Developmental heterogeneity in adolescent depressive symptoms: associations with smoking behavior

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

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

Emotion Regulation Predicts Depressive Symptoms in Adolescents: A Prospective Study

Emotion regulation as a proximal factor has been linked with depressive symptoms. However, studies have mainly focused on a limited number of strategies and have mostly been cross-sectional in design. This is particularly evident when examining the protective effects of adaptive strategies. This study aimed to investigate the prospective relationship between putatively adaptive and maladaptive emotion regulation strategies and depressive symptoms among adolescents. Additionally, a person-oriented approach was applied to identify latent classes of adolescents based on their depressive symptoms and compared these classes in terms of their adaptive and maladaptive strategies. Two waves of data from a prospective study, which included 1371 youth (mean age: 15.66 years; SD = 0.49 years; 55.1% girls), were analysed. The two points of data collection were spaced approximately half a year apart. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale, and putatively adaptive and maladaptive emotion regulation strategies were assessed with the Cognitive Emotion Regulation Questionnaire. Seven strategies (acceptance, positive refocusing, positive reappraisal, putting into perspective, self-blame, rumination, and catastrophizing) were categorised into adaptive and maladaptive factors using exploratory structural equation modeling. After controlling for gender, age, and depressive symptoms at Time 1, both maladaptive and adaptive emotion regulation strategies at Time 1 predicted depressive symptoms at Time 2. Three subgroups emerged based on the intensity of depressive symptoms across the waves: the stable low, stable moderate, and stable high depressive symptom groups. The use of maladaptive emotion regulation strategies (such as rumination, self-blame, and catastrophizing) at Time 1 was more pronounced in the stable moderate and high symptom groups compared to the stable low depressive symptom group. The comparable prospective associations between putatively adaptive and maladaptive strategies with symptoms suggest the need to identify factors that may mitigate the negative impact of maladaptive emotion regulation and/or promote adaptive emotion regulation to buffer the effects of everyday stressors.

Influence of Psychological Factors on College Students' Smoking Behavior: Moderating Role of Tobacco Advertising Receptivity and Health Behavior

Objectives: The main objective of this study was to examine the role of psychological factors affecting college students' smoking behavior. We considered 3 psychological factors in this study - depressive symptoms, novelty seeking personality, and stress, which are common among learners in institutions of higher learning. Furthermore, we also considered the moderating effect of tobacco advertising receptivity and health behavior. Methods: In this study, we used a cross-sectional research design, wherein data were collected through a survey questionnaire, designed on a Likert scale. We received 160 responses for data analysis. Our primary analysis used partial least squares (PLS). Results: Depressive symptoms, novelty seeking personality, stress, and tobacco advertising receptivity had significant positive relationships with college students' smoking behavior; however, pro-health behavior had a negative effect on smoking behavior. Conclusion: Our results reveal a major role of depressive symptoms, novelty seeking personality and stress in shaping the smoking behavior of college students in China. Additionally, the moderating variables of tobacco advertising receptivity and health behavior showed considerable impact, as both showed a positive influence on psychological factors and smoking behavior of college students. Finally, our results provide insights for practitioners to devise strategies to address smoking behavior in college students.

Adolescent Substance Use and the Brain: Behavioral, Cognitive and Neuroimaging Correlates

Adolescence is an important ontogenetic period that is characterized by behaviors such as enhanced novelty-seeking, impulsivity, and reward preference, which can give rise to an increased risk for substance use. While substance use rates in adolescence are generally on a decline, the current rates combined with emerging trends, such as increases in e-cigarette use, remain a significant public health concern. In this review, we focus on the neurobiological divergences associated with adolescent substance use, derived from a cross-sectional, retrospective, and longitudinal studies, and highlight how the use of these substances during adolescence may relate to behavioral and neuroimaging-based outcomes. Identifying and understanding the associations between adolescent substance use and changes in cognition, mental health, and future substance use risk may assist our understanding of the consequences of drug exposure during this critical window.

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

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

Longitudinal association between tobacco use and the onset of depressive symptoms among Swedish adolescents: the Kupol cohort study

Tobacco use in adolescence has been linked to the onset of depressive symptoms, but results of previous studies are inconsistent. The aim of this study was to clarify if tobacco use during early adolescence may affect the short-term onset of depressive symptoms. The study is based on Swedish Kupol study (3959 students). Current cigarette smoking, snus use, and tobacco dependence were assessed using questionnaires at baseline and 1-year follow-up. Outcome was the onset of depressive symptoms measured with the CES-DC scale, using a cut-off ≥ 30 as threshold. Adjusted linear and logistic regression models were employed to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI). CES-DC mean score at baseline was 14.3, higher in females than males (17.5 vs 10.9). The incidence of depressive symptoms at follow-up was 8.3%, greater in current than never smokers at baseline (13.7% vs 3.1%). Current cigarette smoking at the age of 13 years was strongly associated with the onset of depressive symptoms 1 year later, particularly in males (OR 12.7, 95% CI: 2.5-63.9), with a significant interaction between tobacco use and sex; feeling dependent on tobacco was also associated with depressive symptoms in males but not in females. Snus and overall tobacco use were not associated with the onset of depressive symptoms. Tobacco use during adolescence appears to influence the onset of depressive symptoms, with a stronger association in males than females. Pubertal maturation and sex-specific response patterns to the scale instrument may explain the moderating effect of sex.

