Longitudinal Trajectories of Depression Symptoms in Adolescence: Psychosocial Risk Factors and Outcomes

Factors Associated with Mood Transitions among Older Canadian Long-Term Care Residents: A Multistate Transition Model

OBJECTIVES

This study examines the complex transitions between the different mood states and absorbing states out of long-term care settings, as well as the factors affecting those transitions.

DESIGN

A retrospective longitudinal analysis of older residents in Canadian long-term care homes in 3 provinces.

SETTING AND PARTICIPANTS

Residents residing in long-term care homes in 3 Canadian provinces (Alberta, British Columbia, and Ontario) over a 10-year period from January 2010 to February 2020, with an age of at least 65.

METHODS

We used a 1-step Markov multistate transition model to examine transitions in mood over time as well as the factors affecting those transitions using the standardized interRAI MDS 2.0 comprehensive health assessment. The MDS 2.0 assessments are completed by trained assessors within 2 weeks of the resident's admission.

RESULTS

Our results showed that 46% of residents initially present with no mood disturbance on admission and 31% with mild mood disturbance on admission and 23% with moderate/severe mood disturbance on admission. Factors associated with worsening of mood include aggressive behavior; health instability; impaired cognition; major comorbidities; pain or poor sleep; conflict with family, friends, or other residents; and anxiety. Of the facility-level attributes, Alberta was associated with worsening of mood.

CONCLUSIONS AND IMPLICATIONS

Our study identified key factors influencing mood transitions, highlighting pain and aggressive behavior as significant contributors to worsening mood, both of which are modifiable through targeted interventions. The findings suggest substantial opportunities for mood improvement in long-term care settings.

Are Big Five personality traits associated with trajectories of depressive symptom among middle-aged and older adults in China?

BACKGROUND

Personality traits have been confirmed to be associated with mental health, but their influence on the trajectories of depressive symptoms among middle-aged and older adults in China is not well understood. This study seeks to identify distinct trajectories of depressive symptoms and explore their relationship with the Big Five personality traits in China.

METHODS

Data was collected from the China Family Panel Studies (CFPS) for 2016, 2018, 2020, and 2012 were used in this study. 5376 individuals aged 45 and older were included in this study. Latent growth mixture modeling was applied to identify distinct trajectories of depressive symptoms, and multinomial logistic regression was used to examine the association between personality traits and these trajectories.

RESULTS

Three depressive symptom trajectories were identified: stable increasing with low starting point (53.18%), descending type with high starting point (8.03%), and stable at middle level (38.78%). Higher extraversion scores was associated with lower depressive symptom trajectories, while higher levels of openness and neuroticism were associated with an increased risk of severe depressive symptom trajectories. Heterogeneity analyses revealed that, among individuals aged 45-60, conscientiousness was negatively associated with depressive symptoms, while openness was positively related to depression. Among older adults (≥ 60 years), extraversion showed the strongest protective effect against depressive symptoms, while higher openness demonstrated a notably stronger association with depression. Additionally, females showed stronger associations between personality traits and depressive symptom than males.

CONCLUSION

Different trajectories of depressive symptoms are observed among middle-aged and older adults in China. The findings underscore the importance of tailored mental health monitoring, with distinct approaches needed for different genders and age groups.

Gender Differences in the Relationship Between Short-Form Video Addiction and Adolescent Depression: The Mediating Role of Attentional Bias

Previous studies have shown that short-form video addiction (SVA) is a significant predictor of adolescent depression. However, little is known about the mediating mechanisms. Guided by the Interaction of Person-Affect-Cognition-Execution model, this study aimed to investigate the relationship between SVA and depression among Chinese adolescents and to examine the mediating role of attentional bias toward positive information (API) and negative information (ANI), including potential gender differences. A total of 4750 Chinese adolescents (Mage = 16.01, SD = 0.76, 62.15 percent male) completed self-reported scales for SVA, API, ANI, and depression. The structural equation modeling results indicated that both API and ANI mediated the relationship between SVA and depression. Moreover, multigroup analyses revealed that the mediating effect of ANI was significantly stronger in female than in male adolescents. These findings enhance our understanding of the relationship between SVA and depression in adolescents and suggest that developing gender-specific interventions could mitigate the detrimental effects of SVA on depression.

The effects of childhood maltreatment and social support on the trajectories of depressive symptoms from adolescence to young adulthood

BACKGROUND

Depression is one of the most common mental health concerns among adolescents and young adults. Childhood maltreatment is a particularly potent risk factor for the subsequent development of depressive symptoms. Meanwhile, social support has been identified as a robust protective factor against depressive symptoms. However, limited research has investigated the effects of childhood maltreatment and social support on the trajectories of depressive symptoms from adolescence to young adulthood.

OBJECTIVE

The present study aimed to explore trajectories of depressive symptoms from adolescence to young adulthood as well as identify childhood maltreatment as a potential risk factor and social support as a protective factor to depressive symptoms over time.

METHODS

We conducted growth curve modeling using public-use data from Add Health. Main variables (childhood maltreatment, social support, depressive symptoms from Wave I to Wave IV) and control variables (e.g., gender, race, poverty) were included in the analysis.

RESULTS

Depressive symptoms demonstrated a quadratic pattern, with a decline from adolescence to emerging adulthood, and a slight increase in young adulthood. Childhood maltreatment was only significantly associated with the initial level of depressive symptoms but not the trajectories of depressive symptoms. Social support was not only associated with the initial level of depressive symptoms, but also the changes of depressive symptoms over time.

CONCLUSION

The present study provides an avenue towards untangling potential factors contributing to the heterogeneity of depressive symptoms. Identifying risk and protective factors with varying trajectories of depressive symptoms will potentially improve related treatments and interventions.

Association between depressive symptom trajectories and unhealthy lifestyle factors among adolescents based on the China family panel studies

BACKGROUND

The prevalence of depressive symptom in adolescents has sharply increased over the past decade. Depressive symptom during adolescence could hinder the development of social, cognitive, and psychological competencies, potentially influencing young adults' lifestyle factors. This study aimed to identify trajectories of depressive symptom from adolescence to early adulthood and evaluated their association with lifestyle factors in early adulthood.

METHODS

Data was collected from the China Family Panel Studies (CFPS). The Center for Epidemiological Studies Depression Scale (CES-D) was assessed during the 2016, 2018, and 2020. Group - based trajectory modeling was used to identify trajectories of depressive symptom over a 5 - year follow - up. We used binary logistic regression analyze to explore the relationship between depressive symptom trajectories and lifestyle factors.

RESULTS

We identified four trajectories of depressive symptom, characterized by maintained low scores (non - symptom); moderately high scores (moderately high symptom); consistently high scores (persistently high symptom); and low starting scores that steadily increased (increasing symptom). After adjusting for potential confounding factors, the ORs for smoking were 2.95 (1.47, 5.97) for the "persistently high symptom" trajectory comparing to the "non - symptom" trajectory.

CONCLUSION

The depressive symptom trajectories was associated with unhealthy lifestyle factors. Future studies are needed to determine whether depressive symptom might serve as early indicators prompting adolescents to make psychological changes that could reduce the risk of unhealthy lifestyle factors in the later life.

