Validity of the Short Mood and Feelings Questionnaire in late adolescence

It's time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia

PURPOSE

This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14-19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors.

METHODS

This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K' cohort: children aged 4-5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge's g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes).

RESULTS

HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence.

CONCLUSION

Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities.

The association between academic achievement goals and adolescent depressive symptoms: a prospective cohort study in Australia

BACKGROUND

Students define academic competence across two axes: developing skills and understanding (mastery) versus comparisons with peers (performance), and achieving goals (approach) versus avoiding failure (avoidance). We aimed to examine the longitudinal association between achievement goals and adolescent depressive symptoms.

METHODS

We analysed data from the Kindergarten (recruited at age 4-5 years; born between March, 1999, and February, 2000; recruited from March, 2004 to November, 2004) and Baby (recruited at age 0-1 years; born between March, 2003, and February, 2004; recruited from March, 2004 to January, 2005) cohorts of the Longitudinal Study of Australian Children. Participants were identified through the Medicare enrolment database and sampled using a randomised selection stratified by postcode to represent the Australian population. Achievement goals were measured at age 12-13 years with the Achievement Goal Questionnaire (ranges from 1 to 7 on each of the four subscales), and depressive symptoms with the Short Mood and Feelings Questionnaire (score ranges from 0 to 26, with higher scores indicating more severe symptoms) at ages 14-15 years (both cohorts) and 16-17 years (Kindergarten cohort only). Analyses were linear multilevel and traditional regressions, with confounder adjustment, for participants with available data on the exposures, confounders, and outcome.

FINDINGS

We included 3200 participants (1585 female and 1615 male) from the Kindergarten cohort and 2671 participants (1310 female and 1361 male) from the Baby cohort. A 1-point increase in mastery-approach goals was associated with decreased depressive symptom severity score (Kindergarten, -0·33 [95% CI -0·52 to -0·15]; Baby, -0·29 [-0·54 to -0·03]), while a 1-point increase in mastery-avoidance goals was associated with increased depressive symptom severity score (Kindergarten, 0·35 [95% CI 0·21 to 0·48]; Baby, 0·44 [0·25 to 0·64]). A 1-point increase in performance-avoidance goals was associated with increased depressive symptom severity score in the Kindergarten cohort but not the Baby cohort (Kindergarten, 0·26 [95% CI 0·11 to 0·41]; Baby, -0·04 [-0·27 to 0·19]). We found little evidence of an association between depressive symptom severity and performance-approach goals.

INTERPRETATION

Depressive symptoms in adolescents were associated with their achievement goals, which could be targetable risk factors for future trials to investigate whether school-based interventions that aim to enhance factors consistent with mastery goals (ie, learning skills and understanding the subject, rather than assessing competence in comparison to peers) could prevent depression in adolescents.

FUNDING

Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society.

Longitudinal Change in Appearance-Related Social Media Consciousness and Depressive Symptoms: A Within-Person Analysis during Early-to-Middle Adolescence

Online appearance preoccupation may put adolescents at risk of developing mental health challenges, perhaps especially during early-to-middle adolescence. A random intercept cross-lagged panel model assessed within-person associations between appearance-related social media consciousness and depressive symptoms over three time-points with three months between waves. The sample (n = 1594) included U.S. adolescents aged 11-15 (Mage = 13; 47% girls, 46% boys, 7% another gender; 37% Latine, 33% White, 18% Black, 7% Asian). Within-person increases in appearance-related social media consciousness were associated with subsequent increases in depressive symptoms, but not vice versa. There was no evidence of gender differences and results were robust to controlling for both time on social media and offline self-objectification. Thus, online appearance concerns precede mental health challenges during early and middle adolescence.

The association between sexual orientation and psychotic like experiences during adolescence: a prospective cohort study

PURPOSE

Psychotic like experiences (PLEs) are relatively common during adolescence and associated with a range of negative outcomes. There is evidence that sexual minorities are at increased risk of mental health problems including depression, anxiety, self-harm and suicidality. However, no study has investigated the association between sexual orientation and psychotic experiences during adolescence. We compared trajectories of PLEs in sexual minority and heterosexual adolescents from 12 to 24 years of age.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants provided data on sexual orientation at age 16 and PLEs at ages 12, 17 and 24. We used multi-level logistic regression models to test associations between sexual orientation and PLEs, before and after adjusting for covariates. We investigated whether the association differed according to time-point and sex using interaction terms.

RESULTS

We found evidence that the odds of PLEs were 2.35 times (95% Confidence Interval 1.79-3.06, p < 0.0001) higher among sexual minority compared with heterosexual adolescents, across all ages, after adjusting for covariates. There was no evidence that the association between sexual orientation and PLEs differed according to time-point (p = 0.50) or sex (p = 0.29).

CONCLUSION

We found an increased risk of psychosis in sexual minorities compared with heterosexuals, which was present from around 12 years of age and persisted until age 24. Early interventions to prevent this mental health inequality could include universal interventions to promote inclusivity and acceptance of diverse sexual orientations.

Genetic Architectures of Adolescent Depression Trajectories in 2 Longitudinal Population Cohorts

Importance

Adolescent depression is characterized by diverse symptom trajectories over time and has a strong genetic influence. Research has determined genetic overlap between depression and other psychiatric conditions; investigating the shared genetic architecture of heterogeneous depression trajectories is crucial for understanding disease etiology, prediction, and early intervention.

Objective

To investigate univariate and multivariate genetic risk for adolescent depression trajectories and assess generalizability across ancestries.

Design, Setting, and Participants

This cohort study entailed longitudinal growth modeling followed by polygenic risk score (PRS) association testing for individual and multitrait genetic models. Two longitudinal cohorts from the US and UK were used: the Adolescent Brain and Cognitive Development (ABCD; N = 11 876) study and the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 8787) study. Included were adolescents with genetic information and depression measures at up to 8 and 4 occasions, respectively. Study data were analyzed January to July 2023.

Main Outcomes and Measures

Trajectories were derived from growth mixture modeling of longitudinal depression symptoms. PRSs were computed for depression, anxiety, neuroticism, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, and autism in European ancestry. Genomic structural equation modeling was used to build multitrait genetic models of psychopathology followed by multitrait PRS. Depression PRSs were computed in African, East Asian, and Hispanic ancestries in the ABCD cohort only. Association testing was performed between all PRSs and trajectories for both cohorts.

Results

A total sample size of 14 112 adolescents (at baseline: mean [SD] age, 10.5 [0.5] years; 7269 male sex [52%]) from both cohorts were included in this analysis. Distinct depression trajectories (stable low, adolescent persistent, increasing, and decreasing) were replicated in the ALSPAC cohort (6096 participants; 3091 female [51%]) and ABCD cohort (8016 participants; 4274 male [53%]) between ages 10 and 17 years. Most univariate PRSs showed significant uniform associations with persistent trajectories, but fewer were significantly associated with intermediate (increasing and decreasing) trajectories. Multitrait PRSs-derived from a hierarchical factor model-showed the strongest associations for persistent trajectories (ABCD cohort: OR, 1.46; 95% CI, 1.26-1.68; ALSPAC cohort: OR, 1.34; 95% CI, 1.20-1.49), surpassing the effect size of univariate PRS in both cohorts. Multitrait PRSs were associated with intermediate trajectories but to a lesser extent (ABCD cohort: hierarchical increasing, OR, 1.27; 95% CI, 1.13-1.43; decreasing, OR, 1.23; 95% CI, 1.09-1.40; ALSPAC cohort: hierarchical increasing, OR, 1.16; 95% CI, 1.04-1.28; decreasing, OR, 1.32; 95% CI, 1.18-1.47). Transancestral genetic risk for depression showed no evidence for association with trajectories.

Conclusions and Relevance

Results of this cohort study revealed a high multitrait genetic loading of persistent symptom trajectories, consistent across traits and cohorts. Variability in univariate genetic association with intermediate trajectories may stem from environmental factors. Multitrait genetics may strengthen depression prediction models, but more diverse data are needed for generalizability.

Testing the interpersonal theory of suicide in adolescents: A multi-wave longitudinal study

BACKGROUND

Suicide is a major public health crisis among youth. Several prominent theories, including the Interpersonal Theory of Suicide (IPTS), aim to characterize the factors leading from suicide ideation to action. These theories are largely based on findings in adults and require testing and elaboration in adolescents.

METHODS

Data were examined from high-risk 13-18-year-old adolescents (N = 167) participating in a multi-wave, longitudinal study; 63% of the sample exhibited current suicidal thoughts or recent behaviors (n = 105). The study included a 6-month follow-up period with clinical interviews and self-report measures at each of the four assessments as well as weekly smartphone-based assessments of suicidal thoughts and behaviors. Regression and structural equation models were used to probe hypotheses related to the core tenets of the IPTS.