Review: Longitudinal trajectories of child and adolescent depressive symptoms and their predictors - a systematic review and meta-analysis

BACKGROUND

With depression predicted to contribute to an increased disease burden in coming decades, prevention efforts have become increasingly important. In order to prevent depression it is valuable to identify and classify longitudinal patterns of depressive symptoms across development, ideally beginning early in childhood. To achieve this, longitudinal studies are increasingly using person-centered data-analytic methods to model subgroups with similar developmental patterns (trajectories) of depressive symptoms.

METHOD

A search was completed for English language studies that longitudinally modeled depressive symptom trajectories in nonclinical populations with a baseline age of <19 years. Study characteristics were extracted, prevalence rates and risk factors were summarized, a random-effect meta-analysis was undertaken, and risk of bias analysis completed.

RESULTS

Twenty studies published between 2002 and 2015 were included. Participants were recruited at ages 4 through 17 (average age 12.34) and followed longitudinally for an average of 7.45 years. Between 3 and 11 trajectory subgroups were identified. A random pooled effect estimate identified 56% [95% Confidence Interval (CI) 46-65%] of the sampled study populations (N = 41,236) on 'No or low' depressive symptom trajectories and 26% (CI 14-40%) on a 'Moderate' trajectory. 'High', 'Increasing', and 'Decreasing' depressive symptom subgroups were evident for 12% (CI 8-17%). Moderate symptoms were associated with poorer adjustment and outcomes relative to low symptom groups. 'High' or 'Increasing' trajectories were predominantly predicted by: female gender, low socioeconomic status, higher stress reactivity; conduct issues; substance misuse, and problems in peer and parental relationships.

CONCLUSIONS

The review highlighted consistent evidence of subgroups of children and adolescents who differ in their depressive symptom development over time. The findings suggest preventative interventions should evaluate the longer term benefits of increasing membership in low and moderate trajectories, while also targeting reductions in high-risk subgroups. Considerable between-study method and measurement variation indicate the need for future trajectory studies to use standardized methods.

Transitions of Developmental Trajectories of Depressive Symptoms Between Junior and Senior High School Among Youths in Taiwan: Linkages to Symptoms in Young Adulthood

We investigated the heterogeneous developmental trajectories of depressive symptoms in junior and senior high school, the transitions to different trajectories after entering senior high school, and the linkages to the development of depressive symptoms in early adulthood among Taiwanese adolescents. An eight-wave longitudinal data set was analyzed, including 2687 Taiwanese adolescents (51.2% boys, M age = 14.3 at first wave). Using a manual three-step latent transition growth mixture model, we found that a three-class solution fit the data for both junior high school (termed high-improving, cumulative, and JS-low-stable) and senior high school period (termed heightening, moderate-stable, and HS-low-stable). The depressive symptoms of most individuals maintained at a low level (i.e., low-stable) from adolescence to early adulthood; however, nearly a quarter of the adolescents reported depressive symptoms that were moderately or highly severe in senior high school and beyond. More than 30% of the participants experienced transitioning into a different developmental trajectory between junior and senior high school. When perceiving a higher level of paternal behavioral control, adolescents categorized in the high-improving class in junior high school would have a higher chance to transition to the moderate-stable class than to HS-low-stable class in senior high school. Adolescent boys and girls did not differ in the probability of transitioning between trajectories across junior and senior high school. However, a clear and consistent pattern of symptoms between late adolescence and early adulthood was not observed. These results help elucidate the heterogeneity and fluidity associated with the development of depressive symptoms between early adolescence and early adulthood in light of school transition among youths in Taiwan.

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.

Trajectories of emotional symptoms in adolescence: impact on alcohol use

Purpose

The purpose of this paper is to explore how different trajectories of emotional symptoms relate to alcohol use in adolescence.

Design/methodology/approach

In all, 431 participants (majority female), aged approximately 13 years at baseline were followed over three years and reported on their emotional symptoms and alcohol use. Latent class growth analyses explored different trajectories of emotional symptoms and regression models were run to relate these trajectories to alcohol use (full standard drink, and binge drinking) at 36-month follow-up (age 16 years).

Findings

While the majority of adolescents were best characterised by low-stable emotional symptoms, those with high-stable symptoms were more likely to be have consumed a full standard drink of alcohol and binge drunk when aged 16 years.

Research limitations/implications

Findings highlight the importance of prevention and early intervention, particularly targeting adolescents with elevated stable emotional symptoms who were more likely to be using alcohol at 16 years of age.

Originality/value

The present study is one of the first longitudinal investigations into the use of alcohol by community adolescents with different emotional symptom trajectories.

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

Variations in symptom trajectories within a population may represent distinct groups with different etiologies and outcomes. This study aimed to identify subgroups of depression symptom trajectories in a sample of adolescents, and to describe psychosocial attributes of the different groups. In a longitudinal study, 243 adolescents (121 males and 122 females), were assessed using a battery of measures of temperament, psychopathology, and psychological and behavioral functioning. Four phases of data collection over 7 years spanned average ages of the participants from 12 to 18 years old. Depressive symptoms from each phase were used to model latent class growth trajectories. A 4-group solution was selected as the best-fitting model: (1) ongoing stable low levels of depression; (2) very high depressive symptoms initially, but a steep decrease in symptoms over time; (3) moderately high depressive symptoms initially, but symptoms decreased over time; and (4) initially low levels of symptoms that increased over time. Trajectory group membership was associated with a range of psychosocial variables including temperament, childhood maltreatment, and young adult quality of life. Characterising these subgroups allows for a better understanding of how the interaction of risk factors increases the likelihood of depression and other poor outcomes, and highlights the importance of early interventions to prevent and treat adolescent depression.

