Continuity of depression during the transition to adulthood: a 5-year longitudinal study of young women

Common mental disorders among adolescents in an urban area of Delhi

Background

Common mental disorders (CMDs) among adolescents may hamper their psycho-social development.

Aim

This study evaluated the prevalence and determinants of CMD like depression and anxiety among late adolescents of an age of 15--19 years residing in an urban resettlement colony of southeast Delhi.

Methods

A community-based cross-sectional study was carried out among 556 randomly selected adolescents. CMD was assessed using Mini International Neuropsychiatry Interview - Kid version 6 (MINI-Kid) based on DSM-IV TR and compliant with ICD-10 definitions of CMD. The associated risk factors were studied using a self-developed semi-structured interview schedule and analyzed using multi-variable logistic regression.

Results

A total of 491 adolescents were interviewed (a response rate of 88.3%), of whom 247 (50.3%) were female and 210 (42.8%) belonged to a lower-middle socio-economic status. The lifetime prevalence of CMD was 34% [95% confidence interval (CI): 29.8-38.2]. Of the total, 22.4% (95% CI: 18.7-6.1) of the participants reported depression and 6.7% (95% CI: 4.5-8.9) reported generalized anxiety disorder during their lifetime. Female sex [adjusted odds ratio (aOR) 2.1, 95% CI: 1.4-2.2], experiencing a stressful event in the past 6 months (aOR 4.7, 95% CI: 3.1-7.3), and smoking tobacco (aOR 2.0, 95% CI: 1.2-7.4) significantly increased the odds of having CMD in multi-variate analysis.

Conclusion

There is a high prevalence of CMD among adolescents residing in urban resettlement colonies of Delhi, which is composed mostly of people belonging to lower socio-economic strata. Hence, tailored intervention at stress management with promotion of healthy lifestyle is needed for this age group.

Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge

(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.

Heterotypic and homotypic continuity in psychopathology: a narrative review

Psychopathology is a process: it unfolds over time and involves several different factors. To extend our knowledge of such process, it is vital to understand the trajectories that lead to developing and maintaining a specific disorder. The construct of continuity appears very useful to this aim. It refers to the consistency, similarity, and predictability of behaviors or internal states across different developmental phases. This paper aims to present a narrative review of the literature on homotypic and heterotypic continuity of psychopathology across the lifespan. A detailed search of the published literature was conducted using the PsycINFO Record and Medline (PubMed) databases. Articles were included in the review based on the following criteria: (1) publication dates ranging from January 1970 to October 2022; and (2) articles being written in the English language. To ensure a thorough investigation, multiple combinations of keywords such as "continuity," "psychopathology," "infancy," "childhood," "adolescence," "adulthood," "homotypic," and "heterotypic" were used. Articles were excluded if exclusively focused on epidemiologic data and if not specifically addressing the topic of psychopathology continuity. The literature yielded a total of 36 longitudinal studies and an additional 190 articles, spanning the research published between 1970 and 2022. Studies on continuity focus on the etiology of different forms of mental disorders and may represent a fundamental resource from both a theoretical and clinical perspective. Enhancing our understanding of the different trajectories beneath psychopathology may allow clinicians to implement more effective strategies, focusing both on prevention and intervention. Since literature highlights the importance of early detection of clinical signs of psychopathology, future research should focus more on infancy and pre-scholar age.

Reliability and structural validity of the Danish Short 4-item version of the Center for Epidemiological Studies Depression Scale for Children (CES-DC4) in adolescents

Background

The 4-item version of the Center of Epidemiological Studies Depression Scale (CES-DC₄) is a self-reported questionnaire used to measure depressive symptoms in adolescents, but the psychometric properties of the scale have been tested to only a limited extent. The aim of this study was to examine the reliability and structural validity of the Danish CES-DC₄ in 9^th graders.

Methods

Using a sample of 72 adolescents 15 to 17 years of age from five 9^th grade classes, the reliability of the CES-DC₄ was determined by a test–retest study at a 2-week interval. Descriptive statistics of the adolescents were presented, and internal consistency, structural validity, reliability, and agreement between tests were evaluated. The structural validity of the scale was tested by confirmatory factor analysis (CFA), and the sumscores of the test and retest were presented.

Results

The estimated Cronbach’s α was 0.61 (95% CI 0.50; 0.71). Inter-item and item-rest correlations indicated that one of the four items (item 20) did not fit well on the scale. CFA found a one-factor model suited for the scale, but the factor loadings indicated that item 20 contributed the least to measure the factor (0.29). Sum scores ranged from 0–9 within a possible interval of 0–12. There were no signs of systematic error of the scale. Limits of Agreement (-3.01; 3.79) were broad. The standard error of measurement (SEM = 1.25 point (95% CI.1.05; 1.47)) and intraclass correlation (ICC(2,1) = 0.60 (95% CI: 0.44; 0.73)) calculations showed low reliability of the CES-DC₄.

Conclusion

This study found low reliability of the CES-DC₄ with low estimates of ICC and Cronbach’s α. The CES-DC₄ needs revision, and removal of item 20 and adding more items from the CES-DC should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03451-7.

Association Between Place of Secondhand Smoke Exposure and Depression Among Nonsmoking Children and Adolescents: A Systematic Review

Secondhand smoke (SHS) exposure patterns of children and adolescents are different from those of adults because children and adolescents spend a majority of their time in the home and school. It was aimed to conduct a systematic review of the published literature regarding the association between depression and the place of SHS exposure among children and adolescents. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, PubMed, ScienceDirect, and Cochrane Library databases were used for the literature review. The studies were screened and selected by two independent reviewers based on the inclusion criteria. All eight studies included in the systematic review measured SHS exposure in participants' own homes. Two studies measured SHS exposure at school and one study in cars. The majority of the studies showed a positive association between depression and SHS exposure in both private and public places among nonsmoking children and adolescents. Also, they concluded a dose-response relationship between SHS exposure and depression. Health practitioners would be encouraged to work with stakeholders to create smoke-free policies in both private and public places to avoid the adverse effects of SHS exposure.

Genetic markers of the stress generation model: A systematic review

AIM

Robust evidence suggests that depression, and risk for depression, are associated with the generation of stressful life events. This tendency to generate stress may be genetically determined. This systematic review aimed to identify specific molecular genetic markers associated with the generation of interpersonal stressful life events, at least in part dependent on individuals' behavior.

METHOD

We followed the PRISMA guidelines in searching six electronic databases (PubMed, MEDLINE, PsycINFO, CINAHL, Cochrane, and EMBASE) from inception to January 2021, and we reviewed the reference lists of eligible articles for additional records. We restricted eligibility to empirical studies involving at least one genetic marker and including proximal life events. We evaluated the risk of bias using the Newcastle Ottawa Scale for observational studies. The outcome permitted a distinction between life events dependent on the individual's agency versus independent events.

