Protocol for a systematic review of the development of depression among adolescents and young adults: psychological, biological, and contextual perspectives around the world

Feasibility of Identifying Factors Related to Alzheimer's Disease and Related Dementia in Real-World Data

A comprehensive view of factors associated with AD/ADRD will significantly aid in studies to develop new treatments for AD/ADRD and identify high-risk populations and patients for prevention efforts. In our study, we summarized the risk factors for AD/ADRD by reviewing existing meta-analyses and review articles on risk and preventive factors for AD/ADRD. In total, we extracted 477 risk factors in 10 categories from 537 studies. We constructed an interactive knowledge map to disseminate our study results. Most of the risk factors are accessible from structured Electronic Health Records (EHRs), and clinical narratives show promise as information sources. However, evaluating genomic risk factors using RWD remains a challenge, as genetic testing for AD/ADRD is still not a common practice and is poorly documented in both structured and unstructured EHRs. Considering the constantly evolving research on AD/ADRD risk factors, literature mining via NLP methods offers a solution to automatically update our knowledge map.

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

AIM

Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people.

METHODS

We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates.

REGISTRATION

PROSPERO CRD42018103973.

RESULTS

Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16).

CONCLUSIONS

Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.

Relationships among adverse childhood experience patterns, psychological resilience, self-esteem and depressive symptoms in Chinese adolescents: A serial multiple mediation model

Adverse childhood experiences (ACEs) and adolescent depression are both prevalent social problems that can increase the risk of several negative health consequences throughout life. The original definition of ACEs misdirects the focus of intervention efforts for ACEs to only family dysfunction and parenting practices. We used a broader definition of ACEs and a latent class analysis (LCA) model to examine ACE patterns, aiming to overcome the shortcomings of cumulative and single adversity approaches based on the special social context of China. The data were derived from a middle school in Huaibei City of Anhui Province in 2019 and 2020, which was a prospective study involving 1687 junior high school students. At the initial evaluation (T1), ACEs, psychological resilience, self-esteem, and depressive symptoms were assessed by the students. At Time 2 (T2), the depressive symptoms of students were assessed. LCA and mediation analyses were conducted with Mplus version 8.2. The LCA identified the following three heterogeneous ACE classes: "low adversity" (36.4%), "moderate adversity" (44.2%), and "high adversity" (19.4%). The mediation analysis showed that the ACE patterns affected depressive symptoms through the following two mediation paths only in the moderate but not in the high adversity class: self-esteem alone and a path combining psychological resilience and self-esteem. Psychological resilience separately did not mediate the association between ACE patterns and depressive symptoms. To reduce depressive symptoms, interventions for students with ACEs need to improve self-esteem through many channels.

A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression

INTRODUCTION

Although the aetiology and pathophysiology of depression are multifactorial, to date most studies have examined either biological or environmental mechanisms without looking at the integration of both; with most studies conducted in high-income countries (HICs). Therefore, we conducted a systematic review of worldwide studies investigating the relationship between biological and environmental stress risk factors for major depressive disorder (MDD) in adolescence.

METHODS

We searched MEDLINE (via Ovid), PsycINFO, Cochrane Database of Systematic Reviews, Web of Science (Core Collection), Lilacs, African Journals Online and Global Health for prospective and cross-sectional studies that examined the association between biological markers and environmental stress risk factors in MDD during adolescence.

FINDINGS

Of 11,089 articles identified, 21 were included, with only two from middle-income countries. Increased inflammation, telomere length and brain abnormalities, including blunted reward-related activity, white matter disruptions, and altered volume of limbic brain regions, were associated with increased risk for MDD mainly in the context of early life adversity. There is little evidence suggesting that the neurobiological changes investigated were associated with MDD in the context of recent life stress.

INTERPRETATION

The developmental trajectory of depression appears to start with early life adversities and occurs in the context of immune and brain abnormalities. Understanding these biopsychosocial processes will help to improve our ability to detect individuals at risk of developing depression in adolescence. However, generalizability is limited by few studies examining both biological and environmental stress risk factors and a lack of studies on adolescents and young adults in low-and-middle-income countries (LMICs).

An investigation of the effect of smartphone-based pain management application on pain intensity and the quality-of-life dimensions in adolescents with chronic pain: a cluster randomized parallel-controlled trial

INTRODUCTION

Chronic pain negatively affects adolescents' quality of life. Therefore, it is important to seek for ways to effectively manage pain, which may, in turn, promote quality-of-life dimensions in this population. However, there are many barriers including geographical distance which prevent most adolescents from receiving an effective treatment for chronic pain. The present study aimed to investigate the effect of a smartphone-based pain management application compared with face-to-face pain management program and wait-list control on the pain intensity and quality-of-life dimensions in adolescents with chronic pain.

METHODS

This study used a cluster double-blinded randomized parallel-group design with school as the unit of randomization. Participants included were 192 adolescents with chronic pain. The questionnaires (pain intensity and quality of life measuring physical, emotional, social, and school dimensions) were completed at the baseline, immediately at the end of pain management program and three months after the end of the program.