Depressive symptom trajectories in late adolescence and early adulthood: A systematic review

OBJECTIVE

In adolescents and young adults, depressive symptoms are highly prevalent and dynamic. For clinicians, it is difficult to determine whether a young person reporting depressive symptoms is at risk of developing ongoing mood difficulties or whether symptoms form part of a transient maturational process. Trajectory analyses of longitudinally assessed symptoms in large cohorts have the potential to untangle clinical heterogeneity by determining subgroups or classes of symptom course and their risk factors, by interrogating the impact of known or suspected risk factors on trajectory slope and intercept and by tracing the interrelation between depressive symptoms and other clinical outcomes over time.

METHOD

We conducted a systematic review of trajectory studies conducted in cohorts including people aged between 15 and 25 years.

RESULTS

We retrieved 47 relevant articles. These studies suggest that young people fall into common mood trajectory classes and that class membership and symptom course are mediated by biological and environmental risk factors. Furthermore, studies provide evidence that high and persistent depressive symptoms are associated with a range of concurrent health and behavioral outcomes.

CONCLUSION

Findings could assist in the formulation of novel concepts of depressive disorders in young people and inform preventive strategies and predictive models for clinical practice.

The role of bullying in depressive symptoms from adolescence to emerging adulthood: A growth mixture model

BACKGROUND

The present study sought to identify trajectories of depressive symptoms in adolescence and emerging adulthood using a school-based sample of adolescents assessed over a five-year period. The study also examined whether bully and cyberbully victimization and perpetration significantly predicted depressive symptom trajectories.

METHOD

Data from a sample of 1042 high school students were examined. The sample had a mean age of 15.09 years (SD=.79), was 56.0% female, and was racially diverse: 31.4% Hispanic, 29.4% White, and 27.9% African American. Data were examined using growth mixture modeling.

RESULTS

Four depressive symptoms trajectories were identified, including those with a mild trajectory of depressive symptoms, an increasing trajectory of depressive symptoms, an elevated trajectory of depressive symptoms, and a decreasing trajectory of depressive symptoms. Results indicated that bully victimization and cyberbully victimization differentially predicted depressive symptoms trajectories across adolescence, though bully and cyberbully perpetration did not.

LIMITATIONS

Limitations include reliance on self-reports of bully perpetration and a limited consideration of external factors that may impact the course of depression.

CONCLUSIONS

These findings may inform school personnel in identifying students' likely trajectory of depressive symptoms and determining where depression prevention and treatment services may be needed.

The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review

BACKGROUND

Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies.

METHODS

Studies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome.

RESULTS

Outcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results.

CONCLUSIONS

The literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences.

IMPLICATIONS

We systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.

A powerful phenotype for gene-finding studies derived from trajectory analyses of symptoms of anxiety and depression between age seven and 18

To investigate the utility of longitudinal data in genetic analyses of symptoms of anxiety and depression, we assessed individual differences between age 7 and 18 using growth mixture models, and investigated the genetic and non-genetic factors contributing to the trajectories. Mothers of 7,706 girl and 7,418 boy twins from the Netherlands Twin Register rated the anxious depression scale (SxAnxDep) of the Child Behavior Check List (CBCL) at age 7, 10, and 12 years. Two thousand seven hundred and six girl and 1,856 boy twins completed the Youth Self Report (YSR) at age 14, 16, and 18. While individual trajectories varied considerably, these differences were largely idiosyncratic and could not be grouped into separate latent classes with class-specific average growth curves. The intercept, which reflects the individuals' baseline level of SxAnxDep across time, explained 55-58% of the total phenotypic variance. The slope factor, which captures a common average trend over time, did not explain variance in the phenotype. This finding also underlines the high level of idiosyncrasy of trajectories that lack a common longitudinal structure. The analyses of twin data showed that the random intercept factor of SxAnxDep during childhood and during adolescence is considerably more heritable than the observations at any single age, namely between 60% and 84%. One explanation is that different factors contribute to the level of symptoms of anxiety and depression at any given time point, including temporary events and emotions. When considering baseline stability, these temporary influences average out, with the result of a more reliable and more heritable phenotype. © 2015 Wiley Periodicals, Inc.

Trajectories of Depressive Symptoms in Canadian Emerging Adults

OBJECTIVES

We identified courses of depressive symptoms in an epidemiological sample of emerging adults.

METHODS

We used latent class growth modeling to identify trajectories of depressive symptoms measured by the 12-item Center for Epidemiological Studies Depression Scale (CES-D) during a 14-year follow-up of 2825 Canadian youths aged 10 to 25 years enrolled in the National Longitudinal Survey of Children and Youth between 1994 and 2009.

RESULTS

After adjustment for youth, parent, and family factors, the 3 distinct trajectories of depressive symptoms were minimal (55%; CES-D < 6), subclinical (39%; CES-D = 9-13), and clinical (6%; CES-D > 18). All trajectories exhibited a parallel course, with peak symptoms at 15 to 17 years of age. Subclinical and clinical symptoms were more common than minimal symptoms in female youths and in respondents with lower self-concept, lower socioeconomic status, poorer interpersonal relations, and chronic health conditions (P < .01).

