSIONS

It is necessary to carefully screen substance use among adolescents with depressive symptoms, even if they are below the threshold for significant depression.

Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care

BACKGROUND

This study examines the criterion validity of the Patient Health Questionnaire 9-item (PHQ-9) and 2-item (PHQ-2) version as a depression-screening instrument for adolescents.

METHODS

Three hundred twenty-two adolescents aged 13-16 were recruited from pediatric hospitals. Criterion validity of the PHQ-9 and PHQ-2 was assessed against diagnoses of any depressive disorder provided by a structured diagnostic interview. Areas under the receiver operating characteristics curve (AUCs) and sensitivities and specificities at optimal cutoff points were computed for both versions of the PHQ. Besides the dimensional algorithm, a categorical algorithm was applied for the PHQ-9. Validity measures of both scoring procedures of the PHQ-9 as well as PHQ-2 were compared statistically. In addition, unaided clinical depression diagnoses by the attending pediatricians were evaluated.

RESULTS

Using the dimensional algorithm, the AUCof the PHQ-9 (93.2%) was significantly higher than that of the PHQ-2 (87.2%). At optimal cutoffs, there was no significant difference in sensitivity (PHQ-9: 90.0%, PHQ-2: 85.0%), but in specificity (PHQ-9: 86.5%, PHQ-2: 79.4%). Although the categorical algorithm of the PHQ-9 was most specific (94.7%), sensitivity was just above chance (52.5%). The unaided clinical diagnoses yielded a sensitivity of 12.5% and a specificity of 96.0%.

CONCLUSIONS

The dimensional algorithm of the PHQ-9 demonstrated high criterion validity, whereas the categorical algorithm should not be applied due to its low sensitivity. Even though the PHQ-2 performed well, validity of the PHQ-9 was still superior. Hence, the PHQ-9 can be recommended as depression screener for adolescents to improve recognition rates in pediatric care.

Girls' Tobacco and Alcohol Use During Early Adolescence: Prediction from Trajectories of Depressive Symptoms Across Two Studies

Associations between trajectories of depressive symptoms and subsequent tobacco and alcohol use were examined in two samples of girls assessed at age 11.5 (T1), 12.5 (T2), and 13.5 (T3). Two samples were examined to ascertain if there was generalizability of processes across risk levels and cultures. Study 1 comprised a United States-based sample of 100 girls in foster care; Study 2 comprised 264 girls in a United Kingdom community-based sample. Controlling for T1 aggression and T1 substance use, individual variation in intercept and slope of depressive symptoms was associated with tobacco use at T3 in both samples: greater intercept and increases in depressive symptoms increased the risk for T3 tobacco use. A similar pattern of associations was found for alcohol use in Study 1. The replicability of findings for the prediction of tobacco use from trajectories of depressive symptoms suggests potential benefit in identifying girls with elevated depressive symptoms for tobacco use prevention programs prior to the transition to secondary school.

The Small School Friendship Dynamics of Adolescent Depressive Symptoms

Adolescence is a time when depressive symptoms and friendships both intensify. We ask whether friendships change in response to depressive symptoms, whether individual distress is influenced by friends' distress, and whether these processes vary by gender. To answer these questions we use longitudinal Simulation Investigation for Empirical Network Analysis (SIENA) models to study how changes in friendships and depressive symptoms intertwine with each other among all adolescents, boy-only, and female-only networks in seven smaller K-12th grade Add Health schools. Findings indicate that distressed youth are more likely to be socially excluded, though depressive symptoms are also a basis for friendship formation. Moreover, friends influence each other's mood levels. These processes differ for boys and girls, however, such that distressed girls are more likely to face exclusion and distressed boys are more likely to befriend and subsequently influence each other. Differences in these processes have implications for intervention efforts since the joint selectivity-influence mechanisms may undercut intervention efforts.

Emotional health predictors of substance use initiation during middle school

This study aimed to evaluate whether emotional health factors, including anxiety and depression, stress, and social support, are associated with earlier youth initiation of alcohol and illicit substances during middle school (from the sixth to the eighth grade). Data for this study were from the Developmental Pathways Project, a longitudinal study of 521 youth sampled from the Seattle Public Schools. Discrete time survival analyses were used to assess the effects of depression, anxiety, stress, and support on initiation of substance use, measured every 6 months at five time points between sixth and eighth grade. Youth who had initiated prior to sixth grade had significantly higher levels of depressive symptoms. In multivariate survival analyses controlling for child race/ethnicity, gender, and socioeconomic status, and accounting for conduct problems, youth who reported higher levels of separation anxiety/panic symptoms were at decreased risk for early alcohol initiation. Children with higher levels of perceived teacher support had a significantly lower risk of alcohol initiation during early follow-up periods. Recent stressful life events in Grade 6 were associated with significantly greater risk of initiating an illicit substance by Grade 8. The current findings highlight the role of stress in the initiation of illicit substance use and suggest that teacher support is associated with lower risk for very early alcohol use. Future research examining anxiety as a predictor of substance use should distinguish between subtypes of anxiety.

Severity of Victimization and Co-Occurring Mental Health Disorders Among Substance Using Adolescents

BACKGROUND: Co-occurring mental health disorders are widespread among substance using adolescents. Severity of victimization may be an important factor in explaining co-occurrence of mental health problems among adolescents with substance misuse problems. PURPOSE: The purpose of this study was to evaluate whether severe victimization experiences were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. METHOD: Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. RESULTS: Longer duration/frequent victimization, more than one type of victimization, and recent victimization were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. CONCLUSION: The findings show that some indicators of severe victimization experiences are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs.

Shared genetic influences on negative emotionality and major depression/conduct disorder comorbidity

OBJECTIVE

To investigate whether genetic contributions to major depressive disorder and conduct disorder comorbidity are shared with genetic influences on negative emotionality.

METHOD

Primary caregivers of 2,022 same- and opposite-sex twin pairs 6 to 18 years of age comprised a population-based sample. Participants were randomly selected across five regions in Tennessee, with stratification by age and geographic location. Face-to-face structured interviews were conducted with the primary caregiver of a representative sample of twins.

RESULTS

After accounting for genetic influences on negative emotionality, genetic influences on major depressive disorder/conduct disorder comorbidity were nonsignficant, but only in male twins. Specifically, 19% of the variance in the two disorders was accounted for by genetic factors shared with negative emotionality in male twins. Although the full hypothesis could not be tested in female twins, 10% to 11% of the variance in the two disorders was also accounted for by genetic factors shared with negative emotionality. Common shared environmental and nonshared environmental influences were found for major depressive disorder/conduct disorder comorbidity in male and female twins.

CONCLUSIONS

Negative emotionality represents an important dispositional trait that may explain genetic influences on major depressive disorder/conduct disorder comorbidity, at least for boys. Models of major depressive disorder/conduct disorder comorbidity must simultaneously measure common and specific genetic and environmental factors for a full understanding of this phenomenon. Gender differences require specific research attention in dispositional factors and developmental progression.

Comorbidity of Anxiety and Depression in Youth: Implications for Treatment and Prevention

The high level of concurrent and sequential comorbidity between anxiety and depression in children and adolescents may result from (a) substantial overlap in both the symptoms and items used to assess these putatively different disorders, (b) common etiological factors (e.g., familial risk, negative affectivity, information processing biases, neural substrates) implicated in the development of each condition, and (c) negative sequelae of anxiety conferring increased risk for the development of depression. Basic research on their various common and unique etiological mechanisms has guided the development of efficacious treatments for anxiety and depressive disorders in youth. Potential processes through which the successful treatment of childhood anxiety might prevent subsequent depression are described.