[Depression in children and adolescents: prevalence, diagnosis, etiology, gender differences and therapeutic approaches]

The association between urbanization and adolescent depression in China

Background

With the rapid urbanization in many countries, more attention is being paid to the relationship between urbanization and mental health, especially depression. However, in countries with rapid urbanization, few empirical studies exist on the relationship between urbanization and adolescent depression.

Methods

Nationally representative survey data from the China Family Panel Studies in 2012, 2016 and 2018 were used. Data of 1,588 adolescents were obtained from 25 provinces. Depression was measured using the Center for Epidemiology Studies of Depression 20-item score. The urbanization rate was obtained from the National Bureau of Statistics of China. The generalized estimating equation was used to estimate the statistical relationship.

Results

The participants' mean age at baseline was 15 years, and 51.2% (813/1,588) of participants were male. After adjusting for all covariates (gender, age, ethnicity, level of education, marital status, urban/rural areas, body mass index, self-rated health, academic pressure, smoking, drinking and exercise), the rate of urbanization was monotonically and negatively associated with adolescent depression (odds ratio 0.34, 95% CI [0.14-0.79]). Compared with female adolescents, male adolescents had a lower risk of depression (odds ratio 0.80, 95% CI [0.67-0.97]).

Conclusion

In the context of China, urbanization has a positive effect on the mental health of adolescents. Female adolescents are more likely to experience depression than male adolescents.

Diagnosing major depressive disorder and substance use disorder using the electronic health record: A preliminary validation study

Background

One mechanism to examine if major depressive disorder (MDD) is related to the development of substance use disorder (SUD) is by leveraging naturalistic data available in the electronic health record (EHR). Rules for data extraction and variable construction linked to psychometrics validating their use are needed to extract data accurately.

Objective

We propose and validate a methodologic framework for using EHR variables to identify patients with MDD and non-nicotine SUD.

Methods

Proxy diagnoses and index dates of MDD and/or SUD were established using billing codes, problem lists, patient-reported outcome measures, and prescriptions. Manual chart reviews were conducted for the 1-year period surrounding each index date to determine (1) if proxy diagnoses were supported by chart notes and (2) if the index dates accurately captured disorder onset.

Results

The results demonstrated 100% positive predictive value for proxy diagnoses of MDD. The proxy diagnoses for SUD exhibited strong agreement (Cohen's kappa of 0.84) compared to manual chart review and 92% sensitivity, specificity, positive predictive value, and negative predictive value. Sixteen percent of patients showed inaccurate SUD index dates generated by EHR extraction with discrepancies of over 6 months compared to SUD onset identified through chart review.

Conclusions

Our methodology was very effective in identifying patients with MDD with or without SUD and moderately effective in identifying SUD onset date. These findings support the use of EHR data to make proxy diagnoses of MDD with or without SUD.

Identification of novel targets and pathways to distinguish suicide dependent or independent on depression diagnosis

In recent years, postmortem brain studies have revealed that some molecular, cellular, and circuit changes associated with suicide, have an independent or additive effect on depression. The aim of the present study is to identify potential phenotypic, tissue, and sex-specific novel targets and pathways to distinguish depression or suicide from major depressive disorder (MDD) comorbid with suicide. The mRNA expression profiling datasets from two previous independent postmortem brain studies of suicide and depression (GSE102556 and GSE101521) were retrieved from the GEO database. Machine learning analysis was used to differentiate three regrouped gene expression profiles, i.e., MDD with suicide, MDD without suicide, and suicide without depression. Weighted correlation network analysis (WGCNA) was further conducted to identify the key modules and hub genes significantly associated with each of these three sub-phenotypes. TissueEnrich approaches were used to find the essential brain tissues and the difference of tissue enriched genes between depression with or without suicide. Dysregulated gene expression cross two variables, including phenotypes and tissues, were determined by global analysis with Vegan. RRHO analysis was applied to examine the difference in global expression pattern between male and female groups. Using the optimized machine learning model, several ncRNAs and mRNAs with higher AUC and MeanDecreaseGini, including GCNT1P1 and AC092745.1, etc., were identified as potential molecular targets to distinguish suicide with, or without MDD and depression without suicide. WGCNA analysis identified some key modules significantly associated with these three phenotypes, and the gene biological functions of the key modules mainly relate to ncRNA and miRNA processing, as well as oxidoreductase and dehydrogenase activity. Hub genes such as RP11-349A22.5, C20orf196, MAPK8IP3 and RP11-697N18.2 were found in these key modules. TissueEnrich analysis showed that nucleus accumbens and subiculum were significantly changed among the 6 brain regions studied. Global analysis with Vegan and RRHO identified PRS26, ARNT and SYN3 as the most significantly differentially expressed genes across phenotype and tissues, and there was little overlap between the male and female groups. In this study, we have identified novel gene targets, as well as annotated functions of co-expression patterns and hub genes that are significantly distinctive between depression with suicide, depression without suicide, and suicide without depression. Moreover, global analysis across three phenotypes and tissues confirmed the evidence of sex difference in mood disorders.

[Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries]

Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries This study analyzed identity development and parental rearing in adolescents from seven countries. In a sample of 2,259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, maternal parenting (support, psychological control, anxious rearing), identity development (exploration, commitment and ruminative exploration) and psychopathology was assessed. Adolescents from central Europe (France and Germany) were characterized by quite low scores in most identity dimensions, compared to adolescents from all other countries. Particular high were scores in exploration and commitment among adolescents from Turkey, Greece, Peru and Pakistan. In some countries, adolescents described the family relations as characterized by high levels of anxious rearing and psychological control, which was, however, not associated with elevated levels of total symptomatology. The findings show that what is adaptive in one cultural context is depending on cultural norms and family traditions. This information is helpful in designing interventions.

Übereinstimmung von Mutter-Kind-Aussagen und deren Einflussfaktoren am Beispiel des Kinder-DIPS in der Diagnostik psychischer Störungen im Jugendalter

Theoretischer Hintergrund: In der Diagnostik psychischer Störungen im Jugendalter wird der Einbezug unterschiedlicher Urteilerperspektiven empfohlen. Die Aussagen unterschiedlicher Urteiler korrelieren jedoch nur gering. Fragestellung: Die Ziele dieser Arbeit bestehen in der Darstellung der Prävalenzen, der Übereinstimmung von Mutter-Kind-Aussagen sowie der Identifikation potentieller Prädiktoren von Nichtübereinstimmung hinsichtlich psychischer Störungen im Jugendalter. Methode: Die Stichprobe stammt aus dem DFG-Projekt „Zukunft Familie III” der Technischen Universität Braunschweig. Es wurden 234 Mütter (Alter: M = 46.4 Jahre, SD = 4.7) und deren Kinder im Alter zwischen 11 und 17 Jahren mit Hilfe des Diagnostischen Interviews bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS) und weiteren Verfahren befragt. Ergebnisse: Insgesamt liegen geringe Prävalenzen psychischer Störungen vor. Die Aussagen von Müttern und Jugendlichen weisen eine geringe bis mäßige Übereinstimmung auf (durchschnittliches κ = .26). Die Mütter berichten mehr externalisierende Störungen. Für internalisierende Störungen wurde kein signifikanter Unterschied zwischen Müttern und Jugendlichen gefunden. Die Jugendlichen berichten mehr Essstörungen und tendenziell mehr Schlafstörungen. Die psychische Belastung der Mutter, Konflikte innerhalb der Mutter-Kind-Beziehung und das Alter des Jugendlichen sind signifikante Prädiktoren für die Nichtübereinstimmung der Mutter-Kind-Aussagen. Schlussfolgerungen: Die Ergebnisse verdeutlichen die Notwendigkeit, sowohl das Urteil der Mutter als auch das Urteil des Kindes in der Diagnostik psychischer Störungen im Jugendalter zu beachten. Praktische Implikationen werden abgeleitet.

[Psychoanalytic psychotherapy with adolescents: challenges, technical problems, and treatment outcome]

Psychoanalytic treatment of adolescents has a long tradition and is currently one of the most frequent treatments in this age group. However, not many studies document the efficacy of psychoanalytic treatments of adolescents. This article analyses the background of this deficit by focusing on recent changes in symptomatology, the widespread diagnostic insecurity and the special challenges, which such treatment demands of the therapist. The task of researching the efficacy of adolescent psychotherapy is of considerable complexity. Recent own studies about efficacy of adolescent therapy will be presented. The evidence suggests that different approaches in therapy (psychoanalytic vs. psychodynamic) are of similar efficacy. However, long-term treatments ensure a consolidation of symptom reduction. The inclusion of different perspectives (adolescent, parents, therapist) and work with parents may be effective.

Sex distribution and psychiatric features of child and adolescent conversion disorder across 2 decades

BACKGROUND

Earlier research suggested female predominance in adult conversion disorder, and the strong association between conversion disorder and experiences of being abused is well known. However, the data for child and adolescent populations are limited. In Taiwan, the dramatic increase in child abuse may have some impact on the features of child and adolescent conversion disorder. This study aimed to compare the demographic characteristics, psychiatric comorbidity, and experiences of being abused in Taiwanese children and adolescents diagnosed with conversion disorder in psychiatric consultations across 2 decades.

METHODS

Retrospective and consecutive chart reviews were conducted for child and adolescent patients (< 20 years old) who were newly diagnosed with conversion disorder in psychiatric consultations at Taipei Veterans General Hospital from 1987 to 2006. The first group included patients who were diagnosed between 1987 and 1996 (the first decade), and the second group included patients who were diagnosed between 1997 and 2006 (the second decade).

RESULTS

A total of 42 patients diagnosed with conversion disorder were included in this study. Nineteen of the 42 subjects were diagnosed in the first decade (from 1987 to 1996), and 23 in the second decade (from 1997 to 2006). There existed among patients a tendency toward an increasing number of male subjects (p < 0.05), suffering more abuse (p < 0.05), and higher prevalence rates of depression and dysthymia comorbidity (p < 0.05) in the second decade compared to the first.

CONCLUSION

The sex distribution in conversion disorder might have significantly changed over the past 2 decades. There is an increasing need for screening and interventions for psychiatric comorbidity and experiences of being abused in children and adolescents with conversion disorder. Because of the small sample size of our study, further studies that include multiple study sites and a larger number of patients are needed before a firm conclusion can be drawn.