CONCLUSIONS

Among emerging adults, trajectories of depressive symptoms do not trend upward or downward, and variables associated with identified trajectories demonstrated dose-response effects that agreed with vulnerability-stress theories of depression.

Identifying depressive symptom trajectory groups among Korean adults and psychosocial factors as group determinants

BACKGROUND

Longitudinal research is needed to examine the depressive symptom trajectories of different groups during adulthood and their antecedents and consequences, because depressive symptoms may be changeable and heterogeneous over time.

AIMS

This study examined the number of trajectory groups describing the depressive symptoms of Korean adults, as well as the shape of the trajectories and the association between trajectory group membership and psychosocial factors identified based on the ecosystem model.

METHOD

This study used Nagin's semi-parametric group-based modeling to analyze Year 1 to Year 7 data from Korea Welfare Panel Survey (N = 13,735), a nationally representative sample of community-dwelling adults.

RESULTS

Three distinct trajectory groups were identified: a low stable depressive symptoms group, a moderate depressive symptoms group and a high depressive symptoms group. Result from multinominal logit analysis showed that all psychosocial factors except family relationships affected the likelihood of membership in the three depressive symptoms groups. Especially, self-esteem was the psychosocial factor with the largest impact on depressive symptom trajectory group membership. When screening for depressive symptoms, individuals with a low socioeconomic status should be a primary concern and intervention should be made available to them.

CONCLUSION

Prevention or intervention with members of the identified trajectory groups would likely require integrative approaches targeting psychosocial factors across multiple contexts.

Confounders or intermediate variables? Testing mechanisms for the relationship between depression and smoking in a longitudinal cohort study

INTRODUCTION

The relationship between the onset of smoking and the onset of depression among adolescents has been well document, but the mechanisms underlying the relationship are unclear. This paper uses an empirical method to assess potential intermediate variables in the pathway between changes in depressive symptoms and cigarette smoking in a longitudinal cohort of adolescents.

METHODS

837 participants from a cohort in Montreal, Canada who had not smoked and did not have elevated depressive symptoms at baseline were followed for five years from 1999 to 2003. The role of a set of 15 variables previously identified in the literature as potential confounders were systematically evaluated as predictors of exposure and outcome, for attenuation of the association by more than 10%, and for intra-individual change in the variable after onset of exposure.

RESULTS

The magnitude of the association between smoking and depressive symptoms was fully attenuated after adjustment for all variables included indiscriminately. A concept map was developed detailing the empirical associations between the variables within this data set. Stress, worry about weight, and worry about parents were identified as intermediate variables for both smoking predicting depressive symptoms and depressive symptoms predicting smoking. Cox regressions with appropriate confounders maintained statistical significance.

CONCLUSION

Cigarette smoking is associated with higher depressive symptoms prior to and after inclusion of empirical confounders. Inclusion of intermediate variables in multivariable models can lead to the erroneous conclusion that there is no association between smoking and depression.

Affective, biological, and cognitive predictors of depressive symptom trajectories in adolescence

Heterogeneity in the longitudinal course of depressive symptoms was examined using latent growth mixture modeling among a community sample of 382 U.S. youth from ages 11 to 18 (52.1 % female). Three latent trajectory classes were identified: Stable Low (51 %; displayed low depressive symptoms at all assessments), Increasing (37 %; reported low depressive symptoms at age 11, but then significantly higher depressive symptoms than the Stable Low class at ages 13, 15, and 18), and Early High (12 %; reported high early depressive symptoms at age 11, followed by symptoms that declined over time yet remained significantly higher than those of the Stable Low class at ages 13, 15, and 18). By age 15, rates of Major Depressive Disorder diagnoses among the Early High (25.0 %) and Increasing (20.4 %) classes were more than twice that observed among the Stable Low class (8.8 %). Affective (negative affectivity), biological (pubertal timing, sex) and cognitive (cognitive style, rumination) factors were examined as predictors of class membership. Results indicated general risk factors for both high-risk trajectories as well as specific risk factors unique to each trajectory. Being female and high infant negative affectivity predicted membership in the Increasing class. Early puberty, high infant negative affectivity for boys, and high rumination for girls predicted membership in the Early High class. Results highlight the importance of examining heterogeneity in depression trajectories in adolescence as well as simultaneously considering risk factors across multiple domains.

Associations between trajectories of perceived racial discrimination and psychological symptoms among African American adolescents

Many African American adolescents experience racial discrimination, with adverse consequences; however, stability and change in these experiences over time have not been examined. We examined longitudinal patterns of perceived racial discrimination assessed in Grades 7-10 and how these discrimination trajectories related to patterns of change in depressive and anxious symptoms and aggressive behaviors assessed over the same 4-year period. Growth mixture modeling performed on a community epidemiologically defined sample of urban African American adolescents (n = 504) revealed three trajectories of discrimination: increasing, decreasing, and stable low. As predicted, African American boys were more frequent targets for racial discrimination as they aged, and they were more likely to be in the increasing group. The results of parallel process growth mixture modeling revealed that youth in the increasing racial discrimination group were four times more likely to be in an increasing depression trajectory than were youth in the low stable discrimination trajectory. Though youth in the increasing racial discrimination group were nearly twice as likely to be in the high aggression trajectory, results were not statistically significant. These results indicate an association between variation in the growth of perceived racial discrimination and youth behavior and psychological well-being over the adolescent years.

