1
|
Klein DN, Perlman G, Feltman SM, Kotov R. Preonset predictors of chronic-intermittent depression from early adolescence to early adulthood. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:694-703. [PMID: 37276087 PMCID: PMC10524144 DOI: 10.1037/abn0000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Individuals with prolonged or frequent episodes account for a disproportionate share of the burden of depression. However, there are surprisingly few data on whether individuals at risk for developing chronic-intermittent depression (CID) as opposed to briefer, infrequent depressive episodes (time-limited depression [TLD]) can be distinguished before their first depressive episode. We followed a community sample of 465 never-depressed females on five occasions from age 14 to 20 years and examined whether 18 preonset clinical and psychosocial variables prospectively predicted CID. The CID group accounted for 40% of depressed cases but 84% of the cumulative time depressed in the sample. Participants with CID (n = 60) exhibited significantly higher preonset levels of 16 of the 18 risk factors than the never-depressed group (n = 315). The TLD group (n = 90) had significantly higher preonset levels of nine risk factors than never-depressed participants. Finally, the CID group had significantly higher levels of nine risk factors than the TLD group, five of which were similar in TLD and never-depressed participants. These findings indicate that differences between CID and TLD are evident before onset and suggest that the liability to CID may be both greater than, and somewhat different from, the liability to TLD. Moreover, they suggest that individuals at risk for a malignant course of depression can be targeted for prevention and early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Scott M. Feltman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University
| |
Collapse
|
2
|
Rivera-Santiago K, Cumba-Aviles E, Gómez-Rivera D. Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes. HEALTH PSYCHOLOGY REPORT 2023; 12:1-13. [PMID: 38425888 PMCID: PMC10900980 DOI: 10.5114/hpr/162649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/12/2022] [Accepted: 03/27/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes (T1D) are at increased risk for depression. A history of recurrent depression (HRD) may relate to worse health outcomes than single-episode depression. However, no study has explored this issue among T1D adolescents. PARTICIPANTS AND PROCEDURE We examined differences in psychosocial and diabetes-related outcomes between T1D adolescents with (G1; n = 33) and without (G2; n = 18) HRD. Participants were 51 youths (aged 12-17 years) enrolled in a depression treatment study. Youths and one caregiver each completed several measures. Using MANOVA, followed by individual ANOVAs, and chi-square tests, we compared groups in continuous and categorical variables, respectively. RESULTS MANOVA results were significant, F(7, 43) = 3.97, p = .002. Adolescents from G1 obtained higher scores than youths in G2 in self-esteem/guilt problems, cognitive alterations, and sadness due to T1D. Their caregivers reported more burden and rated their offspring as having more internalizing problems, facing more barriers to complying with T1D treatment, and using a medical ID less frequently than their counterparts did. A higher percentage of G1 participants presented clinical anxiety and inadequate glycemic control, and reported a history of major depression. According to caregivers, a higher proportion of G1 members had experienced multiple diabetes-related hospitalizations, were non-compliant with insulin treatment, and lived in homes with a conflictive environment. CONCLUSIONS Our study documents important differences in outcomes between T1D youths with vs. without any HRD. Clinicians may need an intensive and integrative approach to treat mental and physical aspects of health among these patients.
Collapse
Affiliation(s)
- Keiliany Rivera-Santiago
- Institute for Psychological Research, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| | - Eduardo Cumba-Aviles
- Institute for Psychological Research, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| | - Demivette Gómez-Rivera
- Institute for Psychological Research, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| |
Collapse
|
3
|
Halonen J, Hakko H, Riala K, Riipinen P. Familial Risk Factors in Relation to Recurrent Depression Among Former Adolescent Psychiatric Inpatients. Child Psychiatry Hum Dev 2022; 53:515-525. [PMID: 33651209 PMCID: PMC9107395 DOI: 10.1007/s10578-021-01146-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 02/02/2023]
Abstract
Treating recurrent depression is a challenge for clinical practitioners. We investigated which family environmental factors contribute to differences between recurrent and non-recurrent depression by the young adulthood of the former adolescent inpatients. The initial sample covered 237 adolescent psychiatric inpatients with depression, of which 35.4% had later diagnosed with recurrent depression. Recurrence in depression was associated to distant maternal relationships in both male (p = 0.022) and female patients (p = 0.042). In females, the likelihood for recurrent depression was also related to psychiatric problems of the father (p = 0.013) and siblings (OR = 3.7, p = 0.032), and having a grand multiparous mother (p = 0.005). Our results emphasise the need for effective family-centred approaches in treatment of adolescents with depression.