RESULTS

Repeated measures ANOVAs with adjustment for clustering effect showed that there were significant main effects of time on ratings of pain intensity (p < 0.01), physical (p < 0.005), emotional (p < 0.008), social (p < 0.001), and school (p < 0.005) dimensions of quality of life. There was also a significant main effect of group on ratings of emotional (p < 0.001), social (p < 0.009), and school (p < 0.002) dimensions. The interaction of group × time for emotional (p < 0.004), social (p < 0.001), and school (p < 0.005) dimensions of quality of life was statistically significant.

DISCUSSION

The findings suggest that smartphone-based pain management program, which is a highly accessible and cost-effective intervention, may provide benefits similar to a face-to-face intervention and shows promise for being effective on emotional, social, and school dimensions of quality of life in adolescents with different types of chronic pain. The study was registered within the Iranian Registry of Clinical Trials (IRCT20180808040744N2).

Identifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study

BACKGROUND

Adolescence represents a vulnerable period for the onset of depression. Globally, there is a need to better understand risk factors for adolescent depression to inform policies for effective prevention initiatives.

METHODS

A Delphi consensus study was conducted on risk factors, early signs, and detection strategies for adolescent depression in global settings. Over 3 survey rounds, global experts formulated and ranked these variables for (1) specificity for adolescent depression and (2) feasibility of measurement (round 1, n=21 participants; rounds 2 and 3, n=17). We calculated Smith's salience index as a measure of consensus. Interviews were conducted with 10 participants to elicit qualitative reflections on the ranking results, and on the influence of cultural and contextual factors on depression risks.

RESULTS

Thirty-one risk factors for adolescent depression were generated. Panelists ranked three as highly specific and highly feasible to measure: family history of depression, exposure to bullying, and a negative family environment. Six were ranked as modestly specific and highly feasible: physical illness or disability, female sex, bereavement, trauma exposure, substance abuse, and low self-esteem. An additional 5 items were modestly specific and modestly feasible: social difficulties, academic stress, poverty, loss of family, and cognitive distortions. Five symptoms were at least modestly specific and feasible to measure: mood changes, loss of interest, social isolation, suicidality, and sleep changes. Schools were considered the most feasible place for screening.

LIMITATIONS

The participants were not representative of all countries and cultural regions.

CONCLUSIONS

This study offers a profile of risk factors developed and prioritized by experts to inform a research agenda for risk, identification and prevention of adolescent depression across global settings.

Detection of risk for depression among adolescents in diverse global settings: protocol for the IDEA qualitative study in Brazil, Nepal, Nigeria and the UK

INTRODUCTION

Globally, depression is a leading cause of disability among adolescents, and suicide rates are increasing among youth. Treatment alone is insufficient to address the issue. Early identification and prevention efforts are necessary to reduce morbidity and mortality. The Identifying Depression Early in Adolescence (IDEA) consortium is developing risk detection strategies that incorporate biological, psychological and social factors that can be evaluated in diverse global populations. In addition to epidemiological and neuroscience research, the IDEA consortium is conducting a qualitative study to explore three domains of inquiry: (1) cultural heterogeneity of biopsychosocial risk factors and lived experience of adolescent depression in low-income and middle-income countries (LMIC); (2) the feasibility, acceptability and ethics of a risk calculator tool for adolescent depression that can be used in LMIC and high-income countries and (3) capacity for biological research into biomarkers for depression risk among adolescents in LMIC. This is a multisite qualitative study being conducted in Brazil, Nepal, Nigeria and the UK.

METHODS AND ANALYSIS

A systematic set of qualitative methods will be used in this study. The Delphi method, Theory of Change (ToC) workshops, key-informant interviews and focus group discussions will be used to elicit perspectives on the study topics from a broad range of stakeholders (adolescents, parents, policy-makers, teachers, health service providers, social workers and experts). Delphi panellists will participate in three survey rounds to generate consensus through facilitated feedback. Stakeholders will create ToC models via facilitated workshops in the LMIC sites. The framework approach will be used to analyse data from the study.

ETHICS AND DISSEMINATION

Ethical approvals were received from the Ethics Review Board of George Washington University and from site-specific institutions in Brazil, Nepal, Nigeria and the UK. The findings generated from this study will be reported in highly accessed, peer-reviewed, scientific and health policy journals.

Toward a New Model of Understanding, Preventing, and Treating Adolescent Depression Focusing on Exhaustion and Stress

OBJECTIVE

Adolescent depression is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. The aim of this paper is to critically assess current hypotheses in adolescent depression research and reframe causes and treatment approaches.

METHODS

A mixed-method approach involved a review based on publications from PubMed, Embase and PsycInfo, and two exemplary adolescent cases.

RESULTS

Both cases show a spiral of stress and exhaustion, but with a different profile of symptoms and coping mechanisms. Reframing both cases from the perspective of coping behavior, searching for the sources of experienced stress and exhaustion, showed coping similarities. This proved essential in the successful personalized treatment and recovery process. In combination with recent evidence, both cases support the functional reframing of depression as the outcome of a stress- and exhaustion-related spiralling mechanism.

CONCLUSIONS

We propose to open up a symptom-based, mood-centered view to a model in which adolescent depression is framed as a consecutive failure of stress coping mechanisms and chronic exhaustion. Addressing exhaustion and coping primarily as a treatment strategy in adolescents and young adults might work in synergy with existing treatments and improve overall outcomes. This perspective warrants further investigation.