Different trajectories of depressive symptoms in children and adolescents: predictors and differences in girls and boys

The development of depressive symptoms in childhood and adolescence can follow different pathways. This study examined heterogeneity in the development of self-reported depressive symptoms and the predictive influence of mothers' depressive symptoms, the number of life events, and loss events via growth mixture modeling over a four-year period in a large community sample of German children and adolescents (N = 3,902; mean age 11.39 years; 49.6% female). This procedure was conducted for the total sample as well as for separate samples of girls and boys. Four different classes of trajectories for the total and the girls' model were identified, but only three classes for the boys. Girls showed higher intercepts and stronger increases in symptoms over time, whereas boys displayed stronger decreases. In the total model, mothers' depressive symptoms and the number of life events significantly increased the level of depressive symptoms. In the gender models, only mothers' depressive symptoms showed significant influence on the level of symptoms in girls and boys, whereas for life events this was only true for boys. In every model, the significant predictors discriminated at least between some classes. Loss events showed no significant influence in any model. In sum, there are meaningful differences in the development of depressive symptoms in girls and boys. These results have several implications for prevention and future research.

Heterogeneous trajectories of depressive symptoms: adolescent predictors and adult outcomes

BACKGROUND

Depressive symptoms display heterogeneous trajectories across adolescence and early adulthood. Identifying risk and protective factors for distinct trajectory groups, and their respective outcomes, may provide insight into the etiological underpinnings of different symptom courses and inform the targets and timing of intervention.

METHODS

A school-based sample of 719 adolescents completed four diagnostic evaluations and up to 7 annually mailed questionnaires assessing psychiatric symptoms and psychosocial risk and protective factors. Parental history of psychiatric disorder was assessed. Growth mixture modeling (GMM) was used to identify latent depressive symptom trajectories from mid-adolescence through age 30, as well as their predictors in mid-adolescence and adult outcomes.

RESULTS

A three class model consisting of high stable (32%), moderate decreasing (44%), and low decreasing (24%) depressive symptom trajectories emerged as the preferred solution. Demographic, psychosocial, and psychiatric characteristics differentiated the low and high symptom classes, and provided support for interpersonal models of depression chronicity. Members of the moderate and high symptom classes evidenced the worst psychosocial and psychiatric outcomes by age 30, with members of the high symptom class showing the greatest levels of impairment.

LIMITATIONS

Cross-sectional measurement and floor effects of several predictor variables may have obscured the relations between those predictors and trajectory class membership.

CONCLUSION

These findings suggest that prevention and intervention strategies may specifically target young women and those who experience poor interpersonal functioning in an effort to alter the course of depressive symptoms through early adulthood.

Influences of mood variability, negative moods, and depression on adolescent cigarette smoking

Understanding the emotional risk factors for cigarette smoking in adolescence can greatly inform prevention efforts. The current study examined prospective relationships between 3 affective dimensions--negative mood variability, overall negative mood, and depression---affect-related smoking motives, and future smoking patterns among adolescents. The current study expands on prior research by using real-time methods to assess mood and by focusing on a key developmental transition in smoking behavior: the progression from experimentation or low level, infrequent use to higher use. Ninth- and 10th-grade students (N = 461; 55% girls) provided data on cigarette use at a baseline and follow-up 15-month wave, and also provided ecological momentary assessments of negative moods via palmtop computers for 1 week at each wave. Negative mood was examined via the means of negative mood reports at each wave, and mood variability was examined via the intraindividual standard deviations of negative mood reports at each wave. Depressive symptoms and smoking motives were also assessed. Findings supported a complex self-medication model of smoking escalation in adolescence whereby mood-smoking relationships differed by affect dimension and gender. For girls, greater negative mood variability at baseline significantly predicted rapid escalation in smoking over time, whereas depressive symptoms and overall negative mood were unrelated to girls' smoking patterns. In contrast, overall negative mood significantly predicted boys' smoking escalation among those with affect-related motives for smoking. Results thus suggest that inconsistent mood-smoking relations in past work may be driven by the complex interrelationships among affect vulnerabilities, gender, and smoking patterns.

Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder

BACKGROUND

Previous research has indicated a strong association of smoking with depression and anxiety disorders, but the direction of the relationship is uncertain. Most research has been done in general population samples. We investigated the effect of smoking and nicotine dependence on the severity and course of depressive and anxiety symptoms in psychiatric patients.

METHODS

Data came from the Netherlands Study of Depression and Anxiety (NESDA) including participants with a current diagnosis of depression and/or an anxiety disorder (N=1725). The course of smoking status and symptoms of depression, general anxiety, social anxiety, and agoraphobia were measured at baseline and after one and two years. Age, gender, education, alcohol use, physical activity, and negative life events were treated as covariates.

RESULTS

At baseline, the symptoms of depression, general anxiety, and agoraphobia were more severe in nicotine-dependent smokers than in never-smokers, former smokers, and non-dependent smokers. These differences remained after adjusting for covariates. Smaller differences were observed for severity of social anxiety which were no longer significant after controlling for covariates. Over a two-year follow-up, the improvement of depressive and anxiety symptoms was slower in nicotine-dependent smokers than in the other groups even after controlling for covariates. There were no differences between the groups in the course of symptoms of social anxiety and agoraphobia over time.