Sociodemographic factors associated with trajectories of depression among urban refugee youth in Kampala, Uganda: A longitudinal cohort study

Background

There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.

Methods

We conducted a longitudinal cohort study with refugee youth aged 16-24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.

Results

Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: "sustained low depression level" (n = 803, 71.9%) and "sustained high depression level" (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.

Conclusions

The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

Disentangling developmental trajectories of childhood anxiety and depression symptoms in the prediction of adolescent substance use

Adolescent substance use is comorbid with internalizing problems (e.g., anxious and depressive symptoms) and externalizing problems (EPs). Developmental researchers have linked early anxious and depressive symptoms to later substance use behaviours via an "internalizing pathway". Support for this pathway exists among young adults; however, evidence from prospective studies of adolescents has been inconsistent. Given the paucity of prospective studies in this area, the current study used a developmental framework to examine childhood anxiety and depression symptom trajectories as predictors of adolescent substance use and whether these relationships depend on sex and EPs. Children with and without EPs participated annually in an ongoing longitudinal study (N = 744; Time 1 age = 6.3-10.6). Youth completed self-report measures of anxiety and depression symptoms (Times 3-6) and substance use (Times 7-8). Parents and teachers completed measures of children's EPs (Time 0). Parallel process growth models showed that changes over time in childhood depression symptoms were significantly positively associated with adolescent alcohol/cannabis use, substance-related consequences, and total score of problematic substance use. Changes over time in childhood anxiety symptoms were significantly negatively associated with adolescent alcohol/cannabis use. These results were invariant by EPs and sex. Research implications of this study emphasize the importance of isolating the respective pathways of anxious and depressive symptoms to later substance use outcomes, while clinical implications focus on targets for early identification and prevention of problematic substance use in adolescence.

Consequence of child and adolescent depressive symptom trajectories for adult depressive disorders and symptoms: A systematic review & meta-analysis

BACKGROUND

Group differences in longitudinal patterns of child and adolescent depressive symptoms are commonly observed. However, the implications for adult mental health are unclear. This study presents a systematic review of child and adolescent depressive symptom trajectory research and meta-analysis of their longitudinal effects on adult depressive symptoms and disorders.

METHODS

A systematic search identified 12 longitudinal studies (12 cohorts, N = 35,058) that were harmonized to identify common symptom trajectories prior to age 18 years. Examination of follow-up in the same groups was made (at average age 20.5 years) to estimate longitudinal associations with adult depressive symptoms (Sx) and disorders (Dx), using random effects meta-analyses.

RESULTS

The included studies identified Low (70.3 %), Moderate (17.9 %), High (9.5 %), Increasing (9.5 %) and Decreasing (5.1 %) symptom trajectories. These trajectories were found to predict variation in symptoms and disorders in adulthood: Low, Dx = 4.5 %, 95 % Confidence Interval [CI] 2.7-6.8 %, Sx [Mean] = 8.33, Standard Deviation [SD] = 6.30; Moderate, Dx = 20.9 %, CI 11.9-31.5 % - Sx = 18.13, SD = 3.38; High, Dx = 34.4 % CI 17.2-54.0 % - Sx = 38.80, SD = 7.75; Increasing, Dx = 38.3 %, CI 12.7-67.5 % - Sx = 24.73, SD = 18.64; Decreasing, Dx = 15.4 %, CI 10.5-20.9 % - Sx = 17.00, SD = 12.18.

LIMITATIONS

Confidence intervals are wide for some trajectory effects. There was significant between-cohort heterogeneity in predictive effects for High trajectories, suggesting the need for further research to identify characteristics influencing variation.

CONCLUSION

Low symptom trajectories forecast lower adult depression symptoms and disorders. Programs effectively targeting reductions in Moderate, High, Increasing and Decreasing trajectories will likely prevent problems in early adulthood.

Internet addiction and depressive symptoms in adolescents: joint trajectories and predictors

OBJECTIVE

Internet addiction and depressive symptoms are common mental health problems in adolescents. Due to the comorbidity of Internet addiction and depressive symptoms, their mutual relationship influences their developmental trajectories over time. Thus, this study aimed to identify the joint trajectories of Internet addiction and depressive symptoms, and examined the individual, family, and school antecedents of these trajectories among Chinese adolescents.

METHODS

Using a battery of self-report scales, three waves of data collection were conducted in a Chinese adolescent sample (N = 1,301). The co-developmental trajectories of Internet addiction and depressive symptoms were extracted by adopting parallel-process latent class growth modeling (PPLCGM). Multinomial logistic regression was performed to assess predictive factors.

RESULTS

Four unique joint trajectory classes were detected: the Health Group (n = 912, 70.1%), Comorbidity-Worsening Group (n = 85, 6.5%), Asymptomatic-Comorbid Risk Group (n = 148, 11.4%), and Prominent Depressive Symptoms-Remission Group (n = 156, 12.0%). Individual, family, and school factors (e.g., gender, positive youth development, family function, academic performance) significantly predicted the membership in these distinct co-developmental trajectories.

CONCLUSION

Our findings illustrate that the joint development of Internet addiction and depressive symptoms among adolescents presents a heterogeneous distribution, which could better inform prevention and intervention strategies since each co-developmental trajectory may represent unique experience for adolescents who need targeted treatment. Various individual, family, and school factors are important predictors that play different roles in distinguishing the joint trajectories of Internet addiction and depressive symptoms during this critical developmental transition period.

Relationship between ruminative style and adolescent depression

BACKGROUND

The role of rumination in depression remains controversial. We aimed to establish the ruminative tendency style theory (RTST), discuss the occurrence of depression in adolescents with rumination as the core, and explore the different associations between adolescent ruminative tendency, ruminative style, and depression.

METHODS

This study employed an online questionnaire survey of 1110 Chinese adolescents aged 12-17 years, assessing ruminative tendency, ruminative style, stressful life events, depressive state, depressive trait, the Big Five personality traits, and social support. Conditional process analysis was used to test the chain mediation effect with Ruminative Style as a moderator. After screening for the predictor variables, a logistic regression risk prediction model was established and validated internally.

RESULTS

The chain mediation effect of ruminative tendency and depressive trait between stressful life events and depressive state was significant, with the indirect effect accounting for 63.4%. Ruminative Style negatively moderated the relationship between Ruminative Tendency and Depressive Trait (β=-0.053，P＜0.001). The risk prediction model for depressive state showed good calibration and clinical utility. Area under the curve values for the validation and training sets were 0.926 and 0.927, respectively.

CONCLUSION

Different associations may exist between adolescent ruminative tendency, ruminative style, and depression, and the proposal of ruminative style is of great significance for intervention in adolescent depression.

Joint developmental trajectories of depression and post-traumatic stress disorder symptoms among Chinese children during COVID-19

BACKGROUND

In early 2020, Chinese children started to demonstrate severe depression and post-traumatic stress disorder symptoms (PTSS) caused by lockdown and self-isolation (measures taken at the beginning of the COVID-19 pandemic).

OBJECTIVES

Concerning the significant impact of the pandemic on children's physical and mental development, the study aimed to explore children's depression and PTSS during the COVID-19 pandemic and the protective effects of family resilience on the trajectories.