RESULTS

Seven studies, including 3585 participants, met eligibility criteria. Three were longitudinal, and four were cross-sectional; six included adolescents and young adults, and one focused on middle adulthood. Four examined the serotonin-transporter-linked promoter region (5-HTTLPR), two examined the rs53576 single nucleotide polymorphism of the oxytocin receptor gene (OXTR), and one examined a multilocus genetic profile score including four hypothalamic-pituitary-adrenal (HPA) axis genes. There were no significant direct correlations between genotype and life events in any study. Instead, their relation was significantly moderated by symptoms, exposure to early adversity, or attachment. Consistent with the stress generation hypothesis, this moderation relation was significant in predicting exposure to dependent life events but was not significant in predicting independent life event exposure.

CONCLUSIONS

There is evidence that genetic variation in the serotonin, HPA axis, and oxytocin systems moderates the effects of psychosocial vulnerability markers on the generation of proximal, dependent life events. Future research should examine additional genetic markers in systems known to confer risk for stress generation.

PROSPERO

CRD42019136886.

Friend Support and Internalizing Symptoms in Early Adolescence During COVID-19

The COVID-19 pandemic has impacted adolescents' psychosocial adjustment and social relationships across the world. This prospective longitudinal study examined whether internalizing problems during the pandemic could be predicted by precrisis friend support, and whether this effect was moderated by the time adolescents spent with their friends and COVID-19-related stress. 245 Dutch adolescents (M_age  = 11.60) participated before and during COVID-19. Higher pre-COVID-19 friend support predicted less (self-reported and parent-reported) internalizing problems during COVID-19, and this effect was not moderated by the time adolescents spent with friends or COVID-19-related stress. Friends may thus protect against developing internalizing symptoms in times of crisis. We also found the reverse effect: Internalizing problems before COVID-19 were predictive of friend support during COVID-19.

Predicting Suboptimal Transitions in Adolescents With Inflammatory Bowel Disease

OBJECTIVES

Adolescents and young adults (AYAs) are at risk for disease exacerbations and increased health care utilization around the time of transition to adult care. Our aim was to identify risk factors predictive of a suboptimal transition for AYA with inflammatory bowel disease.

MATERIALS AND METHODS

We performed a retrospective chart review of patients with pediatric inflammatory bowel disease transferred to adult care from our institution in 2016 and 2017, recording demographic, psychosocial, and disease-specific data. Post-transfer data were obtained via the health care information exchange from the adult provider within our electronic medical record. We defined suboptimal transition as either a return to pediatric care or requiring care escalation within 1 year of transfer.

RESULTS

Out of 104 subjects 37 (36%) were found to have had a suboptimal transition. Our models suggest that a suboptimal transition is associated with several risk factors including any mental health diagnosis (odds ratio [OR] = 4.15; 95% confidence interval [95% CI]: 1.18-14.59), history of medication nonadherence (OR = 5.15 [95% CI: 1.52-17.42]), public insurance (OR = 6.60 [95% CI: 1.25-34.96]), higher Physician Global Assessment score at time of transition (OR = 6.64 [95% CI: 1.60-27.58], and short Pediatric Crohn Disease Activity Index scores (OR = 1.17 [95% CI: 1.03-1.33]). Higher hemoglobin levels at transition were protective (OR = 0.69 [95% CI: 0.48-0.98]). Age at time of transition, disease duration, and medication type at transition were not found to be associated with transition outcomes.

CONCLUSION

AYA with public insurance, a mental health history, medication nonadherence, and evidence of active disease may be at greater risk for suboptimal and poor health outcomes at transition.

[LIFE Child Depression - a prospective longitudinal cohort study on the origin of depressive disorders between childhood and early adulthood]

LIFE Child Depression - a prospective longitudinal cohort study on the origin of depressive disorders between childhood and early adulthood LIFE Child Depression is a prospective longitudinal study on the origin and course of depressive symptoms and disorders between child- and adulthood. The aim of the study is to identify patterns of developmental courses of symptoms and disorders and to investigate the interplay of psychosocial, biological and genetic risk and protective factors in the development of depressive disorders. The present paper gives an overview on results of the study. The sample was already assessed three times. A clinical sample was recruited from two local child psychiatric in- and outpatient services in Leipzig, a control sample was recruited from a children's health check program at our medical faculty (LIFE Child Health) and from the local registration office. We found some important context- and parent-associated risk factors for depressive disorders, such as negative life events, low socioeconomic status and depression in mothers (but not in fathers). Moreover, we found some characteristic biological and cognitive-emotional characteristics of children with depressive disorders, such as low stress-related cortisol, low evaluation of own performance, and more negative cognitions in dealing with stressful situations, low self-esteem and a general impairment of emotional processing of human faces. Only some of the risk factors were found to be specific to depression. Instead, most of them can be regarded as general risk factors for psychological disorders in childhood. It is also noteworthy, that some of the risk associations were gender-specific and need to be looked at from a differential point of view. Our study gives important indications for prevention for children at risk for depressive disorders as well as for therapeutic approaches.

Early pubertal timing predicts onset and recurrence of depressive episodes in boys and girls

BACKGROUND

Recurrent depressive episodes during adolescence result in significant impairment and increased risk for subsequent adverse outcomes throughout the life span. Evidence suggests that early pubertal timing predicts the onset of depressive episodes (particularly for girls); however, it is not known if pubertal timing prospectively predicts recurrent depressive episodes in youth.

METHODS

At baseline, 603 youth (56% female, at baseline: M_age  = 12.09, SD = 2.35) reported on their pubertal development. Youth and their parents completed a semistructured diagnostic interview to assess depressive episodes at baseline and then evaluated for onset repeatedly every 6 months for a period of 36 months.

RESULTS

Controlling for past history of depression, Cox proportional hazards models examined whether earlier pubertal timing predicted (a) days to first depressive episode from baseline and (b) days to a second (recurrent) depressive episode from the end of the first episode. Early pubertal timing predicted the onset of the first depressive episode after baseline (b = .19, Wald = 5.36, p = .02, HR = 1.21), as well as a recurrent episode during course of study follow-up episode (b = .32, Wald = 6.16, p = .01, HR = 1.38).

CONCLUSIONS

Findings reinforce the importance of considering the impact of early pubertal timing on depression risk. Investigation on how pubertal timing interacts with other risk factors to predict depression recurrence is needed.

Dating Violence in Adolescence: Implications for Girls' Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls' relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.

Randomized control trial testing the effectiveness of implemented depression prevention in high-risk adolescents

BACKGROUND

Adolescent depression is a global mental health concern. Identification and effective prevention in an early stage are necessary. The present randomized, controlled trial aimed to examine the effectiveness of Cognitive Behavioral Therapy (CBT)-based depression prevention in adolescents with elevated depressive symptoms. This prevention approach is implemented in school communities, which allows to examine effects under real-life circumstances.

METHODS

A total of 5222 adolescents were screened for elevated depressive symptoms in the second grade of secondary schools; 130 adolescents aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) were randomly assigned to the experimental (OVK 2.0) or control condition (psycho-education). Self- and parent-reported depressive symptoms were assessed at pretest and post intervention, as well as 6- and 12-months follow-up. Clinical assessment of depression was assessed at pretest and 6-months follow-up.