CONCLUSIONS

In psychiatric patients, smoking is associated with higher severity of depressive and anxiety symptoms, and with slower recovery, but only when smokers are nicotine-dependent.

Longitudinal variation in adolescent physical activity patterns and the emergence of tobacco use

OBJECTIVE

The objective of this investigation was to examine how variation in adolescent physical activity is related to smoking and alternative tobacco use.

METHODS

Adolescents (N = 1,384) completed a self-report survey every 6 months from ages 14- to 18-years old in a prospective study of health behaviors. The 8 waves of data were analyzed using General Growth Mixture Modeling (GGMM) RESULTS: GGMM identified five physical activity trajectories including stable higher (SHPA), decreased (DPA), stable regular (SRPA), curvilinear (CPA), and stable low (SLPA). Across 4 years, the likelihood of smoking was greater among adolescents in the DPA, SLPA and SRPA trajectories compared to adolescents belonging to the SHPA trajectory. Alternative tobacco use was greatest among adolescents in the DPA and SRPA trajectories.

CONCLUSIONS

Adolescents with decreasing physical activity and even adolescents averaging an hour of physical activity a day (SRPA) are important groups to target for tobacco use prevention and intervention efforts.

The efficacy of motivational interviewing versus brief advice for adolescent smoking behavior change

OBJECTIVE

In this study we sought to evaluate the efficacy of motivational interviewing (MI) compared with structured brief advice (SBA) for adolescent smoking behavior change.

METHODS

Participants (N=355) were randomly assigned to 5 sessions of either MI or SBA. The primary outcomes were attempts to reduce and to quit smoking, smoking reduction, and cotinine-validated 7-day point-prevalence smoking abstinence at the end of treatment (week 12) and the 24-week follow-up.

RESULTS

White adolescents were ∼80% less likely to attempt to cut back (odds ratio [OR]: 0.21; confidence interval [CI]: 0.08-0.53) and >80% less likely to attempt to quit smoking compared with black adolescents (OR: 0.17 [CI: 0.06-0.46]). Adolescents who were at least planning to cut back or quit smoking at baseline were almost 3 times more likely to attempt to cut back (OR: 2.87 [CI: 1.26-6.52]) and to attempt to quit smoking (OR: 3.13 [CI: 1.19-8.26]). Adolescents who received MI were ∼60% less likely than adolescents who received SBA to try to quit smoking (OR: 0.41 [CI: 0.17-0.97]). However, adolescents who received MI showed a greater reduction in cigarettes smoked per day than adolescents who received SBA (5.3 vs 3.3 fewer cigarettes per day). There were no statistically significant differences between MI and SBA in smoking abstinence (5.7% vs 5.6%, respectively).

CONCLUSIONS

The effects of MI on adolescent smoking behavior change are modest, and MI may best fit within a multicomponent smoking cessation treatment approach in which behavior change skills can support and promote smoking behavior change decisions.

Longitudinal effects of hostility, depression, and bullying on adolescent smoking initiation

PURPOSE

The present study examined the associations between smoking initiation and, hostility, depressive symptoms, and bullying (bullies and bully-victims) among a culturally diverse sample of 1,771 adolescents who reported never having smoked at baseline.

METHODS

Data were obtained from a longitudinal school-based experimental trial of smoking prevention programs in Southern California. Annual survey was performed for students of the sixth, seventh, and eighth grades. All students in the 24 participating schools were invited to participate in the study during the sixth grade.

RESULTS

The risk of smoking initiation was significantly higher among students who scored higher on hostility and depressive symptoms, and were bully-victims.

CONCLUSION

The findings suggest that tobacco prevention programs should include strategies for managing hostile feelings and negative effect as part of the curriculum. In addition, it might be helpful to identify youth who score high on these psychosocial factors and teach them skills to handle interpersonal conflict and negative feelings to prevent their involvement in substance use.

Self-control and its relation to joint developmental trajectories of cannabis use and depressive mood symptoms

BACKGROUND

Cannabis use and depressive mood symptoms in adolescence have been found to co-occur. In exploring the nature of this relationship and in the search for mechanisms that explain this link, scholars have postulated the idea for a 'common liability model'. According to this model, the link between cannabis use and depressive symptoms can be explained by an underlying risk factor. One important candidate for this underlying risk factor may be self-control, as a reflection of immature self-regulatory systems in adolescence. In the present study, we will test the extent to which joint development of cannabis use and depressive symptoms can be explained as an expression of self-control.

METHODS

A total of 428 adolescents participated in a five-wave longitudinal design. Main study outcomes were self-reports of self-control (age 12) and cannabis use and depressive symptoms (ages 12-16).

RESULTS

We established six trajectories of joint development of cannabis use and depressive symptoms. Conditional probabilities indicated that cannabis use and depressive symptoms were symmetrically related. Levels of self-control were lowest for adolescents following the joint developmental pathway of cannabis use and high depressive symptoms.

CONCLUSIONS

Low levels of self-control are predictive of joint development of cannabis use and depressive symptoms. Future studies should concentrate on the role of self-control in co-occurrence of other health risk behaviors and on psychological and physiological mechanisms underlying self-control and its relation to co-occurrence.

Heterogeneity in adolescent depressive symptom trajectories: implications for young adults' risky lifestyle

OBJECTIVES

The first objective of this study was to empirically identify adolescent depressive symptoms trajectory among classes. The second objective was to investigate the implications of adolescent depressive symptom trajectories for their lifestyle factors in young adulthood.

METHODS

Data came from the National Longitudinal Study of Adolescent Health (Addhealth). The analysis included the identification of depressive symptom trajectory groups using Latent Class Analyses. The identified trajectory groups were then compared with regard to risky lifestyle factors in young adulthood.

RESULTS

Youth in the chronically high, increasing, and decreasing depressive symptoms groups showed significantly higher prevalence rates in most risky lifestyle factors compared with the consistently low trajectory group, after controlling for lagged measures, adolescent delinquency, family characteristics, and race/ethnicity. The risky lifestyle factors included: having multiple sex partners, having been arrested/committed crime, being an excessive drinker, being a smoker, and being unmarried.

CONCLUSIONS

The associations of adolescent depressive symptom trajectory groups with young adult risky lifestyle factors provide evidence for the psychosocial processes through which experiences with depressive symptoms influence young adult lifestyle.

Influences of a Covariate on Growth Mixture Modeling

This study investigated the influence of including a covariate and/or a distal outcome on growth mixture modeling (GMM). GMM was used to examine patterns of days of heroin use over 16 years among 471 heroin users and the relationship of those patterns to mortality (distal outcome). Comparisons were made among four types of models: without a covariate and a distal outcome (two-stage approach), with a distal outcome, with a covariate, and with a covariate and a distal outcome in conjunction with three different covariates. The two-stage approach and models with the inclusion of a distal outcome resulted in different conclusions when testing the impact of latent trajectory membership on the distal outcome. Differences in membership classifications between unconditional and conditional models were mainly determined by two factors: (1) the associations of the trajectories with the covariate and the distal outcome, and (2) the distribution of the covariate in the study sample.

Mechanisms underlying the comorbidity of tobacco use in mental health and addictive disorders

We discuss potential explanations for the high prevalence of tobacco use and tobacco dependence (TD) in people with mental health and addictive (MHA) disorders. The biopsychosocial basis for this comorbidity is presented, integrating evidence from epidemiologic and clinical studies. We also review evidence that suggests a shared vulnerability related to biological, genetic, and environmental factors may be the most parsimonious mechanism to explain the association between TD and MHA disorders. Finally, we review the examples of various MHA disorders that are associated with TD, and suggest avenues for new investigation that could aid in the development of rationale and more effective treatments for tobacco and MHA disorder comorbidities.

Epidemiologic heterogeneity of common mood and anxiety disorders over the lifecourse in the general population: a systematic review

BACKGROUND

Clinical evidence has long suggested there may be heterogeneity in the patterns and predictors of common mood and anxiety disorders; however, epidemiologic studies have generally treated these outcomes as homogenous entities. The objective of this study was to systematically review the epidemiologic evidence for potential patterns of heterogeneity of common mood and anxiety disorders over the lifecourse in the general population.

METHODS

We reviewed epidemiologic studies examining heterogeneity in either the nature of symptoms experienced ("symptom syndromes") or in patterns of symptoms over time ("symptom trajectories"). To be included, studies of syndromes were required to identify distinct symptom subtypes, and studies of trajectories were required to identify distinct longitudinal patterns of symptoms in at least three waves of follow-up. Studies based on clinical or patient populations were excluded.

RESULTS

While research in this field is in its infancy, we found growing evidence that, not only can mood and anxiety disorders be differentiated by symptom syndromes and trajectories, but that the factors associated with these disorders may vary between these subtypes. Whether this reflects a causal pathway, where genetic or environmental factors influence the nature of the symptom or trajectory subtype experienced by an individual, or whether individuals with different subtypes differed in their susceptibility to different environmental factors, could not be determined. Few studies addressed issues of comorbidity or transitions in symptoms between common disorders.

CONCLUSION

Understanding the diversity of these conditions may help us identify preventable factors that are only associated with some subtypes of these common disorders.

Health risk behaviors in relation to making a smoking quit attempt among adolescents

The primary aim of this study was to examine youth risk behaviors in relation to: (a) making a smoking quit attempt, and (b) successful cessation among adolescent smokers. Data were analyzed from the public use dataset of the 2003 national school-based Youth Risk Behavior Survey. The sample consisted of 2,033 students (weighted mean age of 16.3 years, 49.8% female, 73.6% White) who reported a history of daily smoking. While almost two-thirds (63.5%) of adolescent smokers reported making a quit attempt in the last year, only 10% of those were able to successfully quit. Factors associated with making a quit attempt included depression and participating in sports while high-risk sexual activity and engaging in substance use other than alcohol or marijuana were negatively related to making a quit attempt. Externalizing health behaviors (e.g., fighting, drug use, and high risk sexual activity) were associated with decreased likelihood of cessation. Findings from this study may inform efforts to develop more effective smoking prevention and treatment programs for youth.

Longitudinal population-based studies of affective disorders: where to from here?

BACKGROUND

Longitudinal, population-based, research is important if we are to better characterize the lifetime patterns and determinants of affective disorders. While studies of this type are becoming increasingly prevalent, there has been little discussion about the limitations of the methods commonly used.

METHODS

Discussion paper including a brief review of key prospective population-based studies as the basis for a critical appraisal of current approaches.

RESULTS

We identified a number of common methodological weaknesses that restrict the potential of longitudinal research to characterize the diversity, prognosis, and determinants of affective disorders over time. Most studies using comprehensive diagnostic instruments have either been of relatively brief duration, or have suffered from long periods between waves. Most etiologic research has focused on first onset diagnoses, although these may be relatively uncommon after early adulthood and the burden of mental disorders falls more heavily on individuals with recurring disorders. Analysis has tended to be based on changes in diagnostic status rather than anges in symptom levels, limiting study power. Diagnoses have generally been treated as homogeneous entities and few studies have explored whether diagnostic subtypes such as atypical depression vary in their etiology or prognosis. Little research has considered whether there are distinct trajectories of symptoms over time and most has focused on individual disorders such as depression, rather than considering the relationship over time between symptoms of different affective disorders. There has also been limited longitudinal research on factors in the physical or social environment that may influence the onset, recurrence or chronicity of symptoms.

CONCLUSION

Many important, and in some respects quite basic, questions remain about the trajectory of depression and anxiety disorders over the life course and the factors that influence their incidence, recurrence and prognosis. Innovative approaches that consider symptoms of all affective disorders, and how these change over time, has the potential to greatly increase our understanding of the heterogeneity of these important conditions and of the individual and environmental characteristics that influence their life course. Using longitudinal research to define sub classes of affective disorders may also be of great benefit for studies seeking to define the genetic determinants of susceptibility to these conditions.

Risk and protective factors associated with trajectories of depressed mood from adolescence to early adulthood

This study used semi-parametric group-based modeling to explore unconditional and conditional trajectories of self-reported depressed mood from ages 12 to 25 years. Drawing on data from the National Longitudinal Study of Adolescent Health (N = 11,559), 4 distinct trajectories were identified: no depressed mood, stable low depressed mood, early high declining depressed mood, and late escalating depressed mood. Baseline risk factors associated with greater likelihood of membership in depressed mood trajectory groups compared with the no depressed mood group included being female, Black or African American, Hispanic or Latino American, or Pacific Islander or Asian American; having lower socioeconomic status; using alcohol, tobacco, or other drugs on a weekly basis; and engaging in delinquent behavior. Baseline protective factors associated with greater likelihood of membership in the no depressed mood group compared with the depressed mood trajectory groups included 2-parent family structure; feeling connected to parents, peers, or school; and self-esteem. With the exception of delinquent behavior, risk and protective factors also distinguished the likelihood of membership among several of the 3 depressed mood groups. The results add to basic etiologic research regarding developmental pathways of depressed mood in adolescence and young adulthood.

Developmental trajectories of depressive symptoms from early childhood to late adolescence: gender differences and adult outcome

BACKGROUND

Limited information is available on gender differences and young-adult poor outcome in children and adolescents following distinct developmental trajectories of depressive symptoms.

METHODS

Parent information on depressive symptoms of 4- to 18-year-olds from an ongoing Dutch community-based longitudinal multiple-cohort study (N = 2,076) was used to estimate trajectories from semi-parametric mixture models. The identified trajectories were used to predict depressive problems, general mental health problems, referral to mental health care, and educational attainment in young adulthood.

RESULTS

In both genders six distinct developmental trajectories were identified. Gender differences existed not only in level, but also in shape and timing of onset of depressive problems. Only in girls was a chronic trajectory of early childhood-onset depression identified. In both boys and girls a group with increasing levels of depressive symptoms was identified that reached a high level around adolescence, although boys showed an earlier onset. Two decreasing trajectories were found in boys, one reaching normative levels of depressive symptoms around late childhood and one around mid-adolescence, while none was found for girls. Individuals who followed elevated trajectories during their whole childhood or starting at adolescence had significantly more depressive and other mental health problems in young adulthood compared to those who followed normative trajectories. Boys in these elevated trajectories showed lower educational attainment, while girls were more likely to have been referred to mental health care.

CONCLUSIONS

This study shows the value of estimating growth-mixture models separately for boys and girls. Girls with early childhood or adolescence-onset depressive problems and boys with depressive problems during childhood or starting in adolescence are especially at risk for poor outcome as young adults and should be considered candidates for intervention.

How do psychological factors influence adolescent smoking progression? The evidence for indirect effects through tobacco advertising receptivity

OBJECTIVES

To determine whether novelty seeking and depressive symptoms had mediated or indirect effects on adolescent smoking progression through tobacco advertising receptivity.

METHODS

More than 1000 adolescents were monitored from 9th grade to 12th grade and completed annual surveys that measured demographic characteristics, smoking behavior, tobacco advertising receptivity, novelty-seeking personality, depressive symptoms, family and peer smoking, alcohol use, and marijuana use.

RESULTS

Latent growth modeling indicated that novelty seeking had a significant indirect effect on smoking progression through baseline tobacco advertising receptivity. For each 1-SD increase in novelty seeking, the odds of being more receptive to tobacco advertising increased by 12% (ie, being in a specific category or higher), which in turn resulted in an 11% increase in the odds of smoking progression from 9th grade to 12th grade. The indirect effect from depressive symptoms to smoking progression did not reach significance.

CONCLUSIONS

These findings may inform future research on other factors that influence tobacco advertising receptivity, as well as programs aimed at preventing adolescent smoking initiation and progression.