METHODS

883 children participated and completed three waves of online follow-up questionnaires. The latent growth mixture modeling (LGMM) analysis was used to explore the trajectories of children's depression and PTSS based on the individual approach.

RESULTS

Two types of depression trajectories were identified and defined as the resilient group (83.01 %) and the recovery group (16.99 %); Two types of PTSS trajectories were identified and defined as the resilient group (71.12 %) and the recovery group (28.88 %); Two types of the joint trajectories of depression and PTSS were identified and defined as the resilient group (83.47 %) and the chronic group (16.53 %). The results indicated that maintaining a positive outlook (a dimension of family resilience) was the potential predictor of PTSS trajectories.

CONCLUSION

The trajectories of depression and PTSS among Chinese children during the COVID-19 pandemic were heterogeneous, and there were similar evolving subtypes. Family resilience could be a critical protective factor for children and families.

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.

Adolescent Depression Symptom Trajectories Detected Via Universal Screening in Pediatric Primary Care

Unique trajectories of adolescent depression symptoms have been identified, yet less is known about whether such patterns translate to real-world clinical settings. Because annual adolescent depression screening is becoming more prevalent in primary care, we examined whether longitudinal patterns of depression symptoms documented in the developmental psychopathology literature can also be detected via routine screening in primary care and explored how membership in the identified trajectories varied based on concurrent suicide risk and sociodemographic factors. A total of 1,359 adolescents aged 12-16 years old at the first timepoint were included in the current analyses. These adolescents completed three depression screeners during their well-visits in a large pediatric primary care network between November 15, 2017 and February 1, 2020. Retrospective electronic health record data were extracted, including sociodemographic variables and depression screening results. Dynamic functional time series clustering results indicated the optimal number of clusters was five. The five depression symptom trajectories were: (1) A-Shaped (i.e., relatively low depression symptoms at Time 1, a substantial increase in symptoms at Time 2, and a return to low symptoms at Time 3), (2) Increasing, (3) Low-Stable, (4) High-Decreasing, and (5) Low-Decreasing. Cluster differences in suicide risk largely mapped onto depression symptom levels at each assessment. We found cluster differences based on practice location, insurance type, and adolescent race. The symptom trajectories observed in this study resemble those found in the developmental psychopathology literature, though some key differences were noted. Findings can inform future research and symptom monitoring in primary care.

Developmental cascade models linking contextual risks, parenting, and internalizing symptoms: A 17-year longitudinal study from early childhood to emerging adulthood

Although internalizing problems are the most common forms of psychological distress among adolescents and young adults, they have precursors in multiple risk domains established during childhood. This study examined cascading risk pathways leading to depression and anxiety symptoms in emerging adulthood by integrating broad contextual (i.e., multiple contextual risks), parental (i.e., negative parenting), and child (i.e., internalizing behaviors) characteristics in early and middle childhood. We also compared common and differential pathways to depression and anxiety symptoms depending on the conceptualization of symptom outcomes (traditional symptom dimension vs. bifactor dimensional model). Participants were 235 children (109 girls) and their families. Data were collected at 3, 6, 10, and 19 years of child age, using multiple informants and contexts. Results from a symptom dimension approach indicated mediation pathways from early childhood risk factors to depression and anxiety symptoms in emerging adulthood, suggesting common and distinct risk processes between the two disorders. Results from a bifactor modeling approach indicated several indirect pathways leading to a general internalizing latent factor, but not to symptom-specific (i.e., depression, anxiety) latent factors. Our findings highlighted comparative analytic approaches to examining transactional processes associated with later internalizing symptoms and shed light on issues of early identification and prevention.

COVID-19 Related Stressors, Parent-Child Relationship, and Alcohol Use and Mental Health Profiles Among White and Hispanic/Latinx First-Year College Students

Transitioning to college during the novel coronavirus disease 2019 (COVID-19) pandemic may increase risk for alcohol use and mental health problems. We examined how COVID-19 related stressors and parent-child relationships are independently and interactively associated with alcohol use and mental health profiles in a sample of first-year college students (N = 425, 34.8% Hispanic/Latinx; 74.9% female) who completed an online survey in October 2020. Latent profile analysis identified four profiles: well-adjusted (53.2%), mental health problems only (21.6%), alcohol use only (17.4%), and comorbid (7.8%). COVID-19 related stressful events increased risk of being in the alcohol use only and comorbid profiles, whereas COVID-19 related worries increased risk of being in the mental health problems only profile. Parent-child relationship quality lowered risk of being in the mental health problems only and the comorbid profiles. In addition, parent-child relationship quality moderated the role of COVID-19 related worries such that COVID-19 related worries were associated with lower odds of being in the comorbid profile when parent-child relationship quality was high but not when parent-child relationship quality was low. Strengthening parent-child relationship quality appears important for promoting college students' well-being.

Relationship between depression and quality of life among students: a systematic review and meta-analysis

The objectives of this systematic review were to estimate the prevalence of depression and to identify the relationship between depression and quality of life (QOL) among high school and university students. Literature search was performed in the Scopus, Embase, PubMed, Scielo, CINAHL and Web of Science databases, following the PRISMA methodology. The results were presented through descriptive approaches and meta-analysis. Thirty-six studies met the eligibility criteria, and twenty-six were included in the meta-analysis. The prevalence of depressive symptoms was 27% (95% CI 0.21-0.33) among students, being high school and university students was 25% (95% CI 0.14-0.37) and 27% (95% CI 0.20-0.34), respectively, and most studies have shown that depression was associated with low QOL. Among the limitations of the study is the difficulty of generalizing the results found, considering the large sample of health students. New studies should be conducted considering the severity, duration, and patterns of depressive symptoms in high school and university students, to better understand the relationship between depression and QOL.

A cultural-ecosocial systems view for psychiatry

While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals' narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.

The association between adverse childhood experiences and depression trajectories in the Add Health study

BACKGROUND

Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur before age 18. ACEs are linked to depression in adulthood, but little is known about the association between ACEs and depression trajectories across the lifespan.

OBJECTIVE

To examine the association between specific types of ACEs, cumulative ACE scores, and depression trajectories from adolescence to adulthood.

PARTICIPANTS AND SETTING

Waves 1-4 of the National Longitudinal Study of Adolescent to Adult Health (N = 12,888), spanning ages 12 years to 43 years.

METHODS

We constructed trajectories of depression scores using a modified 9-item Center for Epidemiologic Studies Depression Scale (CES-D-9). We used weighted logistic regression to calculate odds ratios and confidence intervals for each ACE and ACE score and depression trajectories after adjusting for confounders.

RESULTS

We found 75.3 % experienced at least one ACE and 14.7 % experienced 4+ ACEs. We identified three CES-D-9 trajectories: consistently low (Group 1), decreasing (Group 2), and increasing (Group 3) depression scores. All types of abuse, neglect, and community violence were significantly associated with trajectory Groups 2 and 3 vs 1 (p < .05). Foster home placement, poverty, and parental incarceration were associated with Group 2 vs 1. ACE scores showed a dose-response association with Group 3 vs 1 [aORs for 1ACE = 1.43 (0.93-2.20); 2-3ACEs = 1.97 (1.30-3.00); 4+ACEs = 3.08 (1.86-5.09)], and Group 2 vs 1 [aORs for 1ACE = 1.26 (0.87-1.83); 2-3ACEs = 1.93 (1.36-2.74); 4+ACES = 2.70 (1.90-3.84)].