RESULTS

Feelings of perceived burdensomeness were associated with more severe self-reported suicidal ideation (b = 0.58, t(158) = 7.64, p < .001). Similarly, burdensomeness was associated with more frequent ideation based on weekly smartphone ratings (b = 0.11, t(1460) = 3.41, p < .001). Contrary to IPTS hypotheses, neither feelings of thwarted belongingness, nor interactions between burdensomeness and thwarted belongingness were significantly associated with ideation (ps > .05). Only elevated depression severity was associated with greater odds of suicide events (i.e., suicide attempts, psychiatric hospitalizations, and/or emergency department visits for suicide concerns) during the follow-up period (OR = 1.83, t(158) = 2.44, p = .01). No effect of acquired capability was found.

CONCLUSIONS

Perceptions of burdensomeness to others reflect a critical risk factor for suicidal ideation among high-risk adolescents. Null findings with other IPTS constructs may suggest a need to adopt more developmentally sensitive models or measures of interpersonal and acquired capability risk factors for youth. Refining methods and theoretical models of suicide risk may help improve the identification of high-risk cases and inform clinical intervention.

Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm

To evaluate the effect of ADHD diagnosis by the age of 10 on the suicide/self-harm risk at age 14 and examine factors that may modify/mediate the association, a longitudinal study based on the nationwide survey consisting of 5,107 children in Australia was used. Self-harm and suicidal risks in children with ADHD at age 14 were the main outcomes; ADHD medication, history of bullied or depression, and other sociodemographic disadvantages, were treated as covariates. The diagnosis of ADHD at age 10 is associated with elevated risks of self-harm, suicidal thoughts, planning, or attempts by age 14, with greater susceptibility in males. The pathway from ADHD symptoms to suicide/self-harm could also be mediated by depression and exposure to bullying assessed at age 12. Note that depression and exposure to bullying might at best contribute to less than 10 % of the total effect of ADHD diagnosis on either the risk of suicide or self-harm. Early gender-tailored intervention and prevention strategies are crucial in clinical practice and health policy.

How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children

This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.Data were analyzed from 3089 children followed between Waves 1 (age 4-5 years) and 7 (16-17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16-17. Anxiety and depressive symptoms were measured using the Children's Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16-17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35-56) and 21% of depressive symptoms (95% CI: 12-29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11-25%) of anxiety and 15% (95% CI: 4-25%) of depressive symptoms at age 16-17 years were attributable to parental psychological distress experienced between the ages of 4-15 years.The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.

Neuron enriched extracellular vesicles' MicroRNA expression profiles as a marker of early life alcohol consumption

Alcohol consumption may impact and shape brain development through perturbed biological pathways and impaired molecular functions. We investigated the relationship between alcohol consumption rates and neuron-enriched extracellular vesicles' (EVs') microRNA (miRNA) expression to better understand the impact of alcohol use on early life brain biology. Neuron-enriched EVs' miRNA expression was measured from plasma samples collected from young people using a commercially available microarray platform while alcohol consumption was measured using the Alcohol Use Disorders Identification Test. Linear regression and network analyses were used to identify significantly differentially expressed miRNAs and to characterize the implicated biological pathways, respectively. Compared to alcohol naïve controls, young people reporting high alcohol consumption exhibited significantly higher expression of three neuron-enriched EVs' miRNAs including miR-30a-5p, miR-194-5p, and miR-339-3p, although only miR-30a-5p and miR-194-5p survived multiple test correction. The miRNA-miRNA interaction network inferred by a network inference algorithm did not detect any differentially expressed miRNAs with a high cutoff on edge scores. However, when the cutoff of the algorithm was reduced, five miRNAs were identified as interacting with miR-194-5p and miR-30a-5p. These seven miRNAs were associated with 25 biological functions; miR-194-5p was the most highly connected node and was highly correlated with the other miRNAs in this cluster. Our observed association between neuron-enriched EVs' miRNAs and alcohol consumption concurs with results from experimental animal models of alcohol use and suggests that high rates of alcohol consumption during the adolescent/young adult years may impact brain functioning and development by modulating miRNA expression.

Do adolescents use choice to learn about their preferences? Development of value refinement and its associations with depressive symptoms in adolescence

Independent decision making requires forming stable estimates of one's preferences. We assessed whether adolescents learn about their preferences through choice deliberation and whether depressive symptoms disrupt this process. Adolescents aged 11-18 (N = 214; participated 2021-22; Female: 53.9%; White/Black/Asian/Mixed/Arab or Latin American: 26/21/19/9/8%) rated multiple activities, chose between pairs of activities and re-rated those activities. As expected, overall, participants uprated chosen and downrated unchosen activities (dz = .20). This value refinement through choice was not evident in younger participants but emerged across adolescence. Contrary to our predictions, depressive symptoms were associated with greater value refinement. Despite this, more depressed adolescents reported lower value certainty and choice confidence. The cognitive processes through which choice deliberation shapes preference develop over adolescence, and are disrupted in depression.

The genetic architecture of youth anxiety: a study protocol

BACKGROUND

Anxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care.

METHODS

The Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10-19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span.

DISCUSSION

Results will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.

Mental ill-health and substance use among sexuality diverse adolescents: The critical role of school climate and teacher self-efficacy

INTRODUCTION

Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents' mental health is also unclear, as well as the role of teachers in conferring this benefit.

METHOD

Using Wave 8 'B Cohort' data from the Longitudinal Study of Australian children (N = 3127, Mage = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents' mental health.

RESULTS

Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%.

DISCUSSION

Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these.

Mental health problems and suicidal behavior from adolescence to young adulthood in college: linking two population-based studies

It is well established that mental health problems are highly recurrent and persistent from childhood to adolescence, but less is known to what extent mental health problems also persist from adolescence into young adulthood. The aim of the current study was therefore to examine the chronicity and risk of mental health problems and suicidality from adolescence to young adulthood. Data stem from two Norwegian population-based studies conducted 6 years apart; the youth@hordaland study from 2012 (age 16-19) and the SHoT2018 study (age 22-25). These two data sources were linked to produce a longitudinal sample of 1257 individuals. A wide range of self-reported mental health and suicidality instruments (used both continuously and categorically) were analyzed using log-link binomial regression analysis, adjusting for age, sex, parental education, and financial problems. We found that high levels of mental health problems in late adolescence were a significant risk factor for reporting poor mental health 6 years later. Internalizing and externalizing problems in adolescence were associated with a 2.8-fold and 1.9-fold increased risk, respectively, of reporting a mental disorder 6 years later. Similarly, self-harm in adolescence was associated with a 2.1-fold increased risk of suicidal thoughts 6 years later. The magnitudes of the adjusted risk ratios were generally similar across the various mental health and suicidality measures used at the two assessment points. Adjustment for confounders did not, or only slightly, attenuate the risk ratios, and all associations remained statistically significant in the adjusted analyses. This longitudinal study provides new evidence of the chronicity of mental health problems and suicidality from adolescence to adulthood in Norway. The results emphasize the importance of early identification and timely interventions to reduce the prevalence and impact of mental health problems and suicidality.

Emotional problems and peer victimization in adolescents born very preterm and full-term: Role of self-control skills in childhood

The aim of the current study was to examine whether self-control skills in childhood moderate the association between very preterm birth (<32 weeks of gestational age) and emotional problems and peer victimization in adolescence. We used data from four prospective cohort studies, which included 29,378 participants in total (N = 645 very preterm; N = 28,733 full-term). Self-control was mother-reported in childhood at 5-11 years whereas emotional problems and peer victimization were both self- and mother-reported at 12-17 years of age. Findings of individual participant data meta-analysis showed that self-control skills in childhood do not moderate the association between very preterm birth and adolescence emotional problems and peer victimization. It was shown that higher self-control skills in childhood predict lower emotional problems and peer victimization in adolescence similarly in very preterm and full-term borns.

Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study

BACKGROUND

Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings.

METHODS

We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables.

RESULTS

Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase.

CONCLUSION

Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.

Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning

Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.

Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood?

BACKGROUND

Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health.

METHODS

We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years).

RESULTS

For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation.

CONCLUSIONS

Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.

Changes in Early Childhood Irritability and Its Association With Depressive Symptoms and Self-Harm During Adolescence in a Nationally Representative United Kingdom Birth Cohort

OBJECTIVE

This study aimed to investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years.

METHOD

We used data from 7,225 children in a UK-based general population birth cohort. Childhood irritability was measured at 3, 5, and 7 years using 4 items from 2 questionnaires (the Children's Social Behaviour Questionnaire [CSBQ] and the Strengths and Difficulties Questionnaire [SDQ]). Participants reported depressive symptoms via the short Mood and Feelings Questionnaire (sMFQ) and self-harm via a single-item question, at 14 years. We used multilevel models to calculate within-child change in irritability between 3 and 7 years and examined associations between irritability, and depressive symptoms and self-harm at 14 years using linear and logistic regression models, respectively. We adjusted for child and family sociodemographic/economic characteristics, mental health difficulties, and child cognitive development.