RESULTS

Intent-to-treat analyses revealed that the decrease in adolescent-rated depressive symptoms was significantly larger in the intervention condition than in the control condition. There was no significant difference in decrease of parent-rated depressive symptoms between both conditions.

CONCLUSIONS

Based on the findings, we recommend the implementation of screening and prevention in schools, according the basics of this study design. Since this is a new step forward, we discuss the clinical impact and challenges, as well possibilities for future research.

TRIAL REGISTRATION

The study is registered in the Dutch Trial Register for RCT's ( NTR5725 ). Date registered: 11 March 2016.

Individual and Relationship Characteristics of Adolescent Girls With Histories of Physical Dating Violence

The objective of this article is to examine the individual and relational characteristics of adolescent girls with a history of physical DV, as well as to utilize partner-specific, temporal data to explore links between these factors and recent or ongoing DV experiences. Participants were 109 high school girls (ages 14-17) identified as having a history of DV through a school-based screening procedure. Details regarding the timing of DV and links with specific dating partners were gathered using Timeline Followback (TLFB) interview methodology. At study entry, 30% endorsed clinical levels of depression symptoms and 89% reported delinquent behaviors. Forty-four percent reported vaginal intercourse in their lifetime and of those, 35% reported not using a condom at last sex. During the 90 days prior to study entry, 69% of youth reported having a romantic relationship and 58% of those youth reported physical/sexual violence. Data revealed that more physical/sexual violence was associated with longer relationship length, Wald χ²(2) = 1,142.63, p < .001. Furthermore, depressive symptoms, not delinquency, contributed significantly to recent DV experiences, even when relationship length was controlled. Our findings suggest that prevention programs for this population should teach participants how to quickly recognize unhealthy relationship characteristics, as violence severity increases with relationship length. Programs for adolescent girls should also address depressive symptoms, which are linked to DV severity when other risks are taken into account. Finally, the TLFB calendar method appears useful for gathering the temporal and partner-specific data needed to understand the complexity of dating relationships and violence experiences in this population.

Incidence and recurrence of depression from adolescence to early adulthood: A longitudinal follow-up of the Mexican Adolescent Mental Health Survey

BACKGROUND

Depression is a leading cause of disease burden around the globe, often develops during adolescence and is recurrent. Thus, disentangling risk factors for incidence from those of recurrence during adolescence is relevant and might suggest different strategies for prevention of onset than for relapse. The aim was to evaluate the relative risk of socio-demographic and clinical factors and traumatic events associated to incidence and recurrence of depression in youth from Mexico City.

METHODS

This is a prospective longitudinal general population survey in which 1071 respondents from the Mexican Adolescent Mental Health Survey were interviewed between the ages of 12 and 17 and again eight years later when they were between 19 and 26 years of age. The World Mental Health Composite International Diagnostic Interview evaluated incidence and persistence of major depression and risk factors.

RESULTS

Eight-year incidence was 12.9% while recurrence was 46.1%. Risk factors for incidence (female sex, any incident trauma, and specifically sexual abuse and an other/private event) differed from the risk factors for recurrence (childhood onset and domestic violence) with the exception of having a parent with depression, which was associated to increased risk for both.

LIMITATIONS

The follow-up response rate was limited by inability to locate participants at wave II. Statistical power was limited for persistence due to low rate of depression at wave I.

CONCLUSIONS

Intervening with both depressed and non-depressed children of parents with depression may have beneficial effects on both the development of depression as well as recurrence.

Close relationships and depression: A developmental cascade approach

Previous research has shown that problematic parent-child, peer, and romantic partner relationships are associated with an increased likelihood for major depressive disorder (MDD). Less research has evaluated the developmental unfolding of how these interpersonal relationship features are both an antecedent versus a consequence of MDD symptoms from adolescence through young adulthood. These gaps were evaluated using a large community sample (N = 1,127; 54% female, 96% white) via a developmental cascade model. Results showed support for significant antecedent effects, as greater parent-child relationship problems at ages 11 and 17 predicted rank-order increases in MDD symptoms at ages 14 and 20. Supporting a developmental cascade of problematic social relationships, greater parent-child relationship problems at ages 11 and 14 also predicted greater subsequent rank-order increases in antisocial peer affiliation at ages 14 and 17. Greater affiliation to antisocial peers at age 20 predicted greater rank-order increases in romantic relationship problems at age 24, which in turn predicted greater MDD symptoms at age 29. Cross-effects were generally small (βs ≤ .16), illustrating other factors may be relevant to the development or consequences of MDD. Nonetheless, findings support the importance of efforts to strengthen social support networks to offset risk as well as potentially treat depression.

Well-Being and Romantic Relationships: A Systematic Review in Adolescence and Emerging Adulthood

Adolescence and emerging adulthood are both stages in which romantic relationships play a key role in development and can be a source of both well-being and negative outcomes. However, the limited number of studies prior to adulthood, along with the multiplicity of variables involved in the romantic context and the considerable ambiguity surrounding the construct of well-being, make it difficult to reach conclusions about the relationship between the two phenomena. This systematic review synthesizes the results produced into this topic over the last three decades. A total of 112 studies were included, following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. On the one hand, these works revealed the terminological heterogeneity in research on well-being and the way the absence of symptoms of illness are commonly used to measure it, while on the other hand, they also showed that romantic relationships can be an important source of well-being for both adolescents and emerging adults. The findings underline the importance of providing a better definition of well-being, as well as to attribute greater value to the significance of romantic relationships. Devoting greater empirical, educational, and community efforts to romantic development in the stages leading up to adulthood are considered necessary actions in promoting the well-being of young people.

Project Date SMART: a Dating Violence (DV) and Sexual Risk Prevention Program for Adolescent Girls with Prior DV Exposure

This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing dating violence and sexual risk behavior in a sample of adolescent girls (ages 14-17) with prior exposure to physical dating violence (DV). One hundred and nine girls were randomly assigned to Date SMART (Skills to Manage Aggression in Relationships for Teens) or a Knowledge-only (KO) comparison group. Both intervention arms consisted of six, weekly 2-h sessions and one "booster" session 6 weeks later. Based on principles of cognitive behavioral therapy, the Date SMART intervention was designed to target common underlying skills deficits linked to both DV and sexual risk behavior in adolescent females: depression, self-regulation deficits, and interpersonal skills deficits. Assessments were administered at four time points (baseline, 3, 6, and 9 months). The Date SMART group was effective as reducing sexual DV involvement across the 9-month follow-up period. Both groups evidenced clinically meaningful reductions in physical, emotional, and digital DV involvement, total time in dating relationships, as well as reductions in depression. Findings indicate that delivering a DV and sexual risk prevention intervention to DV-affected adolescent girls is feasible and well-received. Furthermore, a skills-based approach that addresses the co-occurrence of DV and sexual risk behavior may be particularly useful for promoting reductions of sexual DV among high-risk adolescent girls. A future, large-scale trial with an inactive comparison condition is needed to evaluate the efficacy of Date SMART further.