Collapse
Affiliation(s)
- Joonas Halonen
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O.BOX 5000, 90014 Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, P.O.BOX 26, 90029, Oulu, Finland.
| | - Kaisa Riala
- grid.412326.00000 0004 4685 4917Department of Psychiatry, Oulu University Hospital, Oulu, P.O.BOX 26, 90029 Oulu, Finland
| | - Pirkko Riipinen
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O.BOX 5000, 90014 Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Psychiatry, Oulu University Hospital, Oulu, P.O.BOX 26, 90029 Oulu, Finland
| |
Collapse
|
4
|
Visted E, Sørensen L, Vøllestad J, Osnes B, Svendsen JL, Jentschke S, Binder PE, Schanche E. The Association Between Juvenile Onset of Depression and Emotion Regulation Difficulties. Front Psychol 2019; 10:2262. [PMID: 31695636 PMCID: PMC6816416 DOI: 10.3389/fpsyg.2019.02262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023] Open
Abstract
Juvenile onset of Major Depressive Disorder (MDD) is associated with increased likelihood of recurrent episodes of depression and more detrimental clinical trajectories. The aim of the current study was to investigate the effect of juvenile onset of MDD on emotion regulation as measured by self-report and Heart Rate Variability (HRV). Furthermore, we wanted to assess whether juvenile onset impacted the association between rumination and depressive symptoms. Sixty-four individuals with at least three prior episodes of MDD were recruited and filled out self-report questionnaires measuring rumination and emotion regulation abilities. In addition, electrocardiographic assessments were used to calculate HRV. Based on self-reported age of MDD onset, individuals were divided in two groups: Juvenile onset of MDD (first MDD episode before the age of 18, n = 30) and adult onset of MDD (first MDD episode after the age of 18, n = 34). Results showed that individuals whose first depressive episode occurred in childhood and adolescence reported more rumination and less emotional clarity compared to individuals who had their first episode of MDD in adulthood. Moreover, the tendency to ruminate was strongly associated with depressive symptoms in the juvenile onset of MDD group, whereas no such association was found in the adult onset group. There was no significant group difference for HRV. The findings are discussed in light of existing literature, in addition to suggesting how our findings may inform clinical practice and future research. We conclude that juvenile onset of MDD may lead to difficulties in emotion regulation and that these difficulties may increase depressive symptoms and vulnerability for relapse in this particular subgroup.