RESULTS

Irritability at ages 5 and 7 years was positively associated with depressive symptoms and self-harm at age 14 years. Irritability that remained high between 3 and 7 years was associated with depressive symptoms and self-harm at 14 years in unadjusted (depressive symptoms: β coefficient = 0.22, 95 % CI = 0.08-0.37, p = .003; self-harm: odds ratio = 1.09, 95 % CI = 1.01-1.16, p = .019) and adjusted models (depressive symptoms: β coefficient = 0.31, 95 % CI = 0.17-0.45, p < .001; self-harm: odds ratio = 1.12, 95 % CI = 1.0.4-1.19, p = .004). Results were similar in imputed samples.

CONCLUSION

Children with irritability that remains high between 3 and 7 years are more likely to report higher depressive symptoms and self-harm during adolescence. These findings support early intervention for children with high irritability and universal interventions in managing irritability for parents of preschool-aged children.

Early-life socioeconomic circumstances and the comorbidity of depression and overweight in adolescence and young adulthood: A prospective study

Depression and overweight both often emerge early in life and have been found to be associated, but few studies examine depression-overweight comorbidity and its social patterning early in the life course. Drawing on data from 4,948 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort from the UK (2,798 female, 2,150 male), we investigated how different aspects of early-life socioeconomic circumstances are associated with depression-overweight comorbidity from adolescence to young adulthood exploring any differences by age and sex. We estimated how parental education, social class and financial difficulties reported in pregnancy were associated with depression and overweight, and their comorbidity at approximately the ages 17 and 24 in males and females. The results from multinomial logistic regression models showed that all three socioeconomic markers were associated with depression-overweight comorbidity and results were similar across age. Lower parental education (relative risk ratio (RRR) and 95% confidence interval (CI) of low education v high education: 3.61 (2.30-5.67) in females and 1.54 (1.14-2.07) in males) and social class (class IV/V v class I: 5.67 (2.48-12.94) in females and 3.11 (0.70-13.91) in males) had strong associations with comorbidity at age 17 relative to having neither depression or overweight. Financial difficulties were also a risk factor in females, with less clear results in males. These findings highlight how early socioeconomic circumstances are linked with the accumulation of mental and physical health problems already in adolescence, which has implications for life-long health inequalities.

Trajectories of Child Cognitive and Socioemotional Development and Associations with Adolescent Health in the UK Millennium Cohort Study

OBJECTIVE

To identify and describe distinct trajectories of cognitive and socioemotional development during childhood and to examine their relationships with adolescent health.

STUDY DESIGN

We used group-based multitrajectory modeling applied to longitudinal data on 11 564 children up to age 14 years from the UK Millennium Cohort study to identify trajectories of cognitive and socioemotional development measured using validated instruments. We assessed associations between the derived trajectories and baseline socioeconomic, parental, and school factors using multinomial regression. Logistic regression was used to assess associations between trajectory groups and adolescent health at age 14 and 17 years.

RESULTS

Four child development trajectories were identified: "no problems" (76.5%); "late socio-emotional problems" (10.1%); "early cognitive and socioemotional problems" (8.6%); and "persistent cognitive and socioemotional problems" (4.8%). Those in the problem trajectories were more socioeconomically disadvantaged. Compared with the "no problem" trajectory, the "late socioemotional problems" trajectory had increased odds of overweight and mental ill-health at age 14 years of 1.50 (95% CI 1.24-1.81) and 2.51 (2.03-3.10), respectively. For the "persistent problems" group, the OR for overweight was 1.41 (1.04-1.91), and for mental ill-health, 3.01 (2.10-3.30). For both groups, the associations persisted to age 17 years.

CONCLUSIONS

In a representative UK cohort, groups of distinct trajectories of cognitive and socioemotional development were identified. Adverse development, if unresolved, can have a negative impact on weight and mental health in adolescence. Socioemotional development was the main driver of the impact on adolescent health and this requires emphasis in child health policy.

Continence Problems and Mental Health in Adolescents from a UK Cohort

BACKGROUND

Adolescents with continence problems experience unique threats to their psychological well-being, but long-term mental health sequelae are unknown.

OBJECTIVE

To examine prospective relationships between incontinence/lower urinary tract symptoms (LUTS) and mental health problems in young people.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study of young people (n = 7332: 3639 males and 3693 females) from a population-based sample was conducted.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We estimated the association between incontinence/LUTS and mental health outcomes using multivariable regression models adjusted for sex, socioeconomic position, developmental level, intelligence quotient, stressful life events, maternal psychopathology, body mass index, and emotional/behavioural problems.

RESULTS AND LIMITATIONS

Daytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder (eg, odds ratio for daytime wetting = 3.01, 95% confidence interval [1.78, 5.09], p < 0.001) and/or higher anxiety scores. There was also evidence of associations with common mental disorder (eg, voiding postponement: 1.88 [1.46, 2.41], p < 0.001), depression (eg, urgency: 1.94 [1.19, 3.14], p = 0.008), depressive symptoms (eg, daytime wetting: 1.70 [1.13, 2.56], p = 0.01), self-harm thoughts (eg, voiding postponement: 1.52 [1.16, 1.99], p = 0.003), and disordered eating (eg, nocturia 1.72 [1.27, 2.34], p = 0.001). We are unable to generalise our results to minority ethnic groups, less affluent populations, and non-UK samples.

CONCLUSIONS

Young people with incontinence/LUTS are at an increased risk of mental health problems. Further research is needed to establish the direction of causality.

PATIENT SUMMARY

We looked at the association between continence problems and mental health outcomes in young people from a large population-based cohort. Young people with continence problems at the age of 14 yr were more likely to suffer from a range of mental health problems at the age of 18 yr, including common mental disorder, depression, anxiety, self-harm thoughts, and disordered eating. Paediatric continence clinics should address the mental health needs of young people and provide clear and effective care pathways to child and adolescent mental health services.

The relationship between timing of onset of menarche and depressive symptoms from adolescence to adulthood

AIMS

Girls who experience an earlier onset of menarche than their peers are at increased risk of depressive symptoms in mid-adolescence, but it is unclear if this association persists into adulthood. This study examines whether longitudinal patterns of depressive symptoms from adolescence to adulthood vary according to timing of menarche.

METHODS

About 4,864 female participants in the UK Avon Longitudinal Study of Parents and Children provided data on age at onset of menarche (assessed in repeated questionnaires from 8 to 17 years) and depressive symptoms across nine time points (13 to 26 years) using the Short Mood and Feelings Questionnaire. We compared patterns of depressive symptoms in girls with 'early' (<11.5 years), 'normative' (11.5 to 13.5 years) and 'late' (≥13.5 years) menarche using a linear spline multilevel growth curve model adjusted for indicators of socioeconomic position, father absence and body mass index.

RESULTS

Early, compared with normative, menarche was associated with higher levels of depressive symptoms at age 14 (imputed adjusted estimated difference = 0.94, 95% confidence interval [CI] = 0.44, 1.45), but the association attenuated at 24 years (0.24 [-0.72, 1.19]). Late menarche, compared with normative, was associated with a lower level of depressive symptoms at age 14 (-0.69 [-1.10, -0.29]), but this association also attenuated at 24 years (-0.15 [-0.92, 0.62]).

CONCLUSIONS

This study did not find a persistent effect of early menarche, compared to normative, on depressive symptoms. However, our findings are consistent with the level of depressive symptoms increasing at the onset of menarche irrespective of timing. The late onset girls 'catch up' with their peers who experience menarche earlier in terms of depressive symptoms. Future studies should continue to assess the impact of timing of menarche further into adulthood.

Glycoprotein acetyls and depression: Testing for directionality and potential causality using longitudinal data and Mendelian randomization analyses

BACKGROUND

Inflammation is associated with depression, but causality remains unclear. We investigated potential causality and direction of effect between inflammation and depression.

METHODS

Using data from the ALSPAC birth cohort (n = 4021; 42.18 % male), we used multivariable regression to investigate bidirectional longitudinal associations of GlycA and depression and depression symptoms, assessed at ages 18y and 24y. We used two-sample Mendelian randomization (MR) to investigate potential causality and directionality. Genetic variants for GlycA were obtained from UK Biobank (UKB) (N = 115,078); for depression from the Psychiatric Genomics Consortium and UKB (N = 500,199); and for depressive symptoms (N = 161,460) from the Social Science Genetic Association Consortium. In addition to the Inverse Variance Weighted method, we used sensitivity analyses to strengthen causal inference. We conducted multivariable MR adjusting for body mass index (BMI) due to known genetic correlation between inflammation, depression and BMI.