TRIAL REGISTRATION

Clinical Trials, NCT01326195, and http://www.clinicaltrials.gov.

Cognitive behavioral treatment for depressed adolescents: results from a cluster randomized controlled trial of a group course

BACKGROUND

The group-based CBT intervention, the Adolescent Coping with Depression Course (ACDC), has previously been evaluated within a quasi-experimental design, showing reduction in depressive symptoms compared to a benchmark of similar studies. The aim of our study was to investigate the effectiveness of ACDC within a randomized controlled (RCT) design.

METHOD

Thirty-five course/control leaders randomly assigned to provide ACDC or usual care (UC) recruited 133 adolescents allocated to ACDC and 95 to UC. ACDC participants received eight weekly sessions and two follow-up sessions about 3 and 6 weeks after the last session. UC participants received usual care as implemented at the different sites. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale for adolescents (CES-D), perfectionism with the revised version of the Dysfunctional Attitude Scale (DAS), and rumination with the revised version of the Ruminative Responses Scale (RRS). Attrition was considered missing at random (MAR) and handled with a full information maximum likelihood (FIML) procedure.

RESULTS

Intention to treat analysis (ITT), including baseline scores and predictors of missing data as control or auxiliary variables, showed a small to medium reduction in depressive symptoms for the ACDC group compared to UC (d = -.31). Changes in perfectionism and rumination in favor of the intervention were also significant. Sensitivity analyses confirmed the findings from the ITT analyses.

CONCLUSIONS

The current study supports the effectiveness of this group-based CBT intervention. The intervention can hopefully result in clinically significant reductions in symptoms associated with depression among adolescents.

TRIAL REGISTRATION

ISRCTN registry ISRCTN19700389 . Registered 6 October 2015.

Depression literacy and stigma influence how parents perceive and respond to adolescent depressive symptoms

BACKGROUND

This study aimed to: (1) validate a measure of parental reactions, attitudes and understanding of adolescent depressive symptoms (PRAUD) and (2) examine the impact of adolescent and parent depressive symptoms, parental knowledge about adolescent depression (depression literacy), and parental depression stigma on parental responses to adolescent depression.

METHOD

Parents (N = 440) of adolescents aged 13-17 years completed an anonymous online questionnaire.

RESULTS

Factor analysis suggested four patterns of parental responses to adolescent depressive symptoms: overprotection, criticism, distress and support. Internal consistency was good for all PRAUD subscales (α = 0.80-0.88). Higher parent and adolescent depressive symptoms, greater depression stigma and lower depression literacy were associated with more negative parental responses. Higher adolescent depressive symptoms and poorer parent depression literacy predicted overprotective responses, and depression stigma moderated the effect of parent depressive symptoms. Depression literacy moderated the effect of parent depression on supportive parental responses, and stigma moderated the effect of adolescent depression. Higher levels of depression stigma and parent depression predicted critical responses, and depression literacy moderated the effect of adolescent depressive symptoms. Distress responses were predicted by higher stigma, and depression literacy moderated the effect of parent and adolescent depressive symptoms.

LIMITATIONS

Differences between the two sample recruitment sites.

CONCLUSIONS

There was evidence of more negative parental attitudes and responses among depressed parents and parents of depressed youth. Improving parental depression literacy and reducing depression stigma during treatment of adolescent depression may facilitate parental responsiveness, and in some circumstances, may help buffer against the negative impact of parental depression.

Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort

Anxiety and depression are often co-occurring disorders, reflecting both homotypic and heterotypic continuity as possible developmental pathways. The present study aimed to examine homotypic and heterotypic continuities of anxiety and depression across 3 years in adolescence and young adulthood. Participants included patients presenting to psychiatric care with diagnoses of anxiety and/or depressive disorders aged 13-18 at T1 (N = 717, 44% initial participation rate) and aged 16-21 at T2 (N = 549, 80% follow-up participation rate). McNemar's mid-p test and ordinal proportional odds logistic regression analyses were used to assess changes in prevalence within and across diagnostic categories, respectively. More adolescents had an anxiety disorder (+ 11%), whereas fewer had a depressive disorder (- 11%), at T2 compared to T1. Of adolescents with anxiety and/or depression at T1, only 25% recovered or were non-symptomatic 3 years after referral to a psychiatric clinic. Homotypic continuity was observed for anxiety disorders in general (OR = 2.33), for phobic anxiety disorders (OR = 7.45), and for depressive disorders (OR = 2.15). For heterotypic continuity, depression predicted later anxiety (OR = 1.92), more specifically social anxiety (OR = 2.14) and phobic anxiety disorders (OR = 1.83). In addition, social anxiety predicted later generalized anxiety disorder (OR = 3.11). Heterotypic continuity was thus more common than homotypic continuity. For adolescents presenting with anxiety or depression, treatment should, therefore, target broad internalizing symptom clusters, rather than individual diagnoses. This may contribute to prevent future mental illness, particularly anxiety, in clinical samples.

Co-development of Problem Gambling and Depression Symptoms in Emerging Adults: A Parallel-Process Latent Class Growth Model

This study examines whether there are multiple joint trajectories of depression and problem gambling co-development in a sample of emerging adults. Data were from the Manitoba Longitudinal Study of Young Adults (n = 679), which was collected in 4 waves across 5 years (age 18-20 at baseline). Parallel process latent class growth modeling was used to identified 5 joint trajectory classes: low decreasing gambling, low increasing depression (81%); low stable gambling, moderate decreasing depression (9%); low stable gambling, high decreasing depression (5%); low stable gambling, moderate stable depression (3%); moderate stable problem gambling, no depression (2%). There was no evidence of reciprocal growth in problem gambling and depression in any of the joint classes. Multinomial logistic regression analyses of baseline risk and protective factors found that only neuroticism, escape-avoidance coping, and perceived level of family social support were significant predictors of joint trajectory class membership. Consistent with the pathways model framework, we observed that individuals in the problem gambling only class were more likely using gambling as a stable way to cope with negative emotions. Similarly, high levels of neuroticism and low levels of family support were associated with increased odds of being in a class with moderate to high levels of depressive symptoms (but low gambling problems). The results suggest that interventions for problem gambling and/or depression need to focus on promoting more adaptive coping skills among more "at-risk" young adults, and such interventions should be tailored in relation to specific subtypes of comorbid mental illness.

Follow-up of monotherapy remitters in the PReDICT study: Maintenance treatment outcomes and clinical predictors of recurrence

OBJECTIVE

This study followed remitted patients from a randomized controlled trial of adults with major depressive disorder (MDD). The aims were to describe rates of recurrence and to evaluate 3 clinical predictor domains.