Collapse
Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Center (DPS), Nesttun, Norway
| | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Julie Lillebostad Svendsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | |
Collapse
|
5
|
Matos AP, Pinheiro MDR, Costa JJ, do Céu Salvador M, Arnarson EÖ, Craighead WE. Prevention of Initial Depressive Disorders Among at-Risk Portuguese Adolescents. Behav Ther 2019; 50:743-754. [PMID: 31208684 DOI: 10.1016/j.beth.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
This study evaluated whether Arnarson and Craighead's (2009, 2011) developmentally based behavioral and cognitive program that prevented the initial episode of depressive disorders among Icelandic adolescents could be adapted to prevent depressive disorders among "at-risk" Portuguese adolescents. One hundred sixty-eight Portuguese mid-adolescents (primarily 14 to 15 years old), who had subsyndromal symptoms of depression but who had never met criteria for a depressive disorder, were identified by classroom screening with the CDI and subsequent K-SADS-PL interview. All 168 adolescents were offered participation in the 14-week prevention program; 70 agreed to participate in the program, and 98 agreed to participate only in an assessment control group. Psychological disorders were evaluated at baseline, 6-, 12-, 18-, and 24-month assessments. During the 2-year follow-up period, 12 students in the assessment-only group experienced an initial depressive disorder versus 2 in the prevention group. Survival analyses indicated a significantly lower rate of initial episodes of depressive disorders, χ2(1) = 4.261, p = .039, among the prevention group participants compared to the assessment only comparison group. The hazard ratio was .207, and the NNT was 11. Survival analyses indicated no significant differences between the prevention condition and the assessment only condition in the occurrence of other psychiatric disorders, χ2(1) = 1.080, p =.299. The findings indicate the program can be successfully adapted for use in Portuguese schools, and they provide a preliminary indication that those "at-risk" adolescents who chose to participate in the program, compared to those who chose to participate only in the assessments, developed fewer initial episodes of depressive disorders over the course of 24 months. The program effects were similar to the outcomes of the prior study of this program in Iceland. As in the Icelandic version of the program, its effects appeared to be specific to the depressive disorders for which the program was designed.
Collapse
|
6
|
Cohen JR, So FK, Hankin BL, Young JF. Translating Cognitive Vulnerability Theory Into Improved Adolescent Depression Screening: A Receiver Operating Characteristic Approach. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2019; 48:582-595. [PMID: 29368955 PMCID: PMC6060010 DOI: 10.1080/15374416.2017.1416617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Traditionally, screening research tests how well a given symptom inventory can identify a concurrent depressive episode. Although developmental psychopathology could inform screening protocols for a myriad of depression outcomes (e.g., prospective depressive episodes), approaches typically used in research make it difficult to translate these findings. Using a translational analytic approach and multiwave longitudinal study design, we examined how screening for cognitive vulnerabilities (rumination, dysfunctional attitudes, and attributional style) may improve our ability to identify concurrent depressive episodes, prospective depressive episodes, first lifetime episodes of depression, and recurrent major depressive episodes. There were 473 sixth-grade (early adolescents) and ninth-grade (middle adolescents; AgeM = 13.15, AgeSD = 1.62) students who completed baseline self-report cognitive vulnerability and depressive symptom measures. At baseline and every 6 months for 3 years, pediatric depression interviews were completed by the caregiver and youth. A receiver operating characteristic (ROC) approach was utilized to test our aims. Distinct algorithms best forecasted our depression outcomes. Rumination and attributional style emerged as unique and incrementally valid predictors for prospective episodes after controlling for baseline depressive symptoms. Rumination was the only unique predictor for first lifetime depressive episodes. For recurrent major depression, rumination in early adolescence and attributional style in middle adolescence served as incremental predictors beyond baseline depressive symptoms. Proposed cutoffs and diagnostic likelihood ratios are offered for algorithms for each depression outcome. Assessing cognitive vulnerability represents a feasible method to improve depression screening initiatives. Using an ROC-informed approach can help prevention initiatives better leverage the considerable gains made within developmental psychopathology research.