RESULTS

In the cohort analysis, after adjusting for potential confounders we found no evidence of associations between GlycA and depression symptoms score or vice versa. We observed an association between GlycA and depression (OR = 1∙18, 95 % CI: 1∙03-1∙36). MR suggested no causal effect of GlycA on depression, but there was a causal effect of depression on GlycA (mean difference in GlycA = 0∙09; 95 % CI: 0∙03-0∙16), which was maintained in some, but not all, sensitivity analyses.

LIMITATIONS

The GWAS sample overlap could incur bias.

CONCLUSION

We found no consistent evidence for an effect of GlycA on depression. There was evidence that depression increases GlycA in the MR analysis, but this may be confounded/mediated by BMI.

Neuron Enriched Exosomal MicroRNA Expression Profiles as a Marker of Early Life Alcohol Consumption

Background

Alcohol consumption may impact and shape brain development through perturbed biological pathways and impaired molecular functions. We investigated the relationship between alcohol consumption rates and neuron-enriched exosomal microRNA (miRNA) expression to better understand the impact of alcohol use on early life brain biology.

Methods

Neuron-enriched exosomal miRNA expression was measured from plasma samples collected from young people using a commercially available microarray platform while alcohol consumption was measured using the Alcohol Use Disorders Identification Test. Linear regression and network analyses were used to identify significantly differentially expressed miRNAs and to characterize the implicated biological pathways, respectively.

Results

Compared to alcohol naïve controls, young people reporting high alcohol consumption exhibited significantly higher expression of four neuron-enriched exosomal miRNAs including miR-30a-5p, miR-194-5p, and miR-339-3p, although only miR-30a-5p and miR-194-5p survived multiple test correction. The miRNA-miRNA interaction network inferred by a network inference algorithm did not detect any differentially expressed miRNAs with a high cutoff on edge scores. However, when the cutoff of the algorithm was reduced, five miRNAs were identified as interacting with miR-194-5p and miR-30a-5p. These seven miRNAs were associated with 25 biological functions; miR-194-5p was the most highly connected node and was highly correlated with the other miRNAs in this cluster.

Conclusions

Our observed association between neuron-enriched exosomal miRNAs and alcohol consumption concurs with results from experimental animal models of alcohol use and suggests that high rates of alcohol consumption during the adolescent/young adult years may impact brain functioning and development by modulating miRNA expression.

Commonly reported negative experiences on social media are associated with poor mental health and well-being among adolescents: results from the "LifeOnSoMe"-study

Introduction

Cyberbullying has been extensively studied and is associated with adverse mental health outcomes in adolescents. However, adolescents may also experience a range of other negative experiences, such as name-calling, threats, exclusion, and unwanted attention or contact from others. Few studies have investigated how adolescents' mental health is affected by these relatively common and less severe types of negative experiences on social media (SOME). To assess the association between mental health outcomes and two aspects of negative experiences on SOME; unwanted attention and negative acts and exclusion.

Methods

This study is based on a survey conducted in 2020/21 consisting of 3,253 Norwegian adolescents (56% female, M_age = 17 years). Eight statements about negative experiences on SOME were asked and combined into two composite measures: "Unwanted attention from others" and "Negative acts and exclusion." Dependent variables in regression models were symptoms of anxiety, symptoms of depression, and mental well-being. Covariates in all models included age, gender, subjective socioeconomic status, and amount of SOME-use.

Results

Both "negative acts and exclusion" and "unwanted attention from others" on SOME were consistently positively associated with self-reported symptoms of depression and anxiety, and negatively associated with mental well-being in both crude and adjusted analysis.

Discussion

The results are indicative of an important relationship between experiencing negative events on SOME, even presumably less severe events, and worse mental health and well-being. Future research should extricate the potential causal relationship between negative experiences on SOME and mental health, as well as exploring potential precipitating and intermediating factors.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders

OBJECTIVE

To enhance the quality of care and clinical outcomes for children and adolescents with major depressive disorder (MDD) and persistent depressive disorder (PDD). The aims are as follows: (1) to summarize empirically based guidance about the psychosocial and psychopharmacologic treatment of MDD and PDD in children and adolescents; and (2) to summarize expert-based guidance about the assessment of these disorders as an integral part of treatment, and the implementation of empirically based treatments for these disorders in clinical practice.

METHOD

Statements about the treatment of MDD and PDD are based upon empirical evidence derived from a critical systematic review of the scientific literature conducted by the Research Triangle Institute International-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center under contract with the Agency for Healthcare Research and Quality (AHRQ). Evidence from meta-analyses published since the AHRQ/RTI-UNC review is also presented to support or refute the AHRQ findings. Guidance about the assessment and clinical implementation of treatments for MDD and PDD is informed by expert opinion and consensus as presented in previously published clinical practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, the DSM-5-TR, and government-affiliated prescription drug information websites.

RESULTS

Psychotherapy (specifically, cognitive-behavioral and interpersonal therapies) and selective serotonin reuptake inhibitor (SSRI) medication have some rigorous (randomized controlled trials, meta-analyses) empirical support as treatment options. Because effective treatment outcomes are predicated in part upon accuracy of the diagnosis, depth of the clinical formulation, and breadth of the treatment plan, comprehensive, evidence-based assessment may enhance evidence-based treatment outcomes.

CONCLUSION

Disproportionate to the magnitude of the problem, there are significant limitations in the quality and quantity of rigorous empirical support for the etiology, assessment, and treatment of depression in children and adolescents. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, the demonstration of convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatment of MDD and PDD is a key research need. Other research priorities include the sequencing and comparative effectiveness of depression treatments, delineation of treatment mediators and moderators, effective approaches to treatment nonresponders and disorder relapse/recurrence, long-term effects and degree of suicide risk with SSRI use, and the discovery of novel pharmacologic or interventional treatments.

School Influences on Adolescent Depression: A 6-Year Longitudinal Study Amongst Catholic, Government and Independent Schools, in Victoria, Australia

This study examined associations between school sector (Government, Catholic or Independent) and depressive symptomology over the secondary school years. Six waves of data collected annually from a representative Australian sample were examined. Multilevel piecewise linear and logistic regression controlling for a variety of demographic variables and protective factors was undertaken. In all sectors, depressive symptomology decreased between 10 and 13 years of age, but significantly increased for girls at age 13. Adolescents in Catholic schools reported significantly fewer symptoms of depression compared to those in Government and Independent schools. Adolescents in Catholic schools were less likely to report clinical levels of depressed mood compared to adolescents in Government schools.

Association of Interparental Violence and Maternal Depression With Depression Among Adolescents at the Population and Individual Level

Importance

Parental intimate partner violence (IPV) and maternal depression are associated with increased risk of depression in children at the population level. However, it is not known whether having information about these experiences can accurately identify individual children at higher risk of depression.

Objective

To examine the extent to which experiencing parental IPV and/or maternal depression before age 12 years is associated with depression at age 18 years at the population and individual level.

Design, Setting, and Participants

This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK population-based birth cohort, which initially recruited pregnant mothers with estimated due dates in 1991 and 1992. Data used in this study were collected from 1991 to 2009. Data analysis was performed from February to March 2022.

Exposures

Mother-reported parental IPV was assessed on 8 occasions (child age, 1-11 years). Maternal depression was assessed via the Edinburgh Postnatal Depression Scale or by the mother taking medication for depression, as reported by the mother on 8 occasions (child age, 2-12 years).

Main Outcomes and Measures

Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) and Clinical Interview Schedule-Revised (CIS-R) when the child was aged 18 years. Binary indicators of a case of depression were derived the cutoff point of 11 points or above for the SMFQ and 12 points or above for the CIS-R.

Results

The study included 5029 children (2862 girls [56.9%]; 2167 boys [43.1%]) with a measure of depressive symptoms at age 18 years. IPV only was associated with a 24% (adjusted risk ratio, 1.24; 95% CI, 0.97-1.59) higher risk of depression at age 18 years, exposure to maternal depression only was associated with a 35% (adjusted risk ratio, 1.35; 95% CI, 1.11-1.64) higher risk, and exposure to both IPV and maternal depression was associated with a 68% (adjusted risk ratio, 1.68; 95% CI, 1.34-2.10) higher risk. At the individual level, the area under the receiver operating characteristic curve was 0.58 (95% CI, 0.55-0.60) for depression according to the SMFQ and 0.59 (95% CI, 0.55-0.62) for the CIS-R, indicating a 58% to 59% probability (ie, 8%-9% above chance) that a random participant with depression at age 18 years had been exposed to IPV and/or maternal depression compared with a random participant who did not have depression.