METHOD

Ninety-four treatment-naïve patients (50% female; Mage = 38.1 years; 48.9% White; 30.9% Hispanic) with MDD who had remitted to 12-week monotherapy (escitalopram, duloxetine, or cognitive behavior therapy [CBT]) participated in a 21-month maintenance phase (i.e., continued medication or 3 possible CBT booster sessions per year). Recurrence was assessed quarterly, and the clinical predictors were the following: 2 measures of residual depressive symptoms, 1 measure of lifetime depressive episodes, and 2 measures of baseline anxiety. Survival analysis models evaluated recurrence rates, and regression models evaluated the predictors.

RESULTS

Among all patients, 15.5% experienced a recurrence, and the survival distributions did not statistically differ among treatments. Residual depressive symptoms on the Hamilton Depression Rating Scale at the end of monotherapy were associated with increased risk for recurrence (hazard ratio = 1.31, 95% confidence interval [CI: 1.02, 1.67], Wald χ2 = 4.41, p = .036), and not having a comorbid anxiety disorder diagnosis at study baseline reduced the risk of recurrence (hazard ratio = .31, 95% CI [.10, .94], Wald χ2 = 4.28, p = .039).

CONCLUSIONS

The study supported the benefits of maintenance treatment for treatment-naïve patients who remitted to initial monotherapy; nevertheless, remitted patients with a comorbid anxiety disorder diagnosis at the beginning of treatment or residual depressive symptoms after initial treatment were at risk for poorer long-term outcomes. (PsycINFO Database Record

Hyperactivation in Cognitive Control and Visual Attention Brain Regions During Emotional Interference in Adolescent Depression

BACKGROUND

Individuals with Major Depressive Disorder (MDD) are characterized by biases in attention to negative emotional material. While there is evidence that anomalous functioning in frontocingulate regions may underlie these biases, we know little about the neural correlates of negative emotional biases in depressed adolescents.

METHODS

Eighteen adolescents diagnosed with MDD and 21 matched healthy control (CTL) adolescents underwent fMRI while performing an emotional distractor task. On each trial participants were presented with task-relevant house pairs and task-irrelevant face pairs. Participants indicated whether the house pairs were identical while ignoring the face pairs, which were either fearful, sad, or neutral.

RESULTS

Despite equivalent behavioral performance (response time and accuracy) between groups, adolescents with MDD exhibited greater activation in frontocingulate regions, including dorsal anterior cingulate cortex (dACC) and inferior frontal gyrus/middle frontal gyrus (IFG/MFG), and occipitoparietal regions, including lateral occipital cortex and superior parietal lobule when ignoring fearful versus neutral faces. Response times to these trial conditions also correlated negatively with activation in IFG/MFG and lateral occipital cortex suggesting these regions are recruited in order to effectively ignore emotional distractors. Groups did not differ when ignoring sad versus neutral faces or fearful versus sad faces.

CONCLUSIONS

Adolescents with MDD recruit both cognitive control and visual attention regions to a greater degree than do CTL adolescents, reflecting greater cognitive demand when downregulating threat-related stimuli.

Time-Frequency Reward-Related Delta Prospectively Predicts the Development of Adolescent-Onset Depression

BACKGROUND

A blunted reward positivity (RewP), an event-related potential elicited by feedback indicating monetary gain relative to loss, was recently shown to prospectively predict the development of adolescent-onset depression. Time-frequency-based representations of this activity (e.g., reward-related delta) have also been associated with depression. This study is a reanalysis of the time-domain RewP investigation to examine the incremental value of time-frequency indices in the prediction of adolescent-onset depression.

METHODS

The sample included 444 13- to 15-year-old girls with no lifetime history of a depressive disorder. At baseline, adolescents completed a monetary guessing task, and both time-domain and time-frequency analyses were conducted on the event-related potential response to gain and loss feedback. Lifetime psychiatric history in the adolescent and a biological parent were evaluated with diagnostic interviews, and adolescents' current depressive symptoms were assessed using a self-report questionnaire. Adolescents were interviewed again approximately 18 months later to identify first-onset depressive disorder.

RESULTS

Blunted reward-related delta predicted first-onset depressive disorder 18 months later, independent of the time-domain RewP and psychosocial risk factors (i.e., adolescent baseline depressive symptoms, adolescent and parental psychiatric history). In contrast, loss-related theta did not predict the development of depression. Reward-related delta increased sensitivity (73.8% to 82.8%) and positive predictive value (45.0% to 70.9%) for first-onset depressive disorder when applied in parallel and in series, respectively, with baseline depressive symptoms and the time-domain RewP.

CONCLUSIONS

This study provides evidence that frequency-based representations of event-related potentials provide incremental value in the prediction of psychiatric disorders.

Adrenocortical sensitivity, moderated by ongoing stress, predicts drinking intensity in alcohol-dependent men

Allostatic load from both environmental stressors and persistent glucocorticoid secretion has been associated with disease severity in alcohol dependence. Heightened relapse risk and/or drinking severity, in particular, may be a reaction to alcohol- and withdrawal-induced changes in physiological stress response systems coupled with ongoing life stress, although their shared contributions upon drinking severity have not been assessed. To investigate the combined contribution of hypothalamic-pituitary-adrenal (HPA) reactivity and environmental stressors (e.g., ongoing life stress) to relapse severity in alcohol-dependent men following treatment, plasma adrenocorticotropin (ACTH) and cortisol were obtained in 4-6 weeks abstinent alcohol-dependent men (n=41) following a psychosocial stressor [the Trier Social Stress Test (TSST)] and two pharmacological provocations [ovine corticotropin releasing factor (oCRH) and cosyntropin]. Following treatment discharge, drinking outcomes (primary outcome: drinks per drinking day (DDD); secondary outcomes: total drinks and drinking days) were assessed weekly and ongoing life stress was assessed biweekly for 24 weeks following treatment discharge. Generalized estimating equation models of drinking severity were fit with basal and stimulated ACTH and cortisol concentrations as predictors and ongoing life stress as the moderator. Greater levels of life stress were independently associated with greater drinking intensity (DDD and total drinks) but not frequency (days drinking). Higher basal cortisol:ACTH or provoked cortisol:ACTH ratios were strongly associated with greater post-treatment DDD in individuals who experienced higher levels of ongoing stress. In conclusion, ongoing life stress is associated with post-treatment drinking intensity in alcohol dependent men; stress also strengthens the relationship between adrenocortical sensitivity and post-treatment drinking. Physiological measures of allostatic load and environmental stressors conjointly increase relapse intensity.