Collapse
Affiliation(s)
- Joseph R Cohen
- a Department of Psychology , University of Illinois at Urbana Champaign
| | - Felix K So
- a Department of Psychology , University of Illinois at Urbana Champaign
| | - Benjamin L Hankin
- a Department of Psychology , University of Illinois at Urbana Champaign
| | - Jami F Young
- b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia
| |
Collapse
|
7
|
Salcedo S, Chen YL, Youngstrom EA, Fristad MA, Gadow KD, Horwitz SM, Frazier TW, Arnold LE, Phillips ML, Birmaher B, Kowatch RA, Findling RL. Diagnostic Efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) Depression Subscale for Identifying Youth Mood Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:832-846. [PMID: 28278596 DOI: 10.1080/15374416.2017.1280807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study examined the diagnostic and clinical utility of the Child and Adolescent Symptom Inventory-4 R (CASI-4 R) Depressive and Dysthymia subscale for detecting mood disorders in youth (ages 6-12; M = 9.37) visiting outpatient mental health clinics. Secondary analyses (N = 700) utilized baseline data from the Longitudinal Assessment of Manic Symptoms study. Semistructured interviews with youth participants and their parents/caregivers determined psychiatric diagnoses. Caregivers and teachers completed the CASI-4 R. CASI-4 R depressive symptom severity and symptom count scores each predicted mood disorder diagnoses. Both caregiver scores (symptom severity and symptom count) of the CASI-4 R subscale significantly identified youth mood disorders (areas under the curve [AUCs] = .78-.79, ps < .001). The symptom severity version showed a small but significant advantage. Teacher symptom severity report did not significantly predict mood disorder diagnosis (AUC = .56, p > .05), whereas the teacher symptom count report corresponded to a small effect size (AUC = .61, p < .05). The CASI-4 R Depression scale showed strong incrememental validity even controlling for the other CASI-4 R scales. Caregiver subscale cutoff scores were calculated to assist in ruling in (diagnostic likelihood ratio [DLR] = 3.73) or ruling out (DLR = 0.18) presence of a mood disorder. The CASI-4 R Depressive subscale caregiver report can help identify youth mood disorders, and using DLRs may help improve diagnostic accuracy.
Collapse
Affiliation(s)
- Stephanie Salcedo
- b Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
| | - Yen-Ling Chen
- a Department of Psychology, University of Nevada, Las Vegas
| | - Eric A Youngstrom
- b Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
| | | | | | - Sarah M Horwitz
- e Department of Child and Adolescent Psychiatry, NYU Langone Medical Center
| | | | | | | | | | - Robert A Kowatch
- h Department of Psychiatry, Ohio State University Medical Center and Nationwide Children's Hospital
| | - Robert L Findling
- i Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Kennedy Krieger Institute
| |
Collapse
|
8
|
Ellis R, Seal ML, Adamson C, Beare R, Simmons JG, Whittle S, Allen NB. Brain connectivity networks and longitudinal trajectories of depression symptoms in adolescence. Psychiatry Res Neuroimaging 2017; 260:62-69. [PMID: 28038362 DOI: 10.1016/j.pscychresns.2016.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022]
Abstract
High levels of depression during adolescence may contribute to the risk for future depression later in life. This study examined the relationship between the developmental timing of depressive symptoms, and brain structural outcomes in late adolescence. In a prior work, we examined longitudinal trajectories of depressive symptoms in 243 adolescents (121 males and 122 females), and identified four subgroups: a normative group with stable low levels of depression, two groups with declining symptoms, and one group with increasing symptoms. For the current paper, diffusion-weighted MRI images were acquired at the final wave of the study, and used to perform white matter tractography and brain network analysis. The four depression trajectory groups were tested for differences in brain connectivity variables. This revealed differences in several frontal and temporal regions. The groups that had experienced elevated depression symptoms in early adolescence differed from the normative group in a greater number of areas than the group who had experienced depression later. Affected tracts corresponded to areas of white matter that are still maturing during this period, particularly frontolimbic regions. These findings support the proposition that the timing and duration of depression symptoms during adolescence are associated with brain structural outcomes.
Collapse
Affiliation(s)
- Rachel Ellis
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Australia.