Conclusions and Relevance

In this cohort study, parental IPV and maternal depression were associated with depression in adolescence at the population level. However, estimation of an individual developing depression in adolescence based only on information about IPV or maternal depression is poor. Screening children for maternal depression and IPV to target interventions to prevent adolescent depression will fail to identify many children who might benefit and may unnecessarily target many others who do not develop depression.

Developmental trajectories of autistic social traits in the general population

BACKGROUND

Autistic people show diverse trajectories of autistic traits over time, a phenomenon labelled 'chronogeneity'. For example, some show a decrease in symptoms, whilst others experience an intensification of difficulties. Autism spectrum disorder (ASD) is a dimensional condition, representing one end of a trait continuum that extends throughout the population. To date, no studies have investigated chronogeneity across the full range of autistic traits. We investigated the nature and clinical significance of autism trait chronogeneity in a large, general population sample.

METHODS

Autistic social/communication traits (ASTs) were measured in the Avon Longitudinal Study of Parents and Children using the Social and Communication Disorders Checklist (SCDC) at ages 7, 10, 13 and 16 (N = 9744). We used Growth Mixture Modelling (GMM) to identify groups defined by their AST trajectories. Measures of ASD diagnosis, sex, IQ and mental health (internalising and externalising) were used to investigate external validity of the derived trajectory groups.

RESULTS

The selected GMM model identified four AST trajectory groups: (i) Persistent High (2.3% of sample), (ii) Persistent Low (83.5%), (iii) Increasing (7.3%) and (iv) Decreasing (6.9%) trajectories. The Increasing group, in which females were a slight majority (53.2%), showed dramatic increases in SCDC scores during adolescence, accompanied by escalating internalising and externalising difficulties. Two-thirds (63.6%) of the Decreasing group were male.

CONCLUSIONS

Clinicians should note that for some young people autism-trait-like social difficulties first emerge during adolescence accompanied by problems with mood, anxiety, conduct and attention. A converse, majority-male group shows decreasing social difficulties during adolescence.

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. Higher levels of SARS-CoV-2 anti-Spike antibodies are known to be associated with increased protection against future SARS-CoV-2 infection. However, variation in antibody levels and risk factors for lower antibody levels following each round of SARS-CoV-2 vaccination have not been explored across a wide range of socio-demographic, SARS-CoV-2 infection and vaccination, and health factors within population-based cohorts.

Methods

Samples were collected from 9361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies and tested for SARS-CoV-2 antibodies. Cross-sectional sampling was undertaken jointly in April-May 2021 (TwinsUK, N=4256; ALSPAC, N=4622), and in TwinsUK only in November 2021-January 2022 (N=3575). Variation in antibody levels after first, second, and third SARS-CoV-2 vaccination with health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables were analysed. Using multivariable logistic regression models, we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables.

Results

Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had threefold greater odds of SARS-CoV-2 infection over the next 6-9 months (OR = 2.9, 95% CI: 1.4, 6.0), compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK 'Shielded Patient List' had consistently greater odds (two- to fourfold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations.

Conclusions

These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies.

Funding

Antibody testing was funded by UK Health Security Agency. The National Core Studies program is funded by COVID-19 Longitudinal Health and Wellbeing - National Core Study (LHW-NCS) HMT/UKRI/MRC ([MC_PC_20030] and [MC_PC_20059]). Related funding was also provided by the NIHR 606 (CONVALESCENCE grant [COV-LT-0009]). TwinsUK is funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation (CDRF), Zoe Ltd and the National Institute for Health Research (NIHR) Clinical Research Network (CRN) and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. The UK Medical Research Council and Wellcome (Grant ref: [217065/Z/19/Z]) and the University of Bristol provide core support for ALSPAC.

Adverse childhood experiences and mental ill-health - obesity comorbidity among British adolescents - A national cohort study

Background

Mental ill-health and obesity are increasingly prevalent in childhood with both conditions likely to co-occur. Less is known about associations between adverse childhood experiences (ACEs) and mental ill-health and obesity (MH-OB) comorbidity in adolescence. The aim of this study was to examine associations between ACEs and MH-OB comorbidity in adolescents from a national cohort study.

Methods

Participants; 10,734 adolescents (males = 50.3%) from the Millennium Cohort Study with 6 ACEs (for e.g., parental MH, drug/alcohol misuse, physical punishment) collected prospectively between ages 3-11 years. MH-OB comorbidity (binary indicator) was based on objectively measured BMI (for overweight/obesity) and self-reported depression/anxiety at ages 14 and 17. Associations between: 1.total ACE scores (0, 1, 2 or ≥3) and additionally each individual ACE, and MH-OB, were analysed used logistic regression, separately at 14 and 17 years.

Results

At age 14, ACE scores were associated with higher odds for MH-OB comorbidity, with a gradient of increasing odds ratios (OR) with increasing ACEs. Individuals with 1 (OR:1.22[95%CI: 1.1-1.6]), 2 (OR:1.7[1.3-2.3]), or ≥3ACEs (OR:2[1.5-2.6]) had increased odds for MH-OB comorbidity compared to those with 0 ACEs. At age 17, associations between ACE scores and MH-OB were attenuated and observed in individuals with ≥3ACEs (OR:1.54, 1.1-2.3). Parental MH (OR:1.5, 1.2-1.9), intimate-partner violence (OR:1.2, 1.1-1.6), physical punishment (OR:1.3, 1.1-1.6), bullying (OR:2, 1.6-2.5) were associated with MH-OB comorbidity age 14. However, only parental MH (OR:1.5, 1.1-2.1) and bullying (OR:1.6, 1.2-2.1) were associated with MH-OB comorbidity at age 17.

Conclusion

ACEs are associated with increased risk of MH-OB comorbidity in between ages 14 and 17. These findings provide timely opportunity for interventions to reduce risk and are pertinent given that MH and obesity contribute significantly to global burden of disease and track across the lifecourse.

Early-life inflammatory markers and subsequent psychotic and depressive episodes between 10 to 28 years of age

Inflammation is implicated in depression and psychosis, including association of childhood inflammatory markers on the subsequent risk of developing symptoms. However, it is unknown whether early-life inflammatory markers are associated with the number of depressive and psychotic symptoms from childhood to adulthood. Using the prospective Avon Longitudinal Study of Children and Parents birth cohort (N = up-to 6401), we have examined longitudinal associations of early-life inflammation [exposures: interleukin-6 (IL-6), C-reactive protein (CRP) levels at age 9y; IL-6 and CRP DNA-methylation (DNAm) scores at birth and age 7y; and IL-6 and CRP polygenic risk scores (PRSs)] with the number of depressive episodes and psychotic experiences (PEs) between ages 10-28 years. Psychiatric outcomes were assessed using the Short Mood and Feelings Questionnaire and Psychotic Like Symptoms Questionnaires, respectively. Exposure-outcome associations were tested using negative binomial models, which were adjusted for metabolic and sociodemographic factors. Serum IL-6 levels at age 9y were associated with the total number of depressive episodes between 10 and 28y in the base model (n = 4835; β = 0.066; 95%CI:0.020-0.113; pFDR = 0.041) which was weaker when adjusting for metabolic and sociodemographic factors. Weak associations were observed between inflammatory markers (serum IL-6 and CRP DNAm scores) and total number of PEs. Other inflammatory markers were not associated with depression or PEs. Early-life inflammatory markers are associated with the burden of depressive episodes and of PEs subsequently from childhood to adulthood. These findings support a potential role of early-life inflammation in the aetiology of depression and psychosis and highlight inflammation as a potential target for treatment and prevention.

Parental perception of mental health needs in young children

BACKGROUND

There is evidence of unmet psychiatric needs in children under 6. These young children are dependent on their parents to identify their mental health needs. This study tested child and parent associations with parent perception of young child mental health need.

METHOD

Parents of 917 children (aged 2-6 years) completed a diagnostic interview about their child assessing depression, anxiety, ODD/CD, ADHD, and impairment. Parents were surveyed about their own depression, anxiety, and asked about their psychiatric impairment. Parents were also asked whether they perceived their child as having a mental health need.

RESULTS

Only 38.8% of children who met criteria for a diagnosis were perceived by their parents as having a need, similar to previously studied rates in school-aged children. Perception of need was associated with higher levels of symptoms and impairment. Thresholds for at least half of parents perceiving their child as having a need were relatively high: 19 or more symptoms, or 4 or more impairments. There was evidence of specificity: children with depressive disorders were more likely to be perceived as in need compared with other disorders. In terms of parent factors, more parental depressive symptoms were associated with higher perception of child need when the child had a diagnosis. Parental psychological impairment was associated with higher perception of need when the child had no diagnosis.

CONCLUSIONS

Most preschool children that meet criteria for a psychiatric disorder are not perceived as needing help by their parents, which is dependent on both child and parent factors.