Factor structure of the Emotions as a Child Scale in late adolescence and emerging adulthood

Although the Emotions as a Child Scale (EAC) has been widely used in research with children and adolescents, no peer-reviewed studies have examined its factor structure using factor analytic methods. Likewise, the measurement equivalence of the scale across gender and race/ethnicity has never been investigated. To address these gaps, this study examines the factor structure of the scale in late adolescence and emerging adulthood, compares it to previous theory-driven models, and evaluates its measurement invariance across gender and 2 racial/ethnic groups. Participants were 1,087 individuals participating in a larger community-based study of adolescent health (M = 19.35 years, SD = 1.19). Results of exploratory and confirmatory factor analyses suggest that a 2-factor model from a shortened version of the scale (3 items were eliminated from each emotion scale), involving supportive and unsupportive socialization strategies, is a good alternative model to the original 5-factor structure for researchers interested in broader conceptualization of emotion socialization strategies. This 2-factor model of the shortened scale showed stronger measurement invariance across gender than racial/ethnic groups. Future studies addressing racial/ethnic differences with this measure should compare the results with and without imposing corresponding invariance constraints on noninvariant items. Findings of this study should be replicated in other age and racial/ethnic groups, and examine the predictive utility of the abbreviated 2-factor model for emotion-related outcomes across development. (PsycINFO Database Record

Study protocol for a randomized controlled trial of a group cognitive-behavioral course for depressed adolescents

BACKGROUND

School dropout is considered a serious problem in high schools in Norway. Despite studies which emphasize the importance of mental health as a unique risk factor for dropout, interventions have only taken this into account to a limited extent. Depression is one of the most prevalent mental health issues. Here we report the study protocol of a cluster randomized controlled trial of a group-CBT intervention, "Adolescent Coping with Depression Course" (ACDC) for depressed adolescents in upper secondary school.

METHOD

The aim of this study is to investigate the extent to which ACDC can reduce depressive symptoms, prevent dropout and improve academic and social functioning among adolescents in upper secondary school. This study investigates the effectiveness of ACDC through a cluster randomized trial, in which course leaders are randomized to experimental or control conditions where the control groups receive usual care.

DISCUSSION

The intervention is expected to reduce depressive symptoms among adolescents. The study will further investigate whether the intervention can prevent dropout and improve academic and social functioning among adolescents in upper secondary school.

TRIAL REGISTRATION

ISRCTN registry ISRCTN19700389 . Registered 6 October 2015.

Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset

Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

From Violence in the Home to Physical Dating Violence Victimization: The Mediating Role of Psychological Distress in a Prospective Study of Female Adolescents

Symptoms of psychological distress may be one pathway through which child maltreatment and witnessing violence in the home relate to dating violence victimization. This study examined whether psychological distress in mid-adolescence mediated the link between child maltreatment and witnessing violence in early adolescence and dating violence victimization in young adulthood. The sample included female participants (N = 532) from the National Survey of Child and Adolescent Well Being who were 18 years or older in the fifth and final wave of data collection. At the time of entry into the study, participants were 12.81 (SD = 1.23) years old. Sixteen percent of participants identified as Hispanic; 53 % identified their race as White, 33 % as Black, and 11 % as American Indian. Results showed that psychological distress may play a causal role in the relationship of violence in the home to dating violence victimization. Interventions targeting psychological distress, particularly in samples at risk for child maltreatment, may reduce the risk of dating violence victimization.

The Impact of Asynchronous Pubertal Development on Depressive Symptoms in Adolescence and Emerging Adulthood Among Females

Puberty is accompanied by numerous psychological and interpersonal challenges, including a dramatic rise in the prevalence of depression among girls. Pubertal timing has been identified as a potent predictor of depressive symptoms among females, but less is known about other features of puberty. The present study sought to address this gap in the literature by examining the effect of pubertal synchrony, the degree to which morphological indicators of puberty develop concurrently, on depressive symptoms in adolescence and emerging adulthood in a longitudinal sample. Among 355 female participants, asynchronous development at age 13 was associated with increased depressive symptoms at age 20, but not age 15. Additional analyses indicated that pubertal timing moderated the association between synchrony and depressive symptoms at age 20, such that girls who exhibited asynchronous development had the highest levels of depressive symptoms when they matured later than peers. Results provide initial empirical support for the role of pubertal synchrony in the development of depression among females and are discussed with regard to the biopsychosocial processes that may connect features of puberty with the long-term development of psychopathology.

Hypothesis-driven research for G × E interactions: the relationship between oxytocin, parental divorce during adolescence, and depression in young adulthood

Research in molecular genetics has generally focused on genome-wide association studies (GWAS) and exploratory candidate gene and candidate gene–environment (G × E) studies. In this article it is proposed that hypothesis-driven and biologically informed research provides a complementary approach to GWAS to advance pressing research questions about G × E relations that are of public health relevance. Prior research studies and developmental and evolutionary theory were used to guide hypothesis testing of G × E relationships in this study. The study investigated whether the oxytocin polymorphism, rs53576, moderated the relationship between parental divorce during adolescence and depression symptoms in young adulthood. Oxytocin is a neuropeptide that has been related to the regulation of complex social cognition and behaviors such as empathy, attachment, and nurturance. We hypothesized that the GG polymorphism would be associated with more depressive symptoms following parental divorce, and that this effect would be stronger in females than males. The sample consisted of 340 individuals who participated in a longitudinal study with data used both from adolescence and young adulthood. Findings using prospective follow-up and autoregressive change models supported the hypothesized relationships. Young adult females who had experienced parental divorce during adolescence and had the GG oxytocin genotype reported almost twice as many depressive symptoms relative to young adult females who also experienced parental divorce during adolescence but had the AA or AG genotype. This pattern was not indicated among males. Findings were discussed with regard to how molecular genetic factors in combination with environmental stressors, such parental divorce, framed within a developmental framework may facilitate the future study of G × E relationships in the parental divorce-child adjustment literature and contribute to a prevention science perspective.

Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent course?

Premorbid risk for major depressive disorder (MDD) and predictors of an earlier onset and recurrent course were examined in two studies in a large, community-based sample of parents and offspring, prospectively assessed from late childhood into adulthood. In Study 1 (N = 2,764 offspring and their parents), parental psychiatric status, offspring personality at age 11, and age 11 offspring internalizing and externalizing symptoms predicted the subsequent development of MDD, as did poor quality parent-child relationships, poor academic functioning, early pubertal development, and childhood maltreatment by age 11. Parental MDD and adult antisocial behavior, offspring negative emotionality and disconstraint, externalizing symptoms, and childhood maltreatment predicted an earlier onset of MDD, after accounting for course; lower positive emotionality, trait anxiety, and childhood maltreatment predicted recurrent MDD, after accounting for age of onset. In Study 2 (N = 7,146), we examined molecular genetic risk for MDD by extending recent reports of associations with glutamatergic system genes. We failed to confirm associations with MDD using either individual single nucleotide polymorphism based tests or gene-based analyses. Overall, results speak to the pervasiveness of risk for MDD, as well as specific risk for early onset MDD; risk for recurrent MDD appears to be largely a function of its often earlier onset.

Empirically derived subtypes of serious emotional disturbance in a large adolescent sample

PURPOSE

The heterogeneity of serious emotional disturbance has been thoroughly documented among adolescents with nationally representative data derived from structured interviews, although use of these interviews may not be feasible within the context of brief and self-administered school surveys. This study seeks to identify distinct subtypes of serious emotional disturbance in a large school-based sample.

METHODS

A total of 108,736 students fully completed the K6 scale that was included on the 2012 Kentucky Incentives for Prevention Survey. Latent class analysis was used to derive subtypes of serious emotional disturbance among students receiving a positive screen (n = 15,147). To determine significant predictors of class membership, adjusted rate ratios and 95 % confidence intervals were calculated using multinomial logistic regression.