| | - Marc L Seal
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Christopher Adamson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Richard Beare
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Faculty of Medicine, Monash University, Melbourne, Australia
| | - Julian G Simmons
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Sarah Whittle
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia; Department of Psychology, University of Oregon, Eugene, USA
| |
Collapse
|
9
|
Kovacs M, Obrosky S, George C. The course of major depressive disorder from childhood to young adulthood: Recovery and recurrence in a longitudinal observational study. J Affect Disord 2016; 203:374-381. [PMID: 27347807 PMCID: PMC4975998 DOI: 10.1016/j.jad.2016.05.042] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The episodic nature of major depressive disorder (MDD) in clinically referred adults has been well-characterized, particularly by the NIMH Collaborative Depression Study. Previous work has established that MDD also is episodic prior to adulthood, but no study has yet provided comprehensive information on the actual course of MDD in clinically referred juveniles. Thus, the present investigation sought to characterize recovery, recurrence, and their predictors across multiple episodes of MDD in initially 8- to 13-year-old outpatients (N=102), and to estimate freedom from morbidity ("well-time") across the years. METHOD Clinically referred youngsters with MDD were repeatedly assessed in an observational study across two decades (median follow up length: 15 years). Survival analytic techniques served to model recovery from the 1st, 2nd and 3rd lifetime episodes of MDD, the risk of developing the 2nd, 3rd, and 4th episodes, and the effects of traditional psychosocial and clinical predictors of outcomes. "Well-time" across the follow-up and its predictors also were examined. RESULTS Recovery rates ranged from 96% to 100% across MDD episodes; episode lengths ranged from 6 to 7 months. Up to 72% of those recovered from the first episode of MDD had a further episode; median inter-episode intervals were about 3-5 years. No single demographic, social, or clinical variable, nor treatment, consistently predicted recovery/recurrence. Psychiatric morbidity over time derived mostly from non-affective disorders, which, however, did not alter the course of MDD. LIMITATIONS The sample was relatively small and power to detect small effects further declined with each MDD episode recurrence. CONCLUSIONS Echoing findings on adults, the course of pediatric-onset MDD in this clinical sample was unequivocally episodic. Traditional course predictors had limited temporal stability, highlighting the need to examine novel predictor variables. The ongoing risk of depression episodes into the second and third decades of life suggests that prevention efforts should start in late childhood.
Collapse
Affiliation(s)
- Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | | | | |
Collapse
|
10
|
Liu RT. Taxometric evidence of a dimensional latent structure for depression in an epidemiological sample of children and adolescents. Psychol Med 2016; 46:1265-1275. [PMID: 26744249 PMCID: PMC4958619 DOI: 10.1017/s0033291715002792] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A basic phenomenological question of much theoretical and empirical interest is whether the latent structure of depression is dimensional or categorical in nature. Prior taxometric studies of youth depression have yielded mixed findings. In a step towards resolving these contradictory findings, the current taxometric investigation is the first to utilize a recently developed objective index, the comparison curve fit index, to evaluate the latent structure of major depression in an epidemiological sample of children and adolescents. METHOD Data were derived from Mental Health of Children and Young People in Great Britain surveys. Participants were administered a structured diagnostic interview to assess for current depression. Parents (n = 683) were interviewed for children aged 5-16 years, and child interviews (n = 605) were conducted for those aged 11-16 years. RESULTS MAMBAC (mean above minus below a cut), MAXEIG (maximum eigenvalue) and L-Mode (latent mode) analyses provided convergent support for a dimensional latent structure. CONCLUSIONS The current findings suggest that depression in youth is more accurately conceptualized as a continuous syndrome rather than a discrete diagnostic entity.