Mood and Behaviors of Adolescents With Depression in a Longitudinal Study Before and During the COVID-19 Pandemic

OBJECTIVE

To investigate whether, compared to pre-pandemic levels, depressive and anxiety symptoms in adolescents with depression increased during the pandemic.

METHOD

We used data from National Institute of Mental Health Characterization and Treatment of Depression (NIMH CAT-D) cohort, a longitudinal case-control study that started pre-pandemic. Most of the participants are from the states of Maryland and Virginia in the United States. We compared depressive symptoms (1,820 measurements; 519 measurements pre-pandemic and 1,302 during the pandemic) and anxiety symptoms (1,800 measurements; 508 measurements pre-pandemic and 1,292 ratings during the pandemic) of 166 adolescents (109 girls, 96 adolescents with depression) before and during the pandemic. Data were collected during yearly clinical visits, interim 4-month follow-up visits, inpatient stays, and weekly outpatient sessions, with additional data collection during the pandemic. Pre-pandemic, healthy volunteers (HVs) had a median of 1 depressive and anxiety rating (range, 1-3), and adolescents with depression had a median of 2 ratings (anxiety rating range, 1-25; depressive rating range, 1-26). During the pandemic, HVs had a median of 8 anxiety ratings and 9 depressive ratings (range, 1-13), and adolescents with depression had a median of 7 anxiety and depressive ratings (range, 1-29). We also analyzed adolescent- and parent-reported behaviors in the CoRonavIruS Health Impact Survey (CRISIS), totaling 920 self-reported measures for 164 adolescents (112 girls, 92 adolescents with depression). HVs had a median of 7 surveys (range, 1-8), and adolescents with depression had a median of 5 surveys (range, 1-8).

RESULTS

Pre-pandemic, adolescents with depression had a mean depressive score of 11.16 (95% CI = 10.10, 12.22) and HVs had a mean depressive score of 1.76 (95% CI = 0.40, 3.13), a difference of 9.40 points (95% CI = 7.78, 11.01). During the pandemic, this difference decreased by 22.6% (2.05 points, 95% CI = 0.71, 3.40, p = .003) due to 0.89 points decrease in severity of scores in adolescents with depression (95% CI = 0.08, 1.70, p = .032) and 1.16 points increase in HVs' depressive symptoms (95% CI = 0.10, 2.23, p = .032). Compared to their pre-pandemic levels, adolescents with depression reported overall lower anxiety symptoms during the pandemic. Parent-on-child reports also were consistent with these results.

CONCLUSION

Contrary to our hypothesis, we found that both depressive and anxiety symptoms were lower for adolescents with depression during the pandemic compared to before. In contrast, the depression scores for the HVs were higher during the pandemic relative to their pre-pandemic ratings; these scores remained much lower than those of adolescents with depression.

CLINICAL TRIAL REGISTRATION INFORMATION

Characterization and Treatment of Adolescent Depression; https://clinicaltrials.gov/; NCT03388606.

Emotional Responses to Social Media Experiences Among Adolescents: Longitudinal Associations with Depressive Symptoms

OBJECTIVE

The degree to which adolescent social media use is associated with depressive symptoms has been the source of considerable debate. Prior studies have been limited by a reliance on cross-sectional data and measures of overall "screen time." This study examines prospective associations between adolescents' emotional responses to social media experiences and depressive symptoms, and examines gender differences in these processes.

METHOD

A school-based sample of 687 adolescents (48.6% girls; Mage = 14.3; 38.1% White, 29.4% Hispanic, 23.0% Black) completed measures of positive and negative emotional responses to social media experiences and depressive symptoms at two time points, one year apart.

RESULTS

Higher levels of depressive symptoms were associated with more frequent negative emotional responses to social media experiences one year later, whereas greater positive emotional responses to social media were associated with later depressive symptoms. Girls reported overall greater emotional responses to social media experiences, but gender did not moderate associations between these emotional responses and depressive symptoms.

CONCLUSION

Findings highlight the importance of examining adolescents' positive and negative emotional experiences in the context of social media use, and the ways in which these experiences intersect with depressive symptoms, so as to identify youth who may be most vulnerable to negative effects of social media use.

Father absence and trajectories of offspring mental health across adolescence and young adulthood: Findings from a UK-birth cohort

BACKGROUND

High prevalence of parental separation and resulting biological father absence raises important questions regarding its impact on offspring mental health across the life course. We specifically examined whether these relationships vary by sex and the timing of exposure to father absence (early or middle childhood).

METHODS

This study is based on up to 8409 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants provided self-reports of depression (Clinical Interview Schedule-Revised) at age 24 years and depressive symptoms (Short Mood and Feelings Questionnaire) between the ages of 10 and 24 years. Biological father absence in childhood was assessed through maternal questionnaires at regular intervals from birth to 10 years. We estimated the association between biological father absence and trajectories of depressive symptoms using multilevel growth-curve modelling.

RESULTS

Early but not middle childhood father absence was strongly associated with increased odds of offspring depression and greater depressive symptoms at age 24 years. Early childhood father absence was associated with higher trajectories of depressive symptoms during adolescence and early adulthood compared with father presence. Differences in the level of depressive symptoms between middle childhood father absent and father present groups narrowed into adulthood.

LIMITATIONS

This study could be biased by attrition and residual confounding.

CONCLUSIONS

We found evidence that father absence in childhood is persistently associated with offspring depression in adolescence and early adulthood. This relationship varies by sex and timing of father's departure, with early childhood father absence emerging as the strongest risk factor for adverse offspring mental health trajectories Further research is needed to identify mechanisms that could inform preventative interventions to reduce the risk of depression in children who experience father absence.

Molecular mediators of the association between child obesity and mental health

Biological mechanisms underlying the association between obesity and depression remain unclear. We investigated the role of metabolites and DNA methylation as mediators of the relationship between childhood obesity and subsequent poor mental health in the English Avon Longitudinal Study of Parents and Children. Obesity was defined according to United Kingdom Growth charts at age 7 years and mental health through the Short Mood and Feelings Questionnaire (SMFQ) completed at age 11 years. Metabolites and DNA methylation were measured by nuclear magnetic resonance spectroscopy and Illumina array in blood at the age of 7 years. The associations between obesity and SMFQ score, as continuous count data or using cut-offs to define depressive symptoms (SMFQ >7) or depression (SMFQ >11), were tested using adjusted Poisson and logistic regression. Candidate metabolite mediators were identified through metabolome-wide association scans for obesity and SMFQ score, correcting for false-discovery rate. Candidate DNA methylation mediators were identified through testing the association of putative BMI-associated CpG sites with SMFQ scores, correcting for look-up false-discovery rate. Mediation by candidate molecular markers was tested. Two-sample Mendelian randomization (MR) analyses were additionally applied to test causal associations of metabolites with depression in independent adult samples. 4,018 and 768 children were included for metabolomics and epigenetics analyses, respectively. Obesity at 7 years was associated with a 14% increase in SMFQ score (95% CI: 1.04, 1.25) and greater odds of depression (OR: 1.46 (95% CI: 0.78, 2.38) at 11 years. Natural indirect effects (mediating pathways) between obesity and depression for tyrosine, leucine and conjugated linoleic acid were 1.06 (95% CI: 1.00, 1.13, proportion mediated (PM): 15%), 1.04 (95% CI: 0.99, 1.10, PM: 9.6%) and 1.06 (95% CI: 1.00, 1.12, PM: 13.9%) respectively. In MR analysis, one unit increase in tyrosine was associated with 0.13 higher log odds of depression (p = 0.1). Methylation at cg17128312, located in the FBXW9 gene, had a natural indirect effect of 1.05 (95% CI: 1.01,1.13, PM: 27%) as a mediator of obesity and SMFQ score. Potential biologically plausible mechanisms involving these identified molecular features include neurotransmitter regulation, inflammation, and gut microbiome modulation. These results require replication in further observational and mechanistic studies.

Online treatment of adolescents with comorbid anxiety and depression: A randomized controlled trial

OBJECTIVE

Adolescents experiencing both anxiety and mood disorders show greater life impairment than those with either disorder alone. The aim of this study was to evaluate the efficacy of an online cognitive behavior therapy (CBT) program for these comorbid youth.

METHODS

Ninety-one adolescents aged 12 to 17 years (M = 14.29, S.D. = 1.62; 66% female) participated if they met DSM-5 criteria for both an anxiety and depressive disorder. Diagnoses were assessed by structured interview and participants also completed measures of symptoms, negative thoughts, and life interference. Participants were randomly allocated to either active treatment (n = 45) or wait (n = 46). Treatment comprised access to an 8-module, online program and was supported by 8, 30-minute telephone sessions with a therapist and the youth, of which the caregiver participated in four.