CONCLUSIONS

ACEs can have a lasting impact on depression through adulthood, highlighting the need to mitigate their impact to prevent depression-associated morbidity and mortality.

Changes in the comorbidity patterns of negative emotional symptoms and Internet addiction over time among the first-year senior high school students: A one-year longitudinal study

BACKGROUND

The comorbidity of psychiatric disorders and Internet addiction (IA) has been widely documented. However, changes and instability of the comorbidity between negative emotional symptoms and IA over time are not fully understood.

METHODS

A sample of 453 first-year senior high school students completed all measures three times across one-year period and were included in the current study. The sample consisted of 163 (36.0%) males and 290 (64.0%) females. At the baseline, the mean age of the participants was 15.07 ± 0.46 (range: 12-16) years old. Latent class analysis was used to identify the latent class pattern. Multinomial logistic regression analysis was utilized to examine the association between covariates and latent classes at baseline. Latent transition analysis was applied to explore the changes in latent classes of individuals over time.

RESULTS

Three subgroups of negative emotional symptoms, IA and their comorbidity were identified at all the three time points. Being Internet gamers, high average time of Internet use every day, peer exclusion, verbal and physical bullying experience, and poor self-rated health were found to be significant predictors of the high comorbidity symptom. Students were more likely to remain the same class rather than moving between the latent classes across time.

CONCLUSIONS

A better understanding of change characteristics in latent classes across time contributes to confirm an appropriate time for intervention targeted on students who converted from low symptom class to the high class.

The role of family and peer factors in the development of early adolescent depressive symptoms: A latent class growth analysis

Few studies have explored the trajectories of Chinese early adolescent depressive symptoms or comprehensively considered the factors of family and peers. The present study aimed to identify the trajectories of depressive symptoms in early adolescence using a school-based sample assessed in three waves. The study also examined whether family and peer factors were significant predictors. A total of 586 Chinese primary and middle school students participated in the survey. A growth mixture model was used to find the trajectories of depressive symptoms, and multinominal logistic regression was used to identify the predictors. Three trajectories were identified, including a stable-low class, an increasing class, and a high-decreasing class. Results indicated that gender, parental psychological aggression and neglect, parental psychological control, traditional bullying/cyberbullying victimization, and friendship quality were significant predictors. However, witnessing intimate partner violence, parental behavior control, and traditional bullying/cyberbullying perpetration could not significantly predict the trajectories. The findings of this study can provide an empirical basis for teachers and clinical interveners to determine different development trajectories of depressive symptoms and carry out prevention and intervention.

Evaluating the influence of financial investment in compulsory education on the health of Chinese adolescents: a novel approach

Background

With China's aging and declining fertility rate, the importance of population quality is increasing. As the main force of the labor market in the future, the Chinese government tries to promote the development of adolescents by increasing the financial investment in compulsory education, so as to improve the future population quality of China and enhance the national competitiveness. Therefore, the aim of this study was to investigate the relationship between financial investment in compulsory education and the health of Chinese adolescents.

Methods

This study specifically uses data obtained from China Education Panel Survey (CEPS). The data were nationally representative, which covered families, schools, and communities. For the CEPS data obtained, the 2013–2014 school year was the baseline, and two cohorts of 7th and 9th graders were the starting point of the survey. In the 2014–2015 school year, 8th-grade students who participated in the baseline survey (7th-grade students in the 2013–2014 school year) were followed up. Since the second period only began to investigate the data on financial investment in compulsory education, this article uses the data from the 2014–2015 academic year for research. OLS and Ordered Probit models were used to investigate the impact of financial investment in compulsory education on adolescent health.

Results

With the doubling of financial investment in compulsory education, self-rated health increased by 0.021, frequency of illness decreased by 0.03, the number of sick leave days decreased by 0.207, and depression decreased by 0.191. The heterogeneity analysis shows that compared to only-child, high-income and nonagricultural groups, the financial investment in compulsory education has a greater impact on the health of adolescents with the characteristics of agriculture hukou, non-only-child and low-income families. Further analysis of the impact mechanism shows that financial investment in compulsory education exerts a significant influence on the health of adolescents by easing family budget constraints, improving school sports facilities, and increasing the expected return of health investment and social capital.

Conclusions

Financial investment in compulsory education can enhance the health of adolescents, and vulnerable groups benefit more, which is conducive to promoting health equity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14125-5.

Program for education and enrichment of relational skills (PEERS) training for social skills and depressed mood intervention in young adult with depression: Study protocol for a randomized controlled trial

Introduction

Depression is a common psychiatric disorder characterized by persistent low mood, reduced interest, and slowed thinking. Young adults are the main first-onset group for depression in all categories of the population. Program for education and enrichment of relational skills (PEERS) training, a program for the Education and Enrichment of Relational Skills, has been used in Europe and America for people with various types of social disorders with good results. A Chinese adaptation of the PEERS training program may be a new approach to help youth with depression return to society as soon as possible. This study aimed to construct and optimize a social skills training program for Chinese young adults with depression and to validate the impact of the program.

Materials and methods and analysis

The aim of this trial protocol is to evaluate the efficacy of the localized PEERS training program on social competence, depressed mood in a Chinese young adult population with depression. The primary outcome will be a change in self-reported depressive symptoms from baseline to week 3 post-randomization to week 6 post-randomization measured using the Liebowitz social anxiety scale (LSAS). Secondary outcomes include the rate of decline in severe social anxiety, the Social Avoidance and Distress Scale (SAD), the Social Self-Efficacy Scale (PSSE), and the Hamilton Depression Scale (HAMD-17). Data for each assessment will be collected at baseline, week 3 of the trial, and week 6 of the trial.

Ethics and dissemination

Ethics approval was obtained from the Hospital Ethics Committee. Findings will be disseminated through scientific journals, conferences, and university courses.

Trial registration number

[http://www.chictr.org.cn/], identifier [ChiCTR2100046050].

Is subthreshold depression in adolescence clinically relevant?

BACKGROUND

Subthreshold depression is highly prevalent in adolescence, but compared to major depressive disorder, the clinical impact is under-researched. The aim of this review was to compare subthreshold depression and major depressive disorder in adolescents by reviewing available literature on epidemiology, risk factors, illness trajectories, brain anatomy and function, genetics, and treatment response.

METHODS

We conducted a scoping review of papers on subthreshold depression and major depressive disorder in adolescence published in English. Studies in adults were included when research in adolescence was not available.

RESULTS

We found that individuals with subthreshold depression were similar to individuals with major depressive disorder in several regards, including female/male ratio, onset, functional impairment, comorbidity, health care utilization, suicidal ideation, genetic predisposition, brain alterations, and treatment response. Further, subthreshold depression was about two times more common than major depressive disorder.

LIMITATIONS

The definition of subthreshold depression is highly variable across studies. Adolescent-specific data are limited in the areas of neurobiology and treatment.