Collapse
Affiliation(s)
- R T Liu
- Department of Psychiatry and Human Behavior,Alpert Medical School of Brown University,Bradley Hospital,East Providence,RI,USA
| |
Collapse
|
11
|
Mocking RJT, Figueroa CA, Rive MM, Geugies H, Servaas MN, Assies J, Koeter MWJ, Vaz FM, Wichers M, van Straalen JP, de Raedt R, Bockting CLH, Harmer CJ, Schene AH, Ruhé HG. Vulnerability for new episodes in recurrent major depressive disorder: protocol for the longitudinal DELTA-neuroimaging cohort study. BMJ Open 2016; 6:e009510. [PMID: 26932139 PMCID: PMC4785288 DOI: 10.1136/bmjopen-2015-009510] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is widely prevalent and severely disabling, mainly due to its recurrent nature. A better understanding of the mechanisms underlying MDD-recurrence may help to identify high-risk patients and to improve the preventive treatment they need. MDD-recurrence has been considered from various levels of perspective including symptomatology, affective neuropsychology, brain circuitry and endocrinology/metabolism. However, MDD-recurrence understanding is limited, because these perspectives have been studied mainly in isolation, cross-sectionally in depressed patients. Therefore, we aim at improving MDD-recurrence understanding by studying these four selected perspectives in combination and prospectively during remission. METHODS AND ANALYSIS In a cohort design, we will include 60 remitted, unipolar, unmedicated, recurrent MDD-participants (35-65 years) with ≥ 2 MDD-episodes. At baseline, we will compare the MDD-participants with 40 matched controls. Subsequently, we will follow-up the MDD-participants for 2.5 years while monitoring recurrences. We will invite participants with a recurrence to repeat baseline measurements, together with matched remitted MDD-participants. Measurements include questionnaires, sad mood-induction, lifestyle/diet, 3 T structural (T1-weighted and diffusion tensor imaging) and blood-oxygen-level-dependent functional MRI (fMRI) and MR-spectroscopy. fMRI focusses on resting state, reward/aversive-related learning and emotion regulation. With affective neuropsychological tasks we will test emotional processing. Moreover, we will assess endocrinology (salivary hypothalamic-pituitary-adrenal-axis cortisol and dehydroepiandrosterone-sulfate) and metabolism (metabolomics including polyunsaturated fatty acids), and store blood for, for example, inflammation analyses, genomics and proteomics. Finally, we will perform repeated momentary daily assessments using experience sampling methods at baseline. We will integrate measures to test: (1) differences between MDD-participants and controls; (2) associations of baseline measures with retro/prospective recurrence-rates; and (3) repeated measures changes during follow-up recurrence. This data set will allow us to study different predictors of recurrence in combination. ETHICS AND DISSEMINATION The local ethics committee approved this study (AMC-METC-Nr.:11/050). We will submit results for publication in peer-reviewed journals and presentation at (inter)national scientific meetings. TRIAL REGISTRATION NUMBER NTR3768.
Collapse
Affiliation(s)
- Roel J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Caroline A Figueroa
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maria M Rive
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Hanneke Geugies
- University of Groningen, Neuroimaging Center, University Medical Center Groningen, The Netherlands
- Program for Mood and Anxiety Disorders, Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Michelle N Servaas
- University of Groningen, Neuroimaging Center, University Medical Center Groningen, The Netherlands
- Program for Mood and Anxiety Disorders, Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johanna Assies
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maarten W J Koeter
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Disease, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Marieke Wichers
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, The Netherlands
| | - Jan P van Straalen
- Laboratory of General Clinical Chemistry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Rudi de Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Claudi L H Bockting
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Aart H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
- University of Groningen, Neuroimaging Center, University Medical Center Groningen, The Netherlands
- Program for Mood and Anxiety Disorders, Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, The Netherlands
| |
Collapse
|
12
|
Gadassi R, Mor N. Confusing acceptance and mere politeness: Depression and sensitivity to Duchenne smiles. J Behav Ther Exp Psychiatry 2016; 50:8-14. [PMID: 25958338 DOI: 10.1016/j.jbtep.2015.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 04/19/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Whereas the association between depression and the perception of emotions has been widely studied, only few studies have examined the association between depression and the ability to discriminate genuine (Duchenne) from fake (non-Duchenne) smiles. The present study examined this by comparing currently depressed, previously depressed, and healthy control individuals. Guided by recent theory, the present study also investigated the effect of depression recurrence on smile identification. METHODS Participants were 27 healthy controls, 33 with past depression (51% with recurrent depression), and 22 with current depression (77% with recurrent depression). Participants were presented with a series of 20 videos depicting smiling individuals, and were asked to indicate whether each smile was genuine or fake. RESULTS Having (or having had) a first episode of depression was associated with more mistakes in categorizing smiles as genuine or fake compared to having recurrent depression or to having no history of depression. LIMITATIONS Cross sectional design and a (relatively) small sample size. CONCLUSIONS Our results show that an impaired ability to differentiate between markers of affiliation and politeness is specific to first-episode depression, even after the depression has remitted.