RESULTS

Treated participants showed significantly greater reduction than waiting participants on the primary outcome: total number of disorders and were more likely to remit from all anxiety and mood disorders (43.8% vs 20.9%). Secondary outcomes covering symptoms of anxiety and depression showed similar group by time differences, but there was no significant group by time interaction on life interference.

CONCLUSIONS

This brief, easily accessible, online intervention that requires relatively low levels of therapist time showed promising impact for a very impaired population.

REGISTRATION

This trial was registered on the ANZ clinical trials registry-ACTRN12616000139471.

Association of Depressive Symptoms in Late Adolescence and School Dropout

The present study investigated the association between symptoms of depression in late adolescence and completion of upper secondary school, taking symptoms of ADHD and conduct disorder, and parental education into account. The study is based on the youth@hordaland-survey, conducted in Western Norway in 2012. A total of 9157 adolescents (aged 16–19 years, 53% girls) consented to participation and registry linkage and comprised the sample of the present study. Symptoms of depression, ADHD, and conduct disorder were based on adolescent self-report. Information on parental education, grade point average (GPA), and upper secondary school completion was retrieved from the National Education Database. In the sample, 14.8% had not completed upper secondary education within 5 years. Symptoms of depression were associated with higher odds of failure to graduate within 5 years (adjusted odds ratio (AOR) = 1.50). The association was attenuated but remained significant when adjusting for symptoms of ADHD, conduct disorder, and parental education. Adolescents reporting high levels of both depression and conduct disorder had the highest odds of dropout (AOR = 4.15). GPA partially mediated the association between symptoms of depression and dropout. The results show a consistent, but small association between symptoms of depression in late adolescence and failure to complete upper secondary education within five years. Given the high rate of depressive symptoms in the adolescent population, it is important to identify protective factors that promote school functioning and graduation for adolescents experiencing such symptoms.

Inhibitory control of positive and negative information and adolescent depressive symptoms: a population-based cohort study

BACKGROUND

Large population-based cohort studies of neuropsychological factors that characterise or precede depressive symptoms are rare. Most studies use small case-control or cross-sectional designs, which may cause selection bias and cannot test temporality. In a large UK population-based cohort, we investigated cross-sectional and longitudinal associations between inhibitory control of positive and negative information and adolescent depressive symptoms.

METHODS

Cohort study of 2328 UK adolescents who completed an affective go/no-go task at age 18. Depressive symptoms were assessed with the Clinical Interview Schedule Revised (CIS-R) and short Mood and Feeling Questionnaire (sMFQ) at age 18, and with the sMFQ 1 year later (age 19). Analyses were multilevel and traditional linear regressions, before and after adjusting for confounders.

RESULTS

Cross-sectionally, we found little evidence that adolescents with more depressive symptoms made more inhibitory control errors [after adjustments, errors increased by 0.04% per 1 s.d. increase in sMFQ score (95% confidence interval 0.02-0.06)], but this association was not observed for the CIS-R. There was no evidence for an influence of valence. Longitudinally, there was no evidence that reduced inhibitory control was associated with future depressive symptoms.

CONCLUSIONS

Inhibitory control of positive and negative information does not appear to be a marker of current or future depressive symptoms in adolescents and would not be a useful target in interventions to prevent adolescent depression. Our lack of convincing evidence for associations with depressive symptoms suggests that the affective go/no-go task is not a promising candidate for future neuroimaging studies of adolescent depression.

The validity of the residuals approach to measuring resilience to adverse childhood experiences

BACKGROUND

Resilience is broadly defined as the ability to maintain or regain functioning in the face of adversity. Recent work to harmonise the quantification and definition of resilience quantifies resilience as the residual variance in psychosocial functioning that remains after accounting for adversity exposure. However, there have been no published studies that have formally investigated the validity of this approach. Considering this, we examine the construct and predictive validity of the residuals approach using participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a multigenerational, longitudinal cohort study.

METHODS

We regressed exposures of adolescent adversity on adolescent psychopathology scores using the Strength and Difficulties Questionnaire and obtained the residual variance. We investigated construct validity by analysing whether previously identified demographic and resilience factors significantly predicted resilience. Predictive validity of resilience was investigated by comparing the predictive power of resilience with other determinants of psychosocial functioning on two developmental outcomes: depressive symptoms at 18 years, measured by the Short Moods and Feelings Questionnaire, and NEET (Not in Employment, Education or Training) status at 17 and 23 years. The associations between depressive symptoms at 18, resilience, ACEs and covariates were tested using multiple linear regression. NEET status at 17 and 23 were run as separate binary multiple logistic regression models to test associations with resilience and known demographics previously associated with NEET status.

RESULTS

Seven previously identified protective factors, including self-esteem, positive sibling relationship, temperament, and positive perception of school, significantly predicted resilience to adolescent psychopathology, thus providing strong construct validity. Resilience significantly predicted a reduction in depressive symptoms at 18 years, and significantly decreased the likelihood of having NEET status at both 17 years and 23 years, even after taking into account early childhood adversity and other risk factors. None of the socioeconomic factors were significantly associated with resilience.

CONCLUSIONS

Our study demonstrates that the residuals method of operationalising resilience has good construct and predictive validity yet recommend replication studies. It has the potential to advance research into the mechanisms and modifiability of resilience.

TRIAL REGISTRATION

Not applicable.

Trajectory of post-traumatic stress and depression among children and adolescents following single-incident trauma

OBJECTIVE

Post-traumatic stress disorder and depression have high comorbidity. Understanding their relationship is of clinical and theoretical importance. A comprehensive way to understand post-trauma psychopathology is through symptom trajectories. This study aims to look at the developmental courses of PTSD and depression symptoms and their interrelationship in the initial months post-trauma in children and adolescents.

METHODS

Two-hundred-and-seventeen children and adolescents aged between eight and 17 exposed to single-event trauma were included in the study. Post-traumatic stress symptoms (PTSS) and depression symptoms were measured at 2 weeks, 2 months and 9 months, with further psychological variables measured at the 2-week assessment. Group-based trajectory modelling (GBTM) was applied to estimate the latent developmental clusters of the two outcomes. Logistic regression was used to identify predictors associated with high symptom groups.

RESULTS

The GBTM yielded a three-group model for PTSS and a three-group model for depression. PTSS trajectories showed symptoms reduced to a non-clinical level by 9 months for all participants (if they were not already in the non-clinical range): participants were observed to be resilient (42.4%) or recovered within 2 months (35.6%), while 21.9% experienced high level PTSS but recovered by 9 months post-trauma. The depression symptom trajectories predicted a chronic non-recovery group (20.1%) and two mild symptom groups (45.9%, 34.0%). Further analysis showed high synchronicity between PTSS and depression groups. Peri-event panic, negative appraisals, rumination and thought suppression at 2 weeks predicted slow recovery from PTSS. Pre-trauma wellbeing, post-trauma anxiety and negative appraisals predicted chronic depression.

CONCLUSIONS

Post-trauma depression was more persistent than PTSS at 9 months in the sampled population. Cognitive appraisal was the shared risk factor to high symptom groups of both PTSS and depression.

Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study

BACKGROUND

Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment.

OBJECTIVE

The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools.

METHODS

This study involved 2 iterative design feedback cycles-an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed.

RESULTS

Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided.

CONCLUSIONS

Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools.

The development and preliminary validation of a brief scale of emotional distress in young people using combined classical test theory and item response theory approaches: The Brief Emotional Distress Scale for Youth (BEDSY)

Reliable, valid, and brief measures are important for identifying young people in community contexts who experience mental health problems. This paper reports the development and preliminary validation of the Brief Emotional Distress Scale for Youth (BEDSY), a measure based on anxiety and depression symptoms that load strongly upon the general construct of emotional distress. Participants, aged 11-17 years, included 2663 from a community population and 281 referred anxious youth. From a pool of 20 items, eight were selected for the final scale using methods from classical test theory, followed by item response theory (IRT). The final eight items met the pre-specified criteria for skewness and kurtosis, item-total correlations, IRT characteristics, and discrimination between referred vs. community samples. Exploratory structural equation modeling for a bi-factor model indicated that 81% of total variance was explained by the general emotional distress factor. The 8-item BEDSY showed strong internal consistency, good construct validity, and acceptable sensitivity and specificity in discriminating between a community sample vs anxious youth, and between youth with and without high levels of depressive symptoms. As such the scale has strong potential as a brief screen for identifying emotionally distressed young people in community contexts.

Polygenic risk for depression, anxiety and neuroticism are associated with the severity and rate of change in depressive symptoms across adolescence

BACKGROUND

Adolescence marks a period where depression will commonly onset. Twin studies show that genetic influences play a role in how depression develops and changes across adolescence. Recent genome-wide association studies highlight that common genetic variants - which can be combined into polygenic risk scores (PRS) - are also implicated in depression. However, the role of PRS in adolescent depression and changes in adolescent depression is not yet understood. We aimed to examine associations between PRS for five psychiatric traits and depressive symptoms measured across adolescence using cross-sectional and growth-curve models. The five PRS were as follows: depression (DEP), major depressive disorder (MDD), anxiety (ANX), neuroticism (NEU) and schizophrenia (SCZ).

