Reward function as an outcome predictor in youth with mood and anxiety symptoms

BACKGROUND

Adolescent depression varies considerably in its course. However, there remain no biobehavioral predictors of illness trajectory, and follow-up studies in depressed youth are sparse. Here, we sought to examine whether reward function would predict future clinical outcomes in adolescents with depressive symptoms. We utilized the reward flanker fMRI task to assess brain function during distinct reward processes of anticipation, attainment, and positive prediction error (PPE, i.e. receiving uncertain rewards).

METHODS

Subjects were 29 psychotropic-medication-free adolescents with mood and anxiety symptoms and 14 healthy controls (HC). All had psychiatric evaluations at baseline and approximately 24-month follow-up. Thirty-two participants (10 HC) had usable fMRI data. Correlation and hierarchical regression models examined baseline symptom severity measures as predictors of follow-up clinical outcomes. Whole-brain analyses examined relationships between neural reward processes and follow-up outcomes.

RESULTS

Clinically, anhedonia, but not irritability, predicted future depression and suicidal ideation. Among reward processes, only baseline neural activation during PPE correlated with follow-up depression and anhedonia severity. Specifically, activation in the left angular gyrus-a component of the default mode network-was associated with future depression, while activation in the dorsal anterior cingulate, operculum, and left insula-key salience and pain network regions-was associated with future anhedonia, even when controlling for baseline anhedonia.

LIMITATIONS

The small sample size and variable follow-up intervals limit the generalizability of conclusions.

CONCLUSIONS

This research suggests that reward dysfunction, indexed by anhedonia, may predict worse clinical trajectories in depressed youth. Adolescents presenting with significant anhedonia should be carefully monitored for illness progression.

Can Cognitive-Behavioral Therapy Be Optimized With Parent Psychoeducation? A Randomized Effectiveness Trial of Adolescents With Major Depression in Puerto Rico

This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.

Depression Severity Assessment for Adolescents at High Risk of Mental Disorders

Recent progress in artificial intelligence has led to the development of automatic behavioral marker recognition, such as facial and vocal expressions. Those automatic tools have enormous potential to support mental health assessment, clinical decision making, and treatment planning. In this paper, we investigate nonverbal behavioral markers of depression severity assessed during semi-structured medical interviews of adolescent patients. The main goal of our research is two-fold: studying a unique population of adolescents at high risk of mental disorders and differentiating mild depression from moderate or severe depression. We aim to explore computationally inferred facial and vocal behavioral responses elicited by three segments of the semi-structured medical interviews: Distress Assessment Questions, Ubiquitous Questions, and Concept Questions. Our experimental methodology reflects best practise used for analyzing small sample size and unbalanced datasets of unique patients. Our results show a very interesting trend with strongly discriminative behavioral markers from both acoustic and visual modalities. These promising results are likely due to the unique classification task (mild depression vs. moderate and severe depression) and three types of probing questions.