RESULTS

A four-class model was the most parsimonious, with four distinct subtypes emerging that varied by both symptom type and severity: comorbid moderate severity, comorbid high severity, anxious moderate severity, and depressed high severity. Age, gender, race/ethnicity, family structure, substance use, antisocial behavior, role impairments, and peer victimization were significant predictors of class membership, although the magnitude of these effects was stronger for the two high severity groups.

CONCLUSIONS

Our results suggest heterogeneity of serious emotional disturbance by both symptom type and severity. Prevention programs may benefit by shifting focus from specific disorders to the core features of serious emotional disturbance, including psychological distress, high comorbidity, and role impairments.

Effects of chronic interpersonal stress exposure on depressive symptoms are moderated by genetic variation at IL6 and IL1β in youth

AIMS

Close to one third of patients with major depression show increases in pro-inflammatory cytokines, which are in turn associated with risk for inflammatory disease. Genetic variants that enhance immune reactivity may thus enhance inflammatory and depressive reactions to stress. The aim of the present study was to investigate a trio of functional SNPs in the promoter regions of IL6 (-174G>C, rs1800795), IL1β (-511C>T, rs16944), and TNF (-308G>A, rs1800629) as moderators of the relationship between chronic stress exposure and elevations in depressive symptoms.

METHODS

Participants were 444 Australian youth (mean age=20.12) whose exposure to chronic stress in the past 6months was assessed using the semi-structured UCLA Life Stress Interview, and who completed the Beck Depression Inventory II at ages 15 and 20. Between ages 22 and 25, all participants in the selected sample provided blood samples for genotyping.

RESULTS

In line with a hypothesized moderation effect, -174G allele carriers at IL6 had fewer depressive symptoms following interpersonal stress, relative to C/C homozygotes with equal interpersonal stress exposure. However, IL6 genotype did not moderate the effects of non-interpersonal stress exposure (i.e., financial, work and health-related difficulties) on depression. Also in line with hypotheses, the -511C allele in IL1β, previously associated with higher IL-1β expression, was associated with more severe depression following chronic interpersonal stress exposure, relative to T/T homozygotes. Again, the moderating effect was specific to interpersonal stressors and did not generalize to non-interpersonal stress. TNF was not a moderator of the effects of either interpersonal or non-interpersonal stress on later depression outcomes.

CONCLUSION

Findings were consistent with the hypothesis that pro-inflammatory genetic variation increases the risk of stress-induced depression. The present results provide evidence of a genetic mechanism contributing to individual differences in depressive symptomatology following interpersonal stress exposure.

Motor vehicle driving in high incidence psychiatric disability: comparison of drivers with ADHD, depression, and no known psychopathology

Although not often discussed in clinical settings, motor vehicle driving is a complex multitasking endeavor during which a momentary attention lapse can have devastating consequences. Previous research suggests that drivers with high incidence psychiatric disabilities such as ADHD contribute disproportionately to collision rates, which in turn portend myriad adverse social, financial, health, mortality, and legal outcomes. However, self-referral bias and the lack of psychiatric comparison groups constrain the generalizability of these findings. The current study addressed these limitations and examined the unique associations among ADHD, Depression, and adverse driving outcomes, independent of self-selection, driving exposure, and referral bias. The Strategic Highway Research Program (SHRP-2) Naturalistic Driving Study comprises U.S. drivers from six sites selected via probability-based sampling. Groups were defined by Barkley ADHD and psychiatric diagnosis questionnaires, and included ADHD (n = 275), Depression (n = 251), and Healthy Control (n = 1828). Primary outcomes included self-reported traffic collisions, moving violations, collision-related injuries, and collision fault (last 3 years). Accounting for demographic differences, ADHD but not Depression portended increased risk for multiple violations (OR = 2.3) and multiple collisions (OR = 2.2). ADHD but not Depression portended increased risk for collision fault (OR = 2.1). Depression but not ADHD predicted increased risk for self-reported injury following collisions (OR = 2.4). ADHD appears uniquely associated with multiple collisions, multiple violations, and collision fault, whereas Depression is uniquely associated with self-reported injury following a collision. Identification of the specific mechanisms underlying this risk will be critical to designing effective interventions to improve long-term functioning for drivers with high incidence psychiatric disability.

Type 1 diabetes in young adulthood

Type 1 diabetes has traditionally been studied as a chronic illness of childhood. However, young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by youth with diabetes as they age into adulthood. Most young adults experience multiple transitions during this unstable developmental period, including changes in lifestyle (e.g., education, occupation, living situation), changes in health care, and shifting relationships with family members, friends, and intimate others. Young adults with type 1 diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. Despite these critical health and psychosocial concerns, there is a notable lack of evidence-based clinical services and supports for young adults with type 1 diabetes. We review relevant evolving concerns for young adults with type 1 diabetes, including lifestyle considerations, health care transitions, psychosocial needs, and changes in supportive networks, and how type 1 diabetes impacts and is impacted by these key developmental considerations. Specific avenues for intervention and future research are offered.

Social stress and the oxytocin receptor gene interact to predict antisocial behavior in an at-risk cohort

Polymorphisms in the oxytocin receptor gene are commonly associated with prosocial behaviors in the extant literature, yet their role in antisocial behaviors has rarely been explored, particularly during the transition from adolescence to early adulthood. We examined a prospective cohort (N = 404), collecting youth, mother, and clinician reports of conduct-disordered and antisocial behavior at ages 15 and 20. The oxytocin receptor gene rs53576 polymorphism was hypothesized to interact with social stress to predict antisocial outcomes. Structural equation modeling results revealed a significant main effect at age 15 (p = .025); those with the G allele exhibited higher levels of conduct problems. Structural equation modeling revealed a significant Gene × Environment interaction at age 20 (p = .029); those with the G allele who experienced high social stress exhibited higher levels of antisocial behavior. Heterozygous (AG) grouping models were compared, and parameter estimations supported G dominant groupings. These novel findings suggest that rs53576 polymorphisms may influence social salience and contribute to risk for antisocial outcomes, particularly under conditions of high social stress.

An analysis of natural mentoring relationship profiles and associations with mentees' mental health: considering links via support from important others

We explored associations between natural mentoring relationship profiles and young adults' life satisfaction and symptoms of depression via participants' perceived support from important others accounting for participants' perceived support and mental health prior to the onset of their natural mentoring relationships. Participants included 396 young adults (57% female; mean age = 30.97, SD = .6), the majority of whom identified as Black or African American (79% Black, 18% White, 3% Biracial). Most participants had completed high school but few participants (13%) had completed degrees from 4 year institutions. We used a latent profile approach to identify natural mentoring relationship profiles and employed structural equation modeling to test our study hypotheses. Slightly over half of study participants (53%) reported the presence of a natural mentor in their lives since the age of 14. Results suggest that natural mentoring relationships characterized by high levels of relational closeness and either extended relationship duration or frequent contact may promote improvements in psychological well-being among mentees over time via greater experiences of social support from important others.