METHODS

We used data from over 6,000 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine associations between the five PRS and self-reported depressive symptoms (Short Mood and Feelings Questionnaire) over 9 occasions from 10 to 24 years. The PRS were created from well-powered genome-wide association studies conducted in adult populations. We examined cross-sectional associations between the PRS at each age and then again with longitudinal trajectories of depressive symptoms in a repeated measures framework using multilevel growth-curve analysis to examine the severity and the rate of change.

RESULTS

There was strong evidence that higher PRS for DEP, MDD and NEU were associated with worse depressive symptoms throughout adolescence and into young adulthood in our cross-sectional analysis, with consistent associations observed across all nine occasions. Growth-curve analyses provided stronger associations (as measured by effect sizes) and additional insights, demonstrating that individuals with higher PRS for DEP, MDD and NEU had steeper trajectories of depressive symptoms across development, all with a greater increasing rate of change during adolescence. Evidence was less consistent for the ANX and SCZ PRS in the cross-sectional analysis, yet there was some evidence for an increasing rate of change in adolescence in the growth-curve analyses with the ANX PRS.

CONCLUSIONS

These results show that common genetic variants as indexed by varying psychiatric PRS show patterns of specificity that influence both the severity and rate of change in depressive symptoms throughout adolescence and then into young adulthood. Longitudinal data that make use of repeated measures designs have the potential to provide greater insights how genetic factors influence the onset and persistence of adolescent depression.

Early identification of depressive symptoms in school-aged children: Psychometric properties and validation of a new short version of Short Mood & Feelings Questionnaire

BACKGROUND

Depressive mood is a common problem among children in Western countries. Professionals in school and other health services have an important role in identifying children at increased risk for depression. The Short Mood and Feelings Questionnaire (SMFQ) is a widely used screening tool, but its 13 items still make it quite time-consuming to complete. There is an urgent need for a quick and easy-to-complete self-report depressive mood scale for use in school health examinations.

AIM

This paper aims to describe and validate a revised version of SMFQ: FsMFQ-6 is intended as a short screening tool for the early identification of depressive symptoms in children.

METHODS

Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study. The respondents were fourth- and fifth-grade pupils (aged 10-12) in Finnish primary schools. The data were analysed separately by gender. The construct validity of the scale was studied by principal component analysis and confirmatory factor analysis (CFA), convergent validity by both receiver operating characteristic (ROC) analysis and Spearman's correlation coefficient. Reliability was tested by Cronbach's alpha coefficient.

RESULTS

Principal component analysis yielded a one-component model: the Finnish Short Mood and Feelings Questionnaire 6 (FsMFQ-6). CFA confirmed the validity of FsMFQ-6. Compared with mood at home (AUC = 0.80) and mood at school (AUC = 0.85), overall sensitivity and specificity were optimal at cut-off point 0. Cronbach's alpha coefficient was 0.73, indicating good internal consistency. The results for girls and boys were almost identical.

CONCLUSION

The results confirmed the validity and reliability of FsMFQ-6. FsMFQ-6 recognises depressive mood in children and is suitable for screening depressive symptoms in fourth- and fifth-grade pupils in Finland. However, it is important to pay close attention to children who choose the 'Sometimes' response option more than once, for that can be a sign of depressive symptoms.

Association of mentally-active and mentally-passive sedentary behaviour with depressive symptoms among adolescents

BACKGROUND

The evidence on the association between sedentary behaviour and depression in adolescence is mixed. We aimed to investigate the association between mentally-active and mentally-passive sedentary behaviours at 11 years (11y) and depressive symptoms at 14y, and to examine potential mediators.

METHODS

UK Millennium Cohort Study data were used (n=7,124; 49% boys). At 11y, participants self-reported frequency of mentally-passive (listening to music, internet use) and mentally-active sedentary behaviours (reading, playing electronic games). Additional parental-reported behaviours (mentally-passive: TV viewing; mentally-active: homework) were summed with self-reported behaviours to represent continuous indicators of mentally-active and mentally-passive sedentary behaviour. Depressive symptoms were assessed (at 11y and 14y) using the short-version of Mood and Feelings Questionnaire. Body mass index (BMI), mentally-passive sedentary behaviour and cognition at 14y were examined as potential mediators. Linear regression models were adjusted for confounders and stratified by sex. Subsequent mediation analyses reporting e-values were used to assess unmeasured confounding.

RESULTS

Among girls, mentally-passive sedentary behaviour at 11y was associated with later depressive symptoms (14y) [β:0.089 (95%CI:0.055-0.122), e-value:1.32]. This association was mediated by BMI [5.6% (95%CI:4.1%-8.6%)] and mentally-passive sedentary behaviour [105.6% (95%CI:79.6%-156.7%)]. No associations were observed in boys or between mentally-active sedentary behaviour and later depressive symptoms.

LIMITATIONS

The parental report of behaviours and the assessment of mediators and outcome in the same wave are the main limitations.

CONCLUSION

Future interventions aiming to improve mental health among girls could aim to reduce mentally-passive sedentary behaviour in early teens and could target potential mediators including BMI.

Validation of the short Mood and Feelings Questionnaire in young adulthood

Depression often onsets in adolescence and is associated with recurrence in adulthood. There is a need to identify and monitor depression symptoms across adolescence and into young adulthood. The short Mood and Feelings Questionnaire (sMFQ) is commonly used to measure depression symptoms in adolescence but has not been validated in young adulthood. This study aimed to (1) examine whether the sMFQ is valid in young adulthood, and (2) identify cut-points best capturing DSM-5 depression diagnosis at age 25 METHODS: The sample included participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 25 (n = 4098). Receiver Operating Characteristic analyses examined how well the self-rated sMFQ discriminates between cases and non-cases of DSM-5 Major Depressive Disorder (MDD) classified using the self-rated Development and Well Being Assessment. Sensitivity and specificity values were used to identify cut-points on the sMFQ RESULTS: The sMFQ had high accuracy for discriminating MDD cases from non-cases at age 25. The commonly used cut-point in adolescence (≥12) performed well at this age, best balancing sensitivity and specificity. However, a lower cut-point (≥10) may be appropriate when favouring sensitivity over specificity e.g., in context of screening. Sensitivity analyses suggested similar results for males and females LIMITATIONS: ALSPAC is a longitudinal population cohort that suffers from non-random attrition CONCLUSIONS: The sMFQ is a valid measure of depression in young adults in the general population. It can be used to screen for and monitor depression across adolescence and early adulthood.

Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

OBJECTIVES

We aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.

DESIGN AND SETTING

Prospective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.

PARTICIPANTS

Primary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.

OUTCOME MEASURES

ALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.

RESULTS

Sensitivities for primary care diagnoses were low for CMDs (range: 3.5%-19.1%) and depression (range: 1.6%-34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: -1.3 to 12.6%), but improved with age.

CONCLUSIONS

Primary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

Maternal and paternal depression and child mental health trajectories: evidence from the Avon Longitudinal Study of Parents and Children

BACKGROUND

The relationships between offspring depression profiles across adolescence and different timings of parental depression during the perinatal period remain unknown.

AIMS

To explore different timings of maternal and paternal perinatal depression in relation to patterns of change in offspring depressive mood over a 14 year period.

METHOD

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Parental antenatal depression (ANTD) was assessed at 18 weeks gestation, and postnatal depression (PNTD) at 8 weeks postpartum. Population-averaged trajectories of offspring depressive symptoms were estimated using the Short Mood and Feelings Questionnaire (SMFQ) on nine occasions between 10 and 24 years of age.

RESULTS

Full data were available for 5029 individuals. Offspring exposed to both timings of maternal depression had higher depressive symptoms across adolescence compared with offspring not exposed to ANTD or PNTD, characterised by higher depressive symptoms at age 16 (7.07 SMFQ points (95% CI = 6.19, 7.95; P < 0.001)) and a greater rate of linear change (0.698 SMFQ points (95% CI = 0.47, 0.93; P = 0.002)). Isolated maternal ANTD and to a lesser extent PNTD were also both associated with higher depressive symptoms at age 16, yet isolated maternal PNTD showed greater evidence for an increased rate of linear change across adolescence. A similar pattern was observed for paternal ANTD and PNTD, although effect sizes were attenuated.

CONCLUSIONS

This study adds to the literature demonstrating that exposure to two timings of maternal depression (ANTD and PNTD) is strongly associated with greater offspring trajectories of depressive symptoms.