Collapse
Affiliation(s)
| | - Nilly Mor
- The Hebrew University of Jerusalem, Israel.
| |
Collapse
|
13
|
Klein DN, Kotov R. Course of depression in a 10-year prospective study: Evidence for qualitatively distinct subgroups. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:337-48. [PMID: 26845258 DOI: 10.1037/abn0000147] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The course of depressive disorders can vary considerable, with some individuals exhibiting a chronic course and poor outcomes, while others have a more episodic course and better outcomes. However, it is unclear whether degree of chronicity is continuous or reflects qualitatively distinct subgroups. Using data from a 5-wave, 10-year, naturalistic study of 127 depressed outpatients, we examined whether depression chronicity lies on a continuum or manifests natural boundaries. Spline regression was used to test 7 continuous and discontinuous models of the relationship between depression during the first follow-up interval and multiple outcomes at subsequent follow-ups. In order to further validate the findings, we also created empirically derived subgroups based on the results of the spline regression analyses and compared them on baseline clinical characteristics and long-term outcomes. There was a clear and consistent discontinuity indicating that for higher levels of chronicity during the first 30-month period, depression was linearly related to outcome; in contrast, for lower levels of chronicity, depression in the initial interval was unrelated to subsequent outcomes. The findings were strikingly consistent across the 4 follow-up evaluations using multiple outcomes and goodness-of-fit indices. In addition, the chronic group--as defined by the first follow-up period--exhibited more baseline chronic depression, anxiety and personality disorders, family history of dysthymia, and childhood adversity, and was more likely to attempt suicide and be hospitalized during follow-up, than the nonchronic group. Results suggest that there are qualitatively distinct classes of patients with more and less chronic depressions, and support the utility of longitudinal course as a means of parsing depression into more homogeneous subgroups.
Collapse
Affiliation(s)
| | - Roman Kotov
- Department of Psychology, Stony Brook University
| |
Collapse
|
14
|
Klein DN, Hajcak G. Heterogeneity of Depression: Clinical Considerations and Psychophysiological Measures. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.1032873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
15
|
Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent course? Dev Psychopathol 2015; 26:1477-93. [PMID: 25422974 DOI: 10.1017/s0954579414001151] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Premorbid risk for major depressive disorder (MDD) and predictors of an earlier onset and recurrent course were examined in two studies in a large, community-based sample of parents and offspring, prospectively assessed from late childhood into adulthood. In Study 1 (N = 2,764 offspring and their parents), parental psychiatric status, offspring personality at age 11, and age 11 offspring internalizing and externalizing symptoms predicted the subsequent development of MDD, as did poor quality parent-child relationships, poor academic functioning, early pubertal development, and childhood maltreatment by age 11. Parental MDD and adult antisocial behavior, offspring negative emotionality and disconstraint, externalizing symptoms, and childhood maltreatment predicted an earlier onset of MDD, after accounting for course; lower positive emotionality, trait anxiety, and childhood maltreatment predicted recurrent MDD, after accounting for age of onset. In Study 2 (N = 7,146), we examined molecular genetic risk for MDD by extending recent reports of associations with glutamatergic system genes. We failed to confirm associations with MDD using either individual single nucleotide polymorphism based tests or gene-based analyses. Overall, results speak to the pervasiveness of risk for MDD, as well as specific risk for early onset MDD; risk for recurrent MDD appears to be largely a function of its often earlier onset.