Natural mentors, mental health, and substance use: Exploring pathways via coping and purpose

The current study tested whether relationships with natural mentors may have contributed to fewer internalizing symptoms and less substance use among emerging adults through improved perceptions of coping abilities and an increased sense of life purpose. In addition, the current study investigated whether natural mentor role (i.e., familial vs. nonfamilial mentor) and the amount of time spent together in shared activities influenced emerging adults' internalizing behaviors and substance use via coping and purpose. Participants in the current study included 3,334 emerging adults (mean age = 20.8, 48.6% female, 75.4% white) from diverse regions across the United States who participated in an online survey. Participants were recruited via an adapted Web version of Respondent-Driven Sampling (webRDS). Forty-two percent of participants reported a relationship with a natural mentor. Indirect relationships between natural mentor presence and emerging adults' mental health and substance use via coping and purpose were found. Additional analyses indicated that emerging adults may benefit more from relationships with nonfamilial natural mentors in comparison with familial natural mentors. Findings also suggested that the amount of time participants spent with their natural mentors in shared activities was related to participants' alcohol use. Implications of this study's findings and directions for future research are discussed.

Indicators of Adolescent Depression and Relationship Progression in Emerging Adulthood

Adolescent depression may be associated with future relationship problems that have long-term consequences given the developmental importance and health benefits of forming committed unions in emerging adulthood. The authors examined associations between emotional and behavioral indicators of adolescent depression (depressive symptoms, alcohol problems, and suicidal ideation) and romantic relationship and union formation and dissolution in emerging adulthood (n = 14,146) using the National Longitudinal Study of Adolescent Health. Adolescent alcohol problems were associated with more romantic relationships in emerging adulthood. Emerging adults with depressive symptoms or alcohol problems in adolescence were significantly more likely to enter into a cohabiting union, and those with adolescent alcohol problems were less likely to marry. Cohabiting emerging adults with a history of adolescent depressive symptoms were less likely to marry, whereas suicidal ideation was associated with a decreased likelihood of cohabitation dissolution. Implications for future research are discussed.

Cognitive control network connectivity in adolescent women with and without a parental history of depression

BACKGROUND

Adolescent women with a parental history of depression are at high risk for the onset of major depressive disorder (MDD). Cognitive theories suggest this vulnerability involves deficits in cognitive control over emotional information. Among adolescent women with and without a parental history of depression, we examined differences in connectivity using resting state functional connectivity analysis within a network associated with cognitive control over emotional information.

METHODS

Twenty-four depression-naïve adolescent women underwent resting state functional magnetic resonance imaging (fMRI). They were assigned to high-risk (n=11) and low-risk (n=13) groups based their parents' depression history. Seed based functional connectivity analysis was used to examine group differences in connectivity within a network associated with cognitive control.

RESULTS

High-risk adolescents had lower levels of connectivity between a right inferior prefrontal region and other critical nodes of the attention control network, including right middle frontal gyrus and right supramarginal gyrus. Further, greater severity of the parents' worst episode of depression was associated with altered cognitive control network connectivity in their adolescent daughters.

CONCLUSIONS

Depressed parents may transmit depression vulnerability to their adolescent daughters via alterations in functional connectivity within neural circuits that underlie cognitive control of emotional information.

Prevention of depression in at-risk adolescents: longer-term effects

IMPORTANCE

Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves.

OBJECTIVE

To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer-term (multiyear) follow-up.

DESIGN

A 4-site randomized clinical trial with 33 months of follow-up was conducted. Recruitment of participants was from August 2003 through February 2006.

SETTING

The study settings included a health maintenance organization, university medical centers, and a community mental health center.

PARTICIPANTS

Three hundred sixteen adolescent (aged 13-17 years) offspring of parents with current and/or prior depressive disorders; adolescents had histories of depression, current elevated depressive symptoms, or both but did not currently meet criteria for a depressive disorder.

INTERVENTIONS

The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly assigned to either the CBP program or usual care (UC).

MAIN OUTCOMES AND MEASURES

The primary outcome was a probable or definite episode of depression (Depression Symptom Rating score ≥4) for at least 2 weeks through the month 33 follow-up evaluation.

RESULTS

Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared with those in UC. Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC (number needed to treat, 6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly different. A 3-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on intervention effectiveness varied across sites.

CONCLUSIONS AND RELEVANCE

The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period. Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00073671.

The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of depression, with evidence that peer and academic difficulties mediate predictions of later depression from ADHD. In the present study, we hypothesized that parent-child relationship difficulties may be an additional potential mediator of this association. Academic, peer, and parent-child functioning were tested as mediators of the association of attention problems and depression in two distinctly different yet complementary samples. Study 1 was a cross-sectional sample of 5- to 10-year-old children (N = 230) with and without ADHD. Study 2 was a prospective longitudinal sample of 472 youth, followed prospectively from birth to age 20 years, at risk for depression. Despite differences in age, measures, and designs, both studies implicated peer and parent-child problems as unique mediators of depressive symptoms, whereas academic difficulties did not uniquely mediate the ADHD-depression association. Furthermore, inattention symptoms, but not hyperactivity, predicted depressive symptoms via the disruption of interpersonal functioning. The inclusion of oppositional defiant disorder into models impacted results and supported its independent role in parent-child problems. Implications include support for interventions that target interpersonal competence, which may effectively reduce the risk of depression among children with ADHD.

Testing the feasibility of therapeutic identification of depression in young people in British general practice

PURPOSE

Depression in young people attending primary care is common and is associated with impairment and recurrence into adulthood. However, it remains under-recognized. This study evaluated the feasibility of training primary care practitioners (PCPs) in screening and therapeutic identification of adolescent depression, and assessed its effects on practitioner knowledge, attitudes, screening, and management.

METHODS

We trained PCPs in therapeutic identification of adolescent depression during general practice consultations. To assess changes in knowledge and attitudes, PCPs completed questionnaires before and after training. We ascertained changes in depression screening and identification rates in the 16 weeks before and after training from electronic medical records of young people aged 13-17 years. Post-training management of depression was recorded on a checklist.

RESULTS

Aspects of practitioner knowledge (of depression prevalence and treatment guidelines) and confidence (regarding depression identification and management) increased significantly (all p < .04). Overall screening rates were enhanced from .7% to 20% after the intervention and depression identification rates from .5% before training to 2% thereafter (29-fold and fourfold increases, respectively). Identification was significantly associated with PCP knowledge of prior mental health problems (Fisher's exact test, p = .026; odds ratio, 4.884 [95% confidence interval, 1.171-20.52]) and of psychosocial stressors (Fisher's exact test, p = .001; odds ratio, 17.45 [95% confidence interval, 2.055-148.2]).

CONCLUSIONS

The Therapeutic Identification of Depression in Young People program is a feasible approach to improving primary care screening for adolescent depression, with promising evidence of effectiveness. Further evaluation in a randomized trial is required to test practitioner accuracy, clinical impact, and cost benefit.