CONCLUSIONS

The findings of the current review support the idea that subthreshold depression is of clinical importance and provide evidence for a spectrum, versus categorical model, for depressive symptomatology. Given the frequency of subthreshold depression escalating to major depressive disorder, a greater recognition and awareness of the significance of subthreshold depression in research, clinical practice and policy-making may facilitate the development and application of early prevention and intervention.

Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study

BACKGROUND

Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode.

OBJECTIVE

Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder.

METHODS

A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline.

RESULTS

Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants' social support networks at baseline (r=0.22; P=.03; R²=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5.

CONCLUSIONS

Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis

BACKGROUND

Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes.

OBJECTIVE

This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU).

METHODS

Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU.

RESULTS

A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F_2,51=3.58; P=.04), negative symptoms (F_2,51=4.45; P=.02), and overall psychiatric symptom severity (F_2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F_1,62=4.68; P=.03), negative symptoms (F_1,62=14.61; P<.001), and overall psychiatric symptom severity (F_1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F_1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes.

CONCLUSIONS

Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.

Going beyond risk factor: Childhood maltreatment and associated modifiable targets to improve life-long outcomes in mood disorders

Childhood maltreatment increases risk for mood disorders and is associated with earlier onset-and more pernicious disease course following onset-of mood disorders. While the majority of studies to date have been cross-sectional, longitudinal studies are emerging and support the devastating role(s) childhood maltreatment has on development of, and illness course in, mood disorders. This manuscript extends prior reviews to emphasize more recent work, highlighting longitudinal data, and discusses treatment studies that provide clues to mechanisms that mediate disease risk, course, relapse, and treatment response. Evidence suggesting systemic inflammation, alterations in hypothalamic-pituitary-adrenal (HPA) axis function and corticotropin-releasing factor (CRF) neural systems, genetic and other familial factors as mechanisms that mediate risk and onset of, and illness course in, mood disorders following childhood maltreatment is discussed. Risky behaviors following maltreatment, e.g., substance use and unhealthy lifestyles, may further exacerbate alterations in the HPA axis, CRF neural systems, and systematic inflammation to contribute to a more pernicious disease course. More research on sex differences and the impact of maltreatment in vulnerable populations is needed. Future research needs to be aimed at leveraging knowledge on modifiable targets, going beyond childhood maltreatment as a risk factor, to inform prevention and treatment strategies and foster trauma-informed care.

Lifestyle Behaviors and Depressive Symptoms in Chinese Adolescents Using Regression and fsQCA Models

The study was to compare the performance of the regression models and fuzzy set qualitative comparative analysis (fsQCA) models in analyzing the possible effects of sociodemographic variables (age and sex) and lifestyle behaviors (physical activity, sedentary time, sleep duration, physical education class and screen time) on depressive symptoms in adolescents. This cross-sectional surgery was conducted among 726 adolescents in Jilin Province of China, selected by random cluster sampling. The regression model showed that age, physical education (PE) class and sleep duration were associated with depressive symptoms. Meanwhile, the fsQCA models showed that shorter physical activity, PE class and sleep duration as well as longer sedentary and screen time were related to higher levels of depressive symptoms. Both regression and fsQCA models indicated that promoting lifestyle behaviors could affect depressive symptoms. Considering the differences between the two methods, they are not superior to the other method, but complementary and should be used in other studies at the same time.

Long Term Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders: Analyses at 12 Months Post-Treatment

Depression is a major problem in youth mental health and identified as the leading cause of disability worldwide. There is ample research on the acute effects of treatment, with estimated small-to-moderate effect sizes. However, there is a lack of research on long-term outcomes. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03), received blended CBT, face-to-face CBT or treatment as usual. Data were collected at 12 months after the intervention and compared between treatment conditions. Clinical diagnosis, depressive symptoms, suicide risk, internalizing symptoms and externalizing symptoms decreased significantly over time, from baseline to the 12-month follow-up, and also from post-treatment to the 12-month follow-up in all three conditions. Changes were not significantly different between conditions. At the long-term, improvements following the treatment continued. Due to the large amount of missing data and use of history control condition, our findings need to be interpreted with caution. However, we consider these findings as a clinical imperative. More evidence might contribute to convincing adolescents to start with therapy, knowing it has lasting effects. Further, especially for adolescents for whom it is not possible to receive face-to-face treatment, blended treatment might be a valuable alternative. Our findings might contribute to the implementation of blended CBT.

Distinct trajectories of depression symptoms in early and middle adolescence: Preliminary evidence from longitudinal network analysis

Adolescent depression is a clinically relevant concern that has major implications for mental and physical health. The trajectory of depressive symptoms among adolescents suggests that there is likely variability throughout this developmental period. The aim of the study was to assess the longitudinal relationship between individual symptoms of depression among early and middle adolescents to provide guidance for future research investigating targeted intervention efforts. Data were extracted from electronic medical records (2015-2017) from a pediatric primary care clinic in an urban setting. Cross-Lagged Panel Network analysis was used to evaluate symptoms of depression measured with the Patient Health Questionnaire (PHQ-9) measured twice over a 1-year period among early adolescents (ages 11-13 years; n = 309) and middle adolescents (ages 14-16 years; n = 255). The sample was predominantly Hispanic (90%) and 56% female. The analyses highlighted key differences and similarities between early and middle adolescence, largely focused on the role of suicidal ideation and tightly linked with feelings of failure and appetitive disturbance. In early adolescence suicidal ideation was highly likely to lead to other symptoms. In middle adolescence, however, suicidal ideation no longer had connections to other symptoms and instead the strongest connections were toward suicidal ideation. Interestingly, across both early and middle adolescence feelings of failure and appetitive disturbance were highly likely to lead to suicidal ideation. These exploratory findings highlight several longitudinal associations between early and middle adolescence that provide insight into differences and similarities regarding how symptoms might progress within those developmental periods. Taken together these results can provide direction for future research to evaluate brief, targeted interventions for adolescents.

Joint associations of parental personality traits and socio-economic position with trajectories of offspring depression: Findings from up to 6925 families in a UK birth cohort

Background

Parental personality may influence the course of offspring depression but epidemiological evidence for associations is lacking. It is also unknown whether associations between parental personality and offspring depression differ by socio-economic position (SEP). Our aims were to describe the trajectories of depressive symptoms across adolescence of offspring of parents with and without maladaptive personality traits and to test for effect modification by SEP.

Methods

A longitudinal study in the Avon Longitudinal Study of Parents and Children birth cohort (ns = 3054-7046). Exposures were binary measures of maladaptive maternal and paternal personality traits. The outcome was depressive symptoms measured over nine occasions (ages 11-24) using the short mood and feelings questionnaire (SMFQ; range: 0-26). Effect modifiers were parental education and self-reported material hardship. Multilevel growth curve models were used to estimate trajectories.

Results

offspring of mothers with high (vs. low) maladaptive traits showed higher levels of depressive symptoms at multiple ages of adolescence, the greatest of which was observed at age 22 (predicted SMFQ difference age 10 = 0.66, 95% confidence intervals [CIs]: 0.25 to 1.28; age 22 = 1.00, CI: 0.51 to 1.50). There was weaker and inconsistent evidence of an association between paternal maladaptive personality and offspring depressive symptoms (SMFQ difference age 10 = 0.21, CI: -0.58 to 0.99; age 22 = 0.02, CI: -0.94 to 0.90). Lower SEP was also associated with higher offspring depressive symptoms (SMFQ difference material hardship vs. no hardship age 10 = 0.79, 95% CI: 0.46 to 1.13; age 22 = 0.96, CI: 0.56 to 1.36). There was minimal statistical evidence for effect modification.

Conclusions

The offspring of mothers with high levels of maladaptive personality traits show evidence of greater depressive symptoms throughout adolescence although the absolute increase in symptoms is small. Evidence for the associations with fathers' personality was weaker. Socio-economic position and maladaptive personality traits appear to be independent risk factors for offspring depressive symptoms.

No associations in preregistered study of youth depression and functional connectivity of fronto-parietal and default mode networks

Adolescence is characterized by vulnerability to the onset of major depressive disorder (MDD). The goal of this preregistered study was to assess neural correlates of depression symptoms in young adolescents, both cross-sectionally and longitudinally. The default mode network (DMN) is believed to support internal attention towards self-referential thoughts, while the fronto-parietal network (FPN) is theorized to support cognitive control and regulation of attention. As MDD diagnosis has been associated with heightened connectivity within DMN regions and diminished connectivity within FPN regions relative to healthy controls, our study builds upon group-difference analyses by using dimensional measures of depression severity. Our preregistered hypotheses were that within-DMN functional connectivity would be positively associated with concurrent depression severity, while within-FPN functional connectivity would be negatively associated with concurrent depression severity. Preregistered analyses also examined between DMN-FPN connectivity as an alternative predictor variable, and assessed the longitudinal associations between all three functional connectivity measures and change in depression severity over three subsequent waves. Multiple regression models tested cross-sectional analyses and hierarchical linear models tested longitudinal analyses. One hundred and twenty-four youth completed a resting state functional MRI. Their depression severity was assessed at the time of the scan and at three follow-up sessions. None of the predictor variables were associated with concurrent depression severity, nor with the slope of depression symptom trajectories in longitudinal analyses. These negative results add to extant cross-sectional studies, and may inform future investigations of brain correlates of depression psychopathology in youth.

Genetic susceptibility for major depressive disorder associates with trajectories of depressive symptoms across childhood and adolescence

BACKGROUND

Early-onset depression during childhood and adolescence is associated with a worse course of illness and outcome than adult onset. However, the genetic factors that influence risk for early-onset depression remain mostly unknown. Using data collected over 13 years, we examined whether polygenic risk scores (PRS) that capture genetic risk for depression were associated with depressive symptom trajectories assessed from childhood to adolescence.

METHODS

Data came from the Avon Longitudinal Study of Parents and Children, a prospective, longitudinal birth cohort (analytic sample = 7,308 youth). We analyzed the relationship between genetic susceptibility to depression and three time-dependent measures of depressive symptoms trajectories spanning 4-16.5 years of age (class, onset, and cumulative burden). Trajectories were constructed using a growth mixture model with structured residuals. PRS were generated from the summary statistics of a genome-wide association study of depression risk using data from the Psychiatric Genomics Consortium, UK Biobank, and 23andMe, Inc. We used MAGMA to identify gene-level associations with these measures.

RESULTS

Youth were classified into six classes of depressive symptom trajectories: high/renitent (27.9% of youth), high/reversing (9.1%), childhood decrease (7.3%), late childhood peak (3.3%), adolescent spike (2.5%), and minimal symptoms (49.9%). PRS discriminated between youth in the late childhood peak, high/reversing, and high/renitent classes compared to the minimal symptoms and childhood decrease classes. No significant associations were detected at the gene level.

CONCLUSIONS

This study highlights differences in polygenic loading for depressive symptoms across childhood and adolescence, particularly among youths with high symptoms in early adolescence, regardless of age-independent patterns.

The Associations between Sleep Duration, Academic Pressure, and Depressive Symptoms among Chinese Adolescents: Results from China Family Panel Studies

Depressive symptoms are a common mental health problem among adolescents, which may affect their physical and mental health development and impose heavy burdens on individual families and society. This study aimed to examine the associations between sleep duration, academic pressure, and depressive symptoms among Chinese adolescents and to construct the mediation model to explore the mediating effect of sleep duration. The data are from the China Family Panel Studies (CFPS). Methodologically, the aforementioned associations were explored by constructing a structural equation model and applying multivariate multilevel logistic regression. In this study, we found that approximately 6.49% of the 3724 Chinese adolescents had depressive symptoms. Sleep duration of <6 h/night (OR = 2.39, 95%CI = 1.33-4.32) and high/maximum academic pressure (high: OR = 1.43, 95%CI = 1.02-1.99; maximum: OR = 2.43, 95%CI = 1.58-3.73) were both associated with an increased risk of depressive symptoms in adolescents. Meanwhile, the multiplicative interaction between sleep duration and academic pressure was significantly associated with depressive symptoms in adolescents (p < 0.001). The sleep duration played a partial mediating role in the relationship between academic pressure and depressive symptoms (a*b = 0.006, 95%BootCI = 0.001-0.012). Our study highlights that it is essential to mitigate the academic pressure of adolescents to increase their sleep duration and further reduce the occurrence of depressive symptoms by adopting corresponding preventive measures.

Trajectories of depression and anxiety in Chinese high school freshmen: Associations with Internet addiction

BACKGROUND

Most previous studies focused on the associations of depression and anxiety with Internet addiction (IA) have used variable-centered approaches. This study aims to explore the distinct developmental trajectories of depression and anxiety, and their association with IA based on person-centered approaches.

METHODS

A total of 437 Chinese high school freshmen at the baseline were followed across one year. Latent class growth analysis (LCGA) and growth mixture modeling (GMM) were used to identify the heterogeneity of individual trajectories of depression and anxiety.

RESULTS

For depression, there were three distinct trajectories identified, namely, the escalating group (n=60, 13.7%), recovery group (n=31, 7.1%), and the low-stable group (n=346, 79.2%). For anxiety, the subgroups consisted of the escalating group (n=50, 11.4%), the recovery group (n=34, 7.8%), and the low-stable group (n=353, 80.8%). The probability of IA in the depression low-stable group was significantly smaller compared to those in either the recovery group (χ²=10.794, P=0.001) or the escalating group (χ²=19.314, P<0.001). The probability of IA in the anxiety low-stable group was found to be significantly smaller than that in the recovery group (χ²=17.359, P<0.001) and the escalating group (χ²=7.752, P=0.005).

LIMITATIONS

The sample was limited to students from one specific high school and had a one-year follow-up.

CONCLUSIONS

The findings of the study suggest the necessity of early prevention and intervention strategies for those students with depression and anxiety, which are at elevated risk of developing IA.

Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.

Stress, Sleep, and Coping Self-Efficacy in Adolescents

Adults are thought to show a sleep-stress spiral in which greater stress worsens sleep quality, which amplifies stress, which leads to worse sleep. This study examined whether adolescents show a similar spiral, and if so, whether coping self-efficacy-believing one can cope with stress-interrupts the spiral. Temporal dynamics of perceived stress, sleep quality, and coping self-efficacy were tracked in 381 9th graders (49% female, mean age 14.43, age range 14-16) using daily surveys across two school weeks (3184 observations). Though expected associations were evident between individuals, only a unidirectional path was found within individuals from sleep quality to perceived stress via coping self-efficacy. This challenges the conventional bidirectional understanding of sleep-stress relations and suggests coping self-efficacy as an intervention target.

Cohort profile: The Youth and Mental Health Study (YAMHS) - a longitudinal study of the period from adolescence to adulthood

The aim of this article is to provide a detailed description of the Youth and Mental Health Study (YAMHS),a population-based, representative (cluster sampling), prospective cohort study that was conducted to investigate risk and resilience factors for mental health conditions, specifically depressive symptoms and disorders, from adolescence to adulthood. The baseline data were collected in 1998 (T1) in two counties in central Norway from 2464 adolescents (response rate 88.3%, mean age 13.7 years). The first follow-up was conducted in 1999 (T2) (n = 2432, response rate of 87.1%, mean age 14.9 years). A subgroup of individuals was assessed at T2 (n = 345) with clinical interviews, and this subgroup was reassessed in 2005 (T3) (n = 265, 70.1%, 20 years). The last follow-up (of participants assessed at T1 and T2) was conducted in 2012 (T4) (n = 1266, 51.9%, 27.2 years). Demographics, depressive symptoms, general psychopathology, suicidal ideation and attempts and psychological and somatic factors were recorded. Among adolescents of both sexes, psychosocial variables were correlated with and predicted depressive symptom severity. The strongest predictors were sex (female), the levels of depressive symptoms the preceding year, and the total number of stressful events. The association between stressful life events and depressive symptoms was moderated by physical activity, while the relationship between stressful events and coping style was mediated by depressive symptoms. The rate of use of specialised mental health services among the depressed was low. The lifetime prevalence of depressive disorders was 23% at 15 years, and the most common disorder was minor depression. Adolescents who attempted suicide were more often victims of violence and less resilient than were non-suicide attempters. The existing longitudinal data from the cohort will be further analysed. Follow-up data will be obtained from existing national registries by links created with individual identification numbers.

Risk and resource factors for depressive symptoms during adolescence and emerging adulthood - A 5-year follow-up using population-based data of the BELLA study

INTRODUCTION

Depression is one of the most common mental disorders in adolescents and young adults worldwide, and causes a high burden for both individuals and society. The present study aims to investigate the role of risk and resource factors for depressive symptoms during adolescence and emerging adulthood in a German population-based cohort.

METHODS

Within the longitudinal BELLA study, data on risk and resource factors were collected among n = 632 children and adolescents aged 11 to 17 years. Depressive symptoms were measured five years later. Multivariate linear regression models served to investigate effects of risk and resource factors on depressive symptoms. Regression models were stratified by gender. Moreover, we explored potential interaction effects.

RESULTS

A negative mother-child relationship predicted depressive symptoms in girls, whereas school stress served as a risk factor in boys. Peer competence was associated with fewer depressive symptoms in girls, and family cohesion was identified as a resource factor in boys. In addition, few moderating effects of resource factors on the association between risk factors and depressive symptoms were found.

LIMITATIONS

As the BELLA study is a population-based observational study, we only identified associations between risk and resource factors and no cause-effect relationships.

CONCLUSIONS

Findings provide evidence of gender-specific risk and resource factors for depression. Individuals who are exposed to risk factors must be monitored during the transition into adulthood. Gender-sensitive prevention and early intervention programs are needed.

Associations of mental health with driving while impaired and risky driving in emerging adults

OBJECTIVE

Examined cross-sectional associations of driving while impaired (DWI) and risky driving with mental and psychosomatic health among U.S. emerging adults.

METHODS

Data were from years 1-4 after high school (waves 4-7) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009-2010). Outcome variables were DWI (dichotomous variable: ≥ 1 day vs. 0 days in the last 30 days) and risky driving Checkpoints Self-Reported Risky Driving Scale (C-RDS). Independent variables included depressive symptoms and psychosomatic symptoms. Multivariate logistic and linear regressions were conducted with complex survey features considered.

RESULTS

Higher depressive and psychosomatic symptoms were associated with modestly higher likelihood of DWI (Adjusted odds ratio [AOR] ranged from 1.02 to 1.03 and from 1.04 to 1.05, respectively) and higher C-RDS scores (b ranged from 0.06 to 0.12 and from 0.08 to 0.23, respectively) in years 1-4 after high school.

CONCLUSIONS

Depressive and psychosomatic symptoms were associated with greater DWI and risky driving in all 4 years after high school. Negative mental and psychosomatic health should be targeted components of DWI and risky driving prevention to lower fatal motor vehicle crashes among emerging adults.

Individual Differences in the Stability and Change of Childhood Depression: A Growth Mixture Model With Structured Residuals

Studies of developmental trajectories of depression are important for understanding depression etiology. Existing studies have been limited by short time frames and no studies have explored a key factor: differential patterns of responding to life events. This article introduces a novel analytic technique, growth mixture modeling with structured residuals, to examine the course of youth depression in a large, prospective cohort (N = 11,641, ages 4-16.5, 96% White). Age-specific critical points were identified at ages 8 and 13 where depression symptoms spiked for a minority of children. Most depression risk was due to dynamic responses to environmental events, drawn not from a small pool of persistently depressed children, but a larger pool of children who varied across higher and lower symptom levels.

Trajectories of depressive symptoms through adolescence and young adulthood: social and health outcomes

Depressive symptoms display heterogeneous trajectories across adolescence, which can lead to different consequences. This study aimed to identify trajectories of depressive symptoms from adolescence to young adulthood, assessing the association with social and health outcomes at young adulthood. Adolescents born in 1990, enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) completed the Beck Depression Inventory II (BDI-II) at 13, 17 and 21 years. Mixed models and model-based clustering were used to describe the trajectories in the BDI-II score (n = 2010). Outcomes were assessed at age 21 years with self-administered questionnaires and face-to-face interviews (n = 1594). Odds ratios or regression coefficients, with 95% confidence intervals, were estimated using logistic and linear regression. Three trajectory classes of depressive symptoms were identified, similar in shape in both sexes: High (8.4%), Moderate (31.3%) and Low (60.2%). Participants in High or Moderate classes were more likely to describe lower scores of community involvement, more medical appointments during the last year, higher levels of pain and had higher probability of self-rating health as "good" or "fair or poor". Females in the High and Moderate classes were more likely to be current smokers, to describe ever using drugs and to report more sexual partners, emergency room visits and the use of antidepressants. The risk of depressive symptoms in adulthood is likely to be early determined in adolescence. The trajectory classes with higher levels of symptoms were associated with worse social and health outcomes.

Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis

BACKGROUND

Depression among adolescents is rising globally and is the leading cause of illness and disability among adolescents. While antidepressants and psychotherapy are effective, only about 40% of depressed adolescents receive treatments due to lack of professionals and barriers such as cost and personal obstacles including stigma, lack of motivation, and negative perceptions of treatment. Use of alternative and complementary treatments for depression is growing. One such treatment is mindfulness meditation.

OBJECTIVE

We examined the effects of mindfulness interventions on depression among adolescents and explored the moderator effects of participants, methods, and intervention characteristics.

METHODS

We searched 17 databases from their inception to April 2019 to identify studies written in English. Search terms included depress* AND mindful* OR meditat* AND adolescen* OR student*; 29 studies met inclusion criteria. Two researchers independently coded data from all primary studies. Discrepancies were discussed with a third researcher to reach consensus. Using the random effects model, we computed the effect sizes (ESs) of mindfulness interventions on depression using standardized mean differences (Hedge's g) with 95% confidence intervals (CI). Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity.

RESULTS

Across 29 studies (N=3688), 1839 adolescents participated in mindfulness interventions; 1849 served as controls. Mean ages ranged from 10.2 to 19.5 years. Mindfulness groups showed reduced depression compared to control groups (g=.14, 95%CI[.01-.28], p<.042). Funded studies showed greater improvement in depression (g=.34, 95%CI[.09-.58], p<.008) compared to unfunded (g=.05, 95%CI[-.12-.22], p<.554). Interestingly, while only two research teams studied mindfulness-based cognitive therapy, they showed trends toward improvement (p=0.09) in depression (g=.76, 95%CI[.18-1.34], p<.010, s=2) compared to adapted mindfulness interventions (g=.13, 95%CI[-.04-.30], p<.140, s=16) or mindfulness-based stress reduction (g=.07, 95%CI[-.16-.29], p<.559, s=11). Mindfulness interventions with individual counseling tended (p=0.09) to improve depression (g=.46, 95%CI[.07-.85], p<.021, s=3) more than without (g=.10, 95%CI[-.04-.24], p<.168, s=26). Depression improved more when follow-up measures occurred further from the intervention (Slope=.002, τ²=.74, Q_between=4.10, p=.043, s=29). No quality indicators moderated the ES of mindfulness interventions on depression.

CONCLUSION

Mindfulness interventions are mildly effective interventions to reduce depressive symptoms among adolescents. Clinicians trained in mindfulness interventions might encourage mindfulness meditation as adjunctive/alternative treatment for adolescents with mild or moderate depressive symptoms as well as for at-risk adolescents to prevent depression. Funding, type of mindfulness interventions, individual counseling, and time to follow up were moderators of the effects of mindfulness interventions on depression in adolescents.

Trajectories of Depressive Symptoms among Multicultural Adolescents in Korea: Longitudinal Analysis Using Latent Class Growth Model

The purpose of this study was to investigate the trajectory of depressive symptoms in multicultural adolescents using longitudinal data, and to identify predictive factors related to depressive symptoms of multicultural adolescents using latent class analysis. We used six time-point data derived from the 2012 to 2017 Multicultural Adolescents Panel Study (MAPS). Latent growth curve modeling was used to assess the overall features of depressive symptom trajectories in multicultural adolescents, and latent class growth modeling was used to determine the number and shape of trajectories. We applied multinomial logistic regression analysis to each class to explore predictive factors. We found that the overall slope of depressive symptoms in multicultural adolescents increased. Latent class analysis demonstrated three classes: (1) high-increasing class (i.e., high intercept, significantly increasing slope), (2) moderate-increasing class (i.e., moderate intercept, significantly increasing slope), and (3) low-stable class (i.e., low intercept, no significant slope). In particular, we found that the difference in the initial intercept of depressive symptoms determined the subsequent trajectory. There is a need for early screening for depressive symptoms in multicultural adolescents and preparing individual mental health care plans.

Clustering of lifestyle factors and the relationship with depressive symptoms among adolescents in Northeastern China

BACKGROUND

Previous studies have showed the independent associations between screen time, physical activity (PA), sleep duration, and depressive symptoms, but little is known about the influence of lifestyles on depressive symptoms. This study aimed to identify clustering patterns of health-related behavior in Chinese adolescents and their association with depressive symptoms.

METHODS

The sample consisted of 4178 adolescent students. Screen time, physical activity, and sleep time were self-reported. The level of depressive symptoms was measured using the Center for Epidemiologic Studies Depression Scale. A two-step cluster analysis was conducted to identify lifestyle patterns. Univariate and multivariate logistic regression were used to examine the associations between clusters and depressive symptoms.

RESULTS

About 28.1% of participants reported depressive symptoms. Four lifestyle clusters were identified: (1) active pattern (n = 865 [20.7%]); (2) high sleep duration pattern (n = 1263 [30.2%]); (3) high screen time pattern (n = 665 [15.9%]); and (4) low physical activity-low sleep duration pattern (n = 1385[33.1%]). Cluster 1 and 2 were relatively healthy groups. Cluster 3 and 4 were at a higher risk of developing depressive symptoms than cluster 1.

LIMITATIONS

This was a cross-sectional study, and causal relations could not be identified. Self-reported questionnaire instruments were used to collect data, which might have led to some recall bias.

CONCLUSIONS

Clusters of lifestyle behaviors were identified, and differences in depressive symptoms were found among clusters. Public mental illness prevention strategies should expand their capacity to focus on lifestyle patterns.

Psychosocial Risk Factors: its Relation with Social Cognition, Emotional Regulation and Well-Being

In Colombia, an increase of suicidal behavior in adolescents caused by personal and environmental factors is evidenced. This quantitative, descriptive, correlational research aimed to establish the existing relationship between social cognition, perception of the quality of relationships and emotional regulation with the variables of psychosocial risk, suicide risk and level of psychological well-being in adolescents in contexts of high socioeconomic vulnerability of Bogotá. A total of 155 adolescents were selected through non-probabilistic sampling at convenience, with ages between 13 and 17 years (M = 14.47 and DE = 1.03). The results allowed observing the existence of significant relationships between the study variables. From a linear regression analysis, the emotional bond and emotional self-regulation had a higher level of explanation about the perception of well-being and the psychosocial risk associated with suicide. Finally, the results and implications of a greater participation of the emotional bond in comparison to that of social cognition in adolescence are discussed, in order to formulate programs that promote well-being and prevent risk.

Modeling Individual Differences in Brain Development

Within the field of developmental cognitive neuroscience, there is an increasing interest in studying individual differences in human brain development in order to predict mental health outcomes. So far, however, most longitudinal neuroimaging studies focus on group-level estimates. In this review, we highlight longitudinal neuroimaging studies that have moved beyond group-level estimates to illustrate the heterogeneity in patterns of brain development. We provide practical methodological recommendations on how longitudinal neuroimaging datasets can be used to understand heterogeneity in human brain development. Finally, we address how taking an individual-differences approach in developmental neuroimaging studies could advance our understanding of why some individuals develop mental health disorders.

Trajectories of Depressive Symptoms Among North American Indigenous Adolescents: Considering Predictors and Outcomes

We identified developmental trajectories of depressive symptoms among 674 Indigenous adolescents (Mage  = 11.10, SD = 0.83 years) progressing from early to late adolescence. Four depressive symptoms trajectories were identified: (a) sustained low, (b) initially low but increasing, (c) initially high but decreasing, and (d) sustained high levels of depressive symptoms. Trajectory group membership varied as a function of gender, pubertal development, caregiver major depression, and perceived discrimination. Moreover, participants in the different trajectory groups were at differential risk for the development of an alcohol use disorder. These results highlight the benefit of examining the development of depressive symptoms and the unique ways that depressive symptoms develop among North American Indigenous youth as they progress through adolescence.

The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.