Collapse
|
16
|
Hill RM, Yaroslavsky I, Pettit JW. Enhancing depression screening to identify college students at risk for persistent depressive symptoms. J Affect Disord 2015; 174:1-6. [PMID: 25437632 DOI: 10.1016/j.jad.2014.11.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Depressive symptoms in college students are prevalent and are associated with considerable academic impairment. Many universities have implemented depressive symptom screening programs and the number of students identified as in need of services following screening greatly exceeds available mental health resources. The present study sought to refine depressive symptom screening programs by identifying predictors of a persistent course of depressive symptoms and developing cut-scores for accurately identifying students who will experience a persistent symptom course. METHOD Students (n=262) who reported elevated depressive symptoms both an initial screening and baseline assessment (n=150) were invited to participate in telephone-based follow-up assessments 4, 8, and 12 months post-baseline. RESULTS Two depressive symptom courses were identified: a persistently elevated depressive symptoms course and a decreasing depressive symptoms course. Baseline social disconnection and negative feedback-seeking both significantly predicted membership in the persistently elevated depressive symptoms course. Cut-scores that robustly discriminated between the two symptom courses were identified. LIMITATIONS The present sample was predominantly female and Hispanic; the four-month spacing of assessments may have resulted in a failure to identify individuals who experience brief, yet impairing, recurrent depressive episodes. CONCLUSION These findings can inform approaches to identifying college students most in need of mental health services for depressive symptoms based on the presence of social disconnection and/or negative feedback-seeking. Screening cut-points on social disconnection and negative feedback-seeking measures can reduce the number of cases identified as needing mental health services while retaining the majority of cases who will experience a persistent depressive symptom course.
Collapse
Affiliation(s)
- Ryan M Hill
- Department of Psychology, Florida International University, United States.
| | - Ilya Yaroslavsky
- Department of Psychology, Cleveland State University, United States
| | - Jeremy W Pettit
- Department of Psychology, Florida International University, United States
| |
Collapse
|
17
|
Batmaz S, Kaymak SU, Kocbiyik S, Turkcapar MH. From the First Episode to Recurrences: The Role of Automatic Thoughts and Dysfunctional Attitudes in Major Depressive Disorder. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.1.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
18
|
Wilson S, Hicks BM, Foster KT, McGue M, Iacono WG. Age of onset and course of major depressive disorder: associations with psychosocial functioning outcomes in adulthood. Psychol Med 2015; 45:505-514. [PMID: 25007761 PMCID: PMC4289461 DOI: 10.1017/s0033291714001640] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) that onsets by adolescence is associated with various deficits in psychosocial functioning. However, adolescent-onset MDD often follows a recurrent course that may drive its associated impairment. METHOD To tease apart these two clinical features, we examined the relative associations of age of onset (adolescent versus adult) and course (recurrent versus single episodes) of MDD with a broad range of psychosocial functioning outcomes assessed in early adulthood. Participants comprised a large, population-based sample of male and female twins from the Minnesota Twin Family Study (MTFS; n = 1252) assessed prospectively from ages 17 to 29 years. RESULTS A recurrent course of MDD predicted impairment in several psychosocial domains in adulthood, regardless of whether the onset was in adolescence or adulthood. By contrast, adolescent-onset MDD showed less evidence of impairment in adulthood after accounting for recurrence. Individuals with both an adolescent onset and recurrent episodes of MDD represented a particularly severe group with pervasive psychosocial impairment in adulthood. CONCLUSIONS The negative implications of adolescent-onset MDD for psychosocial functioning in adulthood seem to be due primarily to its frequently recurrent course, rather than its early onset, per se. The results highlight the importance of considering both age of onset and course for understanding MDD and its implications for functioning, and also in guiding targeted intervention efforts.
Collapse
Affiliation(s)
- S Wilson
- Department of Psychology,University of Minnesota,Minneapolis, MN,USA
| | - B M Hicks
- Department of Psychiatry,University of Michigan,Ann Arbor, MI,USA
| | - K T Foster
- Departments of Psychiatry and Psychology,University of Michigan,Ann Arbor, MI,USA
| | - M McGue
- Department of Psychology,University of Minnesota,Minneapolis, MN,USA
| | - W G Iacono
- Department of Psychology,University of Minnesota,Minneapolis, MN,USA
| |
Collapse
|
19
|
Dubicka B, Brent D. Combined Therapy in Adolescent Depression. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Curry JF. Future Directions in Research on Psychotherapy for Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 43:510-26. [DOI: 10.1080/15374416.